Week 7 Flashcards
______ is a tool used to measure health plan performance.
HEDIS
______ is an organization dedicated to improving health care quality by measuring and tracking statistics on care delivered by health plans.
NCQA
______ is the most rigid (and oldest) type of managed care.
HMOs
______ is a way to reduce out-of-pocket healthcare related expenses where you, as an employee, contribute to an account with pretax dollars and then use these dollars to cover items such as co-pays, co-insurance and other non-covered health expenses.
Flexible Spending Accounts (FSAs)
______ is a set percent of the bill that you pay for health service such as 20% for a hospital admission. Because this is a percentage versus a set dollar amount, it can be difficult to determine exactly how much a certain type of office visit or procedure will cost you.
Co-insurance
_____ is a form of managed care where health care services can be delivered by either in-network or out-of-network providers.
PPOs
_____ gives you and your family the ability to continue group health benefits through your employer-sponsored group health plan for a limited period of time - usually 18 months.
COBRA
_____ is the cost to purchase insurance. Often this is split between you and your employer.
Premium
_____ are services that are not covered by your insurance plan.
Exclusions
_____ is usually defined as a condition for which medical advice, diagnosis, care or treatment was recommended or received during the 6 months prior to your enrollment date in the plan.
Preexisting condition
_____ is the annual amount that you need to pay before your insurance coverage begins. This amount can range from less than $100 to more than $1,000 depending on your policy.
Deductible
_____ is a type of managed plan that combines features from HMOs and PPOs.
POS
_____ is the time period when you are not covered for a particular medical issue (pre-existing condition).
Waiting period
_____ is a set dollar amount that you pay for health services such as $20 for a physician office visit or $75 for a trip to the emergency department. The health care provider is reimbursed on top of this amount, but the set dollar amount is your responsibility and is often due upon check-out.
Co-pay
_____ is a law that makes it possible for you to change jobs/health plans even if you or a family member have/has a pre-existing medical condition.
HIPAA