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Week One: MI
Medical Insurance week one
| Question | Answer |
|---|---|
| What is Insurance? | Financial protection agains loss or harm |
| Health insurance narrows down "undesired events" to | Illnesses and Injuries |
| Preventive medicine | Keeping a person well or detecting and treating an emerging illness in its early stages |
| Where and when did modern health insurance occur? | England 1850 |
| When did health insurance come to the US? | 1929 |
| What did the frist health insurance in the US become? | Blue Cross |
| What is commuinity rating | established premiums wherein everybody in the community paid the same premium. |
| HMOs were first recongnized in the US in what year? | 1970 |
| A type of insurance that provides comprehensive major medical benefits and allows insured individuals to choose any provider when seeking medical care is? | a fee-for-service plan or Indemnity insurance |
| What is a group insurance plan? | When you are working full-time or a specific number of hours per week. |
| What are preexisting conditions? | When certain illnesses or injuries exist before someone is insured |
| If an insurance company thinks an applicant presents too much of a risk, he or she will be put into a category referred to as? | High-risk pool |
| What is the greek work that "insurance" comes from? | securitas |
| Blue cross was introduced where? | Baylor University in Dallas |
| Blue Shield was introduced where? | Pacific North West |
| What does COBRA stand for? | Consolidated Omnibus Budget Reconciliation Act. |
| What does COBRA do? | it protects health benefits when an employee quits his or her job or is laid off from a company with 20 or more employees. |
| Typical program length in community colleges and technical schools? | 2-4 years |
| What is the standard insurance form used by all government and most commercial insurance payers? | CMS-1500 |
| List six college entry-level skills that candidates should possess? | Reading and coprehension, basic business math, English and grammar, Oral and written communications, keyboarding and office skills, computer application skills. |
| The practice of medicine in the US is a? | Business |
| a breach of medical care can result in? | a malpractice lawsuit |
| failure to exercise a reasonable degree fo care is referred to as? | negligence |
| a health insurance policy and the relationship between a healthcare provider and a patient are considered? | Legal contracts |
| In terms of contract law, when an individual completes an application for health insurance, he or she is? | Making an offer |
| When the insurance company agrees to grant health inusrance coverage to an individual, this is called? | Completing an acceptance |
| The binding force in any contract that gives it legal status-the thing of value that each party gives to the other- is the? | Consideration |
| for a contract to be enforceable, it must be? | legal |
| the parties to a legal contractual agreenment must be? | Mentally competent |
| The contract between a healthcare provider and a patient is referred to as a? | Implied contract |
| Ceasing to provide care to a patient without following prudent steps is a breach of the physician/patient contract, referred to as? | abandonment |
| The act that regulates disclosure of confidential information is the? | federal privacy act of 1974 |
| The act allowing current or former employees or dependents younger than age 65 to become eligible for Medicare because of end-stage renal disease is the? | Federal Omnibus Budget Reconciliation Acto fo 1986 (OBRA) |
| If additional information needs to be added to a patient's record, it should be in the form of a? | appropriate addendum |
| What is Incidental disclosure? | Two people who know eacho other mett inadvertently in a physician's reception area. |
| Timelinss, according to the Joint Commission, is? | 24 hours |
| A signed release of information may not be required when? | The patient is a Medicaid recipient or The patient is being treated as a result of an on-th-job injury. |
| What are the five elements of a legal contract? | Offer and acceptance, consideration, legal object, competent parties, legal form. |
| explain what offer and acceptance is? | filling the application and the company desiding to insure. |
| explain what consideration is? | shows what you will get and what is covered. |
| explain what legal object is? | everything must be legal. |
| explain what competent parties is? | parties must be competent to enter into the contract. |
| explain what legal form is? | must be approved by the state. |
| Under what circumstances and how might a healthcare provider terminate a contract between the provider and a patient? | defaults on the provissions of the policy. |
| What is HIPAA's four primary objectives? | to ensure health insurance portablity, to reduce healthcare fraud and abuse, to enforce standers for health information, and to guarantee security and privacy of health information for parties. |
| What are the two basic types of health insurance? | Indemnity(fee-for-service)and managed care |
| What do you get with an Indemnity plan? | can choose any provider, can change physicians at any time, and pay a monthly "premium." |
| The value of a provider's service is based on specific historical data, referred to as? | UCR or usual, customary, and reasonable fee |
| What do you get with Managed care? | insurance tells patients what physicians they can see and monitors enrollees medications and treatments so that the cost is as low as possible. |
| The kind of policy purchased by a self-employed individual or one who works for a company that does not offer a group policy is? | individual policy |
| The federal health insurance program that provides benefits to individuals age 65 or older and individuals younger than 65 with certain disabilities is? | Medicare |
| the name of the federal entitlement program that covers certain categories of low-income individuals and certain disabled individuals is? | Medicaid |
| The type of plan available to self-employed individuals that works in conjunction with special low-cost high-deductible health insurance is called? | MSA or Medical savings account. |
| A law that provides continuation of group health coverage when an individual leaves his or her place of employment? | COBRA |
| Traditional healthcare in which patients can choose an provider they want and change physicians at any time? | Indemnity insurance |
| An IRS Section 125 cafeteria plan? | Flexible Spending Account (FSA) |
| The part of a provider's charge that the insurance carrrier will allow as covered expenses? | UCR |
| Illnesses or injuries that occurred before the start of a health insurance contract? | preexisting condition |
| The portion of the fee(often a percentage) that the insured must pay? | coinsurance |
| A special tax shelter set up for the purpose of paying medical bills? | medical Savings account (MSA) |
| A provider who is under no contractual agreement with the insurance carrier to accept reimbursement as payment in full? | nonparticipating provider or nonPAR |
| a periodic fee that is paid to an insurer for healthcare coverage? | premium |
| the amount the insured must pay before insurance coverage begins? | deductible |
Created by:
Seanmorrone
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