Lesson 10 Flashcards
beneficiary
a person eligible to receive insurance benefits under specified conditions
catastrophic drug plan
a plan that would cover overriding drug costs causing impending financial hardship on individuals
deductible
the portion of a benefit that a beneficiary must pay before receiving coverage
deregulated
when a service is removed from a province’s or territory’s fee schedule so that it is no longer insured under that jurisdiction’s health plan
insured health care services
medically necessary hospital, physician, and surgical-dental services provided to insured indivisuals
medically necessary
referring to those services or supplies that are essential to the care and treatment of an illness or injury and that could not have been omitted without adversely affecting the patient’s medical condition or the quality of the health care rendered under generally accepted professional standards of medical practice at the time and place incurred
provincial or territorial billing
the process whereby a health care provider submits a claim to a province or territory for insured health services rendered
reciprocal agreement
an agreement among provinces and territories (with the exception of Quebec) that allows providers to bill their own ministries for services rendered to insured residents from other parts of Canada (ex. a person from Manitoba visiting a doctor in Nova Scotia).
