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Week One: MI

Medical Insurance week one

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