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What health insurance plan is sponsored by a large company who forms a contract with certain health agencies to provide certain types of health care at reduced rates? Preferred provider organization or PPO
If a person has 80/20 co-insurance, what percent does the insurance company pay? 80%
What health insurance plan used to be known as CHAMPUS? TRICARE
Complete this sentence – Managed care networks are required to provide quality care at the: Lowest possible cost.
For what type of Medicare must the consumer pay a premium and an initial deductible for services? Type B
John must pay $10 for each visit to his physician. What term describes the $10 payment? Co-payment
What do the initials PPO stand for? Preferred provider organization
What is the disadvantage of belonging to an HMO? Required to use only HMO affiliated providers
What kind of health insurance would someone who is self-employed usually have? Private health insurance
What do the initials HMO stand for? Health maintenance organization
Kayla has been receiving social security for two years and now has a disability. What federal insurance is she eligible for? Medicare
What kind of insurance covers a worker who is injured on the job? Worker’s compensation
What happens if a person who belongs to an HMO goes to see a doctor who is not affiliated with his HMO? The person pays the entire cost of the doctor visit.
If you work for a company with a group insurance plan, who usually pays all or part of the premium? The company
What approach to controlling rising health care costs requires a second opinion before the company will pay for surgery? Managed care
What health insurance plan is funded by the U.S. government for military personnel and their families? TRICARE
When someone uses Medicare to pay for health care services, what percent does the individual pay? 20%
Who administers Worker’s Compensation – local governments, the state, the federal government, or private industry? The state
A person who is blind is eligible for what type of state-administered medical assistance program? Medicaid
Indemnity simply means protection, as by insurance, from liabilities or penalties incurred by one's actions.
Managed Care It refers to the control that an insurance company or other payer exerts over the physician selection and reimbursement process.
Self-insurance An alternative to purchasing an insurance policy.
Flexible Benefits Account It provides the individual with a savings account, usually through payroll deduction, into which a set amount can be deposited routinely.
Champus Provides care for military dependents and retired member of the armed service.
Insurance plans fall into one of two basic categories: indemnity and managed care.
Created by: Mackey1