Unit 16 Flashcards
Any program that helps pay for medical expenses
Medical Expense Insurance
Each time a doctor or hospital provides a service they’re paid a fee
Fee-for-service
Organizations that introduced the idea of prepaid service
Health Maintenance Org
User of an HMO
Subscriber
First providers to cover preventative care
HMOs
Type of payment method, If the provider is charging more than typical for their geographical area the patient pays the difference
Usual/ Customary/Reasonable charges
Type of payment method, Each services are listed with a flat payment and should the received service exceed that the patient pays the difference
Benefit Schedule
Consumers using a Fee-for-service plan
Insureds
Consumers using a prepaid plan
Subscribers
The original medical expense plans with low coverage limits and no deductibles
Basic Hospital, Medical, and Surgical policies
2 groups within Major Medical Insurance
Supplemental Major medical, Comprehensive Major medical
Plan including a basic plan and major medical insurance
Supplemental Major Medical insurance
Stand alone plan with a deductible and possibly coinsurance
Comprehensive Major Medical Insurance
A major way to keep insurance affordable whether the insureds are required to pay a specified yearly amount before benefits kick in
Deductible
Cost sharing feature designed to keep insurance affordable
Coinsurance
Limits the amount of coinsurance an insured pays
Stop Loss Limit
Maximum out of pocket
Deductible plus coinsurance amount
