Insurance (Chap. 4&5) Flashcards
This are the two chapters dealing with the history of insurances and their explinations. It will have the key terms that the teacher wanted us to study, and also some other information.
What is Medicaid?
Medicai is a federal-state health program that is administered by the individual states; which cover some low-income individuals (particularly pregnant women and children) and certain diasabled individuals.
What is Medicare?
A federal health insurance program that provides benefits to individuals 65yrs old or older, and also individuals younger than 65 with certain disabilities.
What is HMO?
The Health Maintanence Organization (HMO) Act passed in 1973 is a plan that provides health care to its enrollees from a specific physician and hospital that is in contract with the plan. There are usually no deductibles to be met, no claim forms to be completed by the enrollee, and they are restricted to a certain geographic service area.
(MANAGED CARE PLAN)
What is PPO?
A Preferred Provider Organization is a plan that allows the insured (policyholder) to chose his/her physician and hospital they want to recieve care from. With this plan there are deductibles that have to be met, and claim forms thay must be filled out each time you change a provider, and the policy holder is not restricted to a certain geographic service area.
(INDEMNITY (FEE-FOR-SERVICE))
What is a deductible?
A deductible is the amount of covered expenses that must be incurred and paid by the insured before any benefits become payable by the insurer.
What is a premium?
A monthly fee paid by the insured with a indemnity plan. Premiums are based on the policy type and coverage; the better the coverage, the higher the premium.
What is a Copayment (Co-pay)?
Also called coinsurance.
After the insured meats the yearly deductible the patient than shares the bill with the insurance, and pays a small amount of money each visit he/she makes to her physician or hospital.
What is a group plan?
This is a contract of insurance maid with a company, a coorporation, or other groups of common intrests wherein all employees or individuals (and their elegible dependents) are insured under a single policy.
What are the advantages of a group plan?
- Group policies are usually less expensive than individual policies
- Everyone is usually eligible for coverage regardless of health issues
- Coverage is typically comprehensive
- Premiums can be deducted from paychecks (if it is the policy of the employer)
- Coverage generally cannot be terminated because of frequent claims
- Protection under HIPPA allows an individual to move from one job to another without fera of exclusion owing to preexisting conditions
