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Health Plan Types

Types of Health Insurance Plans

What insurance usually lets subscribers choose any doctor and is sometimes referred to as a fee-for-service plan? Indemnity Insurance
With _______ Insurance, subscribers get to choose their doctor and hospital with no limits, and the insurer reimburses the provider for the costs incurred. Indemnity
What is a health plan that contracts with health care providers and medical facilities to provide care for members at reduced costs. These provides make up the plan's network. Managed Care Plan
What is a network? A group of health care providers that have contracted with a health insurance carrier (via an HMO, EPO, or PPO) to provide care at a discount and accept the discounted price as payment in full.
What is an HMO? A Health Maintenance Organization (HMO) is a plan that allows patients to only go to physicians, other health care professionals, or hospitals on a list of approved providers, except in an emergency.
What is a Group Practice Model? An HMO that contracts with an outside medical group for services.
What is an Independent Practice Association (IPA) Model? An HMO that contracts with IPA, which in turn contracts with individual health providers.
What is a Network Model? An HMO that contracts with 2 or more independent practices.
What is a Staff Model? An HMO that provides hospitalization and physician services through its own staff.
What is a PPO? a Preferred Provider Organization (PPO) is a plan that allows patients to use physicians, specialists, and hospitals in the plan's network.
A __________ may offer more flexibility by allowing for visits to out-of-network professionals and in-network visits require only the payment of a small fee. Preferred Provider Organization (PPO)
A type of managed care insurance plan that combines characteristics of a health maintenance organization (HMO) and a preferred provider organization (PPO) is called a _____________. Point of Service (POS) Plan
What plan allows lower medical costs in exchange for more limited choices? A Point of Service (POS) Plan
What is an EPO? An Exclusive Provider Organization (EPO) that is a hybrid insurance plan in which a PCP is not necessary, but health care providers must be seen withing a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
A ______ is a type of managed care plan that combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). Point of Service (POS) Plan
Created by: cattomko
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