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UHI ch 13
Understanding Health Insurance chapter 13
| Question | Answer |
|---|---|
| AMERICAN HOSPITAL ASSOCIATION (AHA) | NATIONAL ORGANIZATION THAT REPRESENTS AND SERVES ALL TYPES OF HOSPITALS, HEALTHCARE NETWORKS, AND THEIR PATIENTS AND COMMUNITIES; THE AHA BEGAN AS THE ACCREDITATION AGENCY FOR NEW PREPAID HOSPITALIZATION PLANS IN 1939. |
| AWAY FROM HOME CARE PROGRAM | PROVIDES CONTINUOUS BCBS HEALTHCARE COVERAGE FOR SUBSCRIBERS WHO WILL BE OUT OF THEIR SERIVICE AREA FOR MORE THAN 90 CONSECUTIVE DAYS. |
| BCBS BASIC COVERAGE | BLUE CROSS BLUE SHIELD COVERAGE FOR THE FOLLOWING SERVICES: HOSPITALIZATION, DIAGNOSTIC LABORATORY SERVICES, XRAYS, SURGICAL FEES, ASSISTANT SURGEON FEES, OBSTETRIC CARE, INTENSIVE CARE, NEWBORN CARE, AND CHEMOTHERAPY FOR CANCER. |
| BCBS MAJOR MEDICAL (MM) COVERAGE | BCBS COVERAGE FOR THE FOLLOWING SERVICES, IN ADDITION TO BASIC COVERAGE: OV, OUTPT NONSURGICAL TREATMENT, PT AND OT, PURCHASE OF(DME), MENTAL HEALTH, ALLERGY TESTING AND INJECTIONS, PRESCRIPTION DRUGS, PRIVATE DUTY NURSING, DENTAL CARE BC OF INJURY |
| BLUECARD PROGRAM | PROGRAM THAT ALLOWS BCBS SUBSCRIBERS TO RECIEVE LOCAL BLUE PLAN HEALTHCARE BENEFITS WHILE TRAVELING OR LIVING OUTSIDE OF THEIR PLAN'S AREA. |
| BLUE CROSS(BC) | INSURANCE PLAN CREATED IN 1929 WHEN BAYLOR UNIVERSITY HOSPITAL, IN DALLAS, TX, APPROACHED TEACHERS IN DALLAS SCHOOL WITH A PLAN THAT GUARANTEED UP TO 21 DAYS OF HOSPITALIZATION PER YEAR FOR SUBSCRIBERS AND EACH DEPENDENT FOR A $6 ANNUAL PREMIUM. |
| BLUE CROSS BLUE SHIELD (BCBS) | JOINT VENTURE BETWEEN BLUE CROSS AND BLUE SHIELD WHERE THE CORPORATIONS SHARED ONE BUILDING AND COMPUTER SERVICES BUT MAINTAINED SEPARATE CORPORATE IDENTITIES. |
| BLUE SHIELD (BS) | BEGAN AS A RESOLUTION PASSED BY THE HOUSE OF DELEGATES AT AN AMERICAN MEDICAL ASSOCIATION MEETING IN 1938; INCORPORATES A CONCEPT OF VOLUNTARY HEALTH INSURANCE THAT ENCOURAGES PHYSICIANS TO COOPERATE WITH PREPAID HEALTH PLANS. |
| BLUE WORLDWIDE EXPAT | PROVIDES GLOBAL MEDICAL COVERAGE FOR ACTIVE EMPLOYEES AND DEPENDENTS WHO SPEND MORE THAN 6 MONTHS OUTSIDE THE US; AND US CORPORATION WITH NEW OR EXISITING BLUE COVERAGE THAT SENDS MEMBERS TO WORK AND RESIDE OUTSIDE THE US FOR 6 MONTHS OR MORE IS ELIGIBLE |
| COORDINATED HOME HEALTH AND HOSIPICE CARE | ALLOWS PATIENTS WITH THIS OPTION TO ELECT AN ALTERNATIVE TO THE ACUTE CARE SETTING. |
| FEDERAL EMPLOYEE HEALTH BENEFITS PROGRAM (FEHBP) | FEDERAL EMPLOYEE PROGRAM(FEP)EMPLYOER SPONSORED PROGRAM EST. BY AND ACT OF CONGRESS IN 1959 WHICH NOW PROVIDES BENEFITS TO MORE THAN 9 MILLION FEDERAL ENROLLEES AND DEPENDENTS THROUGH CONTRACTS WITH ABOUT 300 3RD PARTY PAYERS. |
