Week 7 Flashcards

1
Q

______ is a tool used to measure health plan performance.

A

HEDIS

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2
Q

______ is an organization dedicated to improving health care quality by measuring and tracking statistics on care delivered by health plans.

A

NCQA

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3
Q

______ is the most rigid (and oldest) type of managed care.

A

HMOs

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4
Q

______ 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.

A

Flexible Spending Accounts (FSAs)

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5
Q

______ 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.

A

Co-insurance

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6
Q

_____ is a form of managed care where health care services can be delivered by either in-network or out-of-network providers.

A

PPOs

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7
Q

_____ 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.

A

COBRA

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8
Q

_____ is the cost to purchase insurance. Often this is split between you and your employer.

A

Premium

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9
Q

_____ are services that are not covered by your insurance plan.

A

Exclusions

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10
Q

_____ 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.

A

Preexisting condition

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11
Q

_____ 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.

A

Deductible

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12
Q

_____ is a type of managed plan that combines features from HMOs and PPOs.

A

POS

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13
Q

_____ is the time period when you are not covered for a particular medical issue (pre-existing condition).

A

Waiting period

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14
Q

_____ 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.

A

Co-pay

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15
Q

_____ 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.

A

HIPAA

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