Inusrance vocab 1

Question 1

Birthday rule

Answer 1

Insurance companies use the birthday rule to coordinate benefits for the dependent child’s covered health care services. According to the birthday rule, the parent whose birthday (month and day only) falls first in a calendar year is the parent with the primary coverage for the dependent child.

Question 2

Preauthorization

Answer 2

A pre-authorization is a restriction placed on certain medications, tests, or health services by your insurance company that requires your doctor to first check and be granted permission before your plan will cover the item.

Question 3

Premium

Answer 3

The amount you pay for your health insurance every month.

Question 4

Copayment

Answer 4

An amount of money that a person with health insurance is required to pay at the time of each visit to a doctor or when purchasing medicine.

Question 5

Coinsurance

Answer 5

The percentage of costs of a covered health care service you pay after you’ve paid your deductible

Question 6

Deductible

Answer 6

The amount you pay for covered health care services before your insurance plan starts to pay.

Question 7

Explanation of benefits

Answer 7

A statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received.

Question 8

Assignment of benefits

Answer 8

An agreement that transfers the insurance claims rights or benefits of the policy to a third party.

Question 9

Health maintenance organization

Answer 9

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO

Question 10

Preferred provider organization

Answer 10

A type of medical plan in which coverage is provided to participants through a network of selected health care providers, such as hospitals and physicians.

Question 11

Medicare

Answer 11

Federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions

Question 12

Medicaid

Answer 12

Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.

Question 13

Capitation

Answer 13

Fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services.

Question 14

Tricare

Answer 14

Health care program for uniformed service members, retirees, and their families around the world

Question 15

ChampVA

Answer 15

Health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries.

Question 16

Workers Compensation

Answer 16

No-fault insurance system that provides medical and disability benefits for employees who suffer injury or illness because of their work.

Question 17

CHIP

Answer 17

Provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid

Question 18

Pre-existing condition

Answer 18

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can’t refuse to cover treatment for your pre-existing condition or charge you more.