HIT Chapter 6 Vocabulary
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| Administrative Services Organization (ASO) | A person or organization that handles a wide variety of health insurance administrative services for organizations that have chosen to self-fund their health benefits
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| Autonomy | freedom to choose what medical expenses will be covered
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| Basic Health Insurance | plan that includes hospital room and board, inpatient hospital care, some hospital services and supplies, surgery, and some physician visits.
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| BlueCard program | plans that allow members and their families to obtain healthcare services while traveling or working anywhere in the United States
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| BlueCard worldwide | allows members and their families to receive inpatient and outpatient coverage at no additional cost in more than 200 foreign countries
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| Blue Cross and Blue Shield Federal Employee Program (FEP) | largest employer-sponsored group health insurance program in the world; allows eligible members to have access to various types of plans including FFS, PPO, POS, and HMO.
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| Coinsurance | percentage of healthcare expenses
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| Commercial Health Insurance | also known as private insurance; any kind of health insurance paid by someone other than the government
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| Comprehensive Insurance | plan that combines the coverage of basic health and major medical insurance plans
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| Covered expenses | charges incurred that qualify for reimbursement under the terms of the policy contract
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| Deductible | yearly out of pocket payments made by the patient before the health insurance carrier begins to contribute
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| Explanation of Benefits (EOB) | also known as a remittance advice; document prepared by the carrier that gives details of how the claim was adjudicated
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| Federal Employee Health Benefits Program (FEHB) | government health insurance program that provides coverage for its own civilian employees
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| Fee-for-service (FFS)/Indemnity plan | traditional type of healthcare that offers the most choices of providers and in which patients can choose any provider they want and change providers at any time
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| Fiscal intermediary | a commercial insurer that contracts with the DHHS for the purpose of processing and administering Part A Medicare claims for reimbursement of health coverage.
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| Group Insurance | a contract between an insurance company and an employer that covers eligible employees or members
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| Healthcare Service Plans | Individual BCBS plans throughout the United States that each has specific guidelines for completing the CMS-1500 which vary from plan to plan
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| Health insurance policy premium | a standard monthly or quarterly fee for insurance plan coverage
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| Health Maintenance Organization (HMO) | plan that provides healthcare to its enrollees from specific physicians and hospitals that contract with the plan
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| Insurance cap | the amount of money the policyholder has to pay out of pocket for any one incident or in any one year
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| Lifetime maximum cap | amount after which the insurance company would not pay any more of the charges incurred
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| Major medical insurance | plan that covers treatment for long, and high-cost illnesses or injuries, as well as, Inpatient and Outpatient expenses
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| Managed Care Plan | plan that typically involves the financing, managing, and delivery of healthcare services and is composed of a group of providers who share the financial risk of the plan or who have an incentive to deliver cost-effective, but quality, service.
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| Medicare supplement plans | plans designed to provide coverage for some of the costs that Medicare does not pay;such as deductibles, coinsurance, and noncovered services.
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| Nonforfeitable interest | amount of pension employees do not give up when quitting or retiring
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| Participating Provider (PAR) | a provider who signs a contractual arrangement with a third-party insurance contractor and agrees to accept the amount paid by the carrier as payment in full
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| Point-of-service plan (POS) | also referred to as an open ended HMO; plan allows members to use the HMO provider or go outside of the plan for a higher out of pocket expense
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| Policyholder | the individual in whose name the policy is written
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| Preferred provider organization (PPO) | a network of physicians that provide medical services at a discount to the individuals who participate in the PPO
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| Reasonable and customary fee | fee charged by the provider that falls within the parameters of the fee commonly charged for that particular service within a specific geographic area
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| Self-insured/self-insurance | plan where the employer is responsible for the cost of its employees medical services
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| Single or Specialty service plans | health plans that provide services only in certain health specialties, such as mental health, vision, or dental plans
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| Stop Loss Insurance | protection from the devastating effect of exorbitant medical claims resulting from prolonged and intense medical services due to catastrophic illness or injury
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| Supplemental coverage | another example of single or specialty coverage. Add-on coverage such as vision, dental, or prescription drug coverage
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| Third-party payer | any organization that provides payment for specified coverages provided under the health plan
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| Third-party administration(TPA) | person or organization who processes claims and performs contractual administrative services
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