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Health Plan Types
Types of Health Insurance Plans
| Question | Answer |
|---|---|
| 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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