| FEDERAL EMPLOYEE PROGRAM(FEP)FOR PROFIT CORPORATION | SEE FEHBP |
| GOVERNMENT-WIDE SERVICE BENEFIT PLAN | PHRASE PRINTED BELOW THE BCBS TRADEMARK ON FEDERAL EMPLOYEE PLAN (FEP)INSURANCE CARDS, WHICH INDICATES THAT THE ENROLLEE HAS FEDERAL EMPLOYER-HEALTH BENEFITS. |
| HEALTH CARE ANYWHERE | BCBS PROGRAM THAT ALLOWS MEMBERS OF INDEPENDENTLY OWNED AND OPERATED PLANS TO HAVE ACCESS TO HEALCARE BENEFITS THROUGHOUT THE UNITED STATES AND AROUND THE WORLD |
| IMDEMNITY COVEAGE | OFFERS CHOICE AND FLEXIBILITY TO SUBSCRIBERS WHO WANT TO RECIEVE A FULL RANGE OF BENEFITS ALONG WITH THE FREEDOM TO USE ANY LICENSED HEALTHCARE PROVIDER. |
| MEDICAL EMERGENCY CARE RIDER | COVERS IMMEDIATE TRATEMENT FOR SUDDEN, SEVERE, AND UNEXPECTED CONDITIONS THAT, IF NOT TREATED, WOULD PLACE THE PT'S HEALTH IN PERMANENT JEOPARDY OR CAUSE PERMANENT IMPAIRMENT OR DYSFUNCTION OF AN ORGAN OR BODY PART. |
| MEDICAL SUPPLEMENTAL PLANS | AUGMENT THE MEDICARE PROGRAM BY PAYING FOR MEDICARE DEDUCTIBLES AND COPAYMENTS. |
| MEMBER | SUBSCRIBER |
| MEMBER HOSPITAL | HOSPITAL THAT HAS SIGNED A CONTRACT TO PROVIDE SERVICES FOR SPECIAL RATES. |
| NONPROFIT CORPORATION | CHARITABLE, EDUCATIONAL, CIVIC, OR HUMANITARIAN ORGANIZATION WHOSE PROFITS ARE RETURNED TO THE PROGRAM OF THE CORPORATION RATHER THAN DISTRIBUTED TO SHAREHOLDERS AND OFFICERS OF THE CORPORATION. |
| OUTPATIENT PRETREATMENT AUTHORIZATION PLAN (OPAP) | ALSO CALLED PROSPECTIVE AUTHORIZATION OR PRECERTIFICATION; REQUIRES PREAUTHORIZATION OF OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICES. |
| PPN PROVIDER | PROVIDER WHO HAS SIGNED A PPN CONTRACT AND AGREES TO ACCEPT THE PPN ALLOWED RATE, WHICH IS GENERALLY 10 PERCENT LOWER THAN THE PAR ALLOWED RATE. |
| PRECERTIFICATION | ALSO CALLED PROSPECTIVE AUTHORIZATION OR OPPS; REQUIRES PREAUTHORIZATION OF OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICES. |
| PREFERRED PROVIDER NETWORK (PPN) | PROGRAM THAT REQUIRES PROVIDERS TO ADHERE TO MANAGED CARE PROVISION. |
| PREPAID HEALTH PLAN | CONTRACT BETWEEN EMPLOYER AND HEALTHCARE FACILITY (OR PHYSICIAN) WHERE SPECIFIED MEDICAL SERVICES WERE PERFORMED FOR A PREDETERMINED FEE THAT WAS PAID ON EITHER A MONTHLY OR YEARLY BASIS. |
| PROSPECTIVE AUTHORIZATION | ALSO CALLED PROSPECTIVE AUTHORIZATION OR PRECERTIFICATION; REQUIRES PREAUTHORIZATION OF OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICES. |
| RIDER | SPECIAL CONTRACT CLAUSE STIPULATING ADDITIONAL COVERAGE ABOVE THE STANDARD CONTRACT. |
| SECOND SURGICAL OPINION (SSO) | SECOND PHYSICIAN IS ASKED TO EVALUATE |
Created by:
tnatchez