Insurance

Question 1

• TRICARE

Answer 1

For active duty and dependents

Question 2

• CHAMPVA

Answer 2

For retired veterans and dependents.

Question 3

HMO

Answer 3

Health Maintenance Organization: Comprehensive and affordable, needs referrals.

Question 4

PPO

Answer 4

Preferred Provider Organization: More expensive, more choices, no referral needed.

Question 5

POS

Answer 5

Point of Service: Most expensive, most choices, a mix of PPO and HMO.

Question 6

Types of Health Insurance Plans

Answer 6

• Individual policies, government policies, group policies

Question 7

Medicaid

Answer 7

• For indigent, poor, low income.
• Federally and state-funded.

Question 8

• SCHIP

Answer 8

State Children’s Health Insurance Program- Covers uninsured children.

Question 9

• Affordable Care Act:

Answer 9

Offers health insurance options through marketplaces.

Question 10

UB-04

Answer 10

Billing form for institutional locations.

Question 11

CMS

Answer 11

Oversees Medicare and Medicaid.

Question 12

Subscriber number

Answer 12

insurance ID

Question 13

• Preauthorization:

Answer 13

Formal approval for test/procedure coverage

Question 14

• Waiting period:

Answer 14

Time when certain problems aren’t covered.

Question 15

ABN

Answer 15

Advanced Beneficiary Notice: Given to patients if a service may be declined.

Question 16

Allowable amount

Answer 16

Limit on reimbursement for a service or procedure

Question 17

AOB

Answer 17

Assignment of Benefits: Authorizes benefits to be sent directly to providers.

Question 18

Birthday Rule

Answer 18

Determines primary plan holder in dual coverage

Question 19

• Co-payment

Answer 19

Fixed fee for a service collected at each visit.

Question 20

• Deductible:

Answer 20

Amount patient pays before insurance coverage.

Question 21

• Coinsurance:

Answer 21

Cost-sharing after deductible, percentage-based.

Question 22

EOB

Answer 22

Explanation of Benefits: Records patient fees and claim adjustments.

Question 23

• Out-of-pocket expense:

Answer 23

Patient’s responsibility for healthcare expenses.

Question 24

• Out-of-pocket maximum:

Answer 24

Predetermined amount after which insurance pays 100%.

Question 25

Policy

Answer 25

Document describing insurance coverage.

Question 26

• Policyholder:

Answer 26

Patient with the insurance policy.

Question 27

• Premium

Answer 27

Regularly paid amount for insurance.