Insurances

Question 1

Health insurance plans

Answer 1

*deductibles
)Money paid by patient , before insurance payments
-kick in- some services may be exempt from deductibles,such as yearly physicals
*co- pay/insurance- expenses are shared by the patient and insurance company
-office visits
-pharmacy
*Group insurances
-premiums are paid at least partially by employer

Question 2

HMO-Health maintenance org

Answer 2

• Emphasis:preventive care
  - early treatment, health screenings,vision screenings
• Theory:many plans don’t cover routine exams, therefore being skipped by patients, the patient would stay healthier and reduce health care costs in the long run, if probs were diagnosed earlier

*Disatvanage- can only go to facilities that they have contracts with.

• payments:
• fees stays the same regardless of how many patients they see
• (capitation)- per member/ per month
• based on previous made agreement

Question 3

PPO-proffered provider org

Answer 3

• supplied by large companies or industries (GE)
• more popular than HMO’s
• Don’t hire physicians, rather health acre facilities
  - provide more options

Question 4

EPO-Exclusive Provider Org.

Answer 4

• least popular
• charges fees to access network of providers
  - claims to do this to keep costs down and prevent Frivolous use

Question 5

Medicare(title 18)

Answer 5

• Services for people 65 years and older

- amendment of the constitution:entitlement program-can never be undone

Question 6

Workers company

Answer 6

• for the treatment for injuries at work
• admin. by state
• paid by state and employer
• also pays for wages lost because on the job injury

Question 7

Managed care

Answer 7

Focus:to reduce health care have a purpose

- comp. managing costs

Question 8

Medicaid

Answer 8

-gov. Insurance for people who need gov. Assistance

Question 9

Government

Answer 9

-tricare veterans administration,- health insurance for veterans