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11 terms

Assignment 4

STUDY
PLAY
Indemnity plan
A type of healthcare plan that allows patients to choose their own healthcare provider and reimburses the patient or provider at a certain percentage (usually after a deductible is paid) for services provided
Basic medical expense coverage
Coverage for medical expenses, such as hospital and surgical expenses, physicians' visits, and miscellaneous medical services
Major medical insurance
Insurance that covers medical expenses resulting from illness or injury that are not covered by a basic medical expense plan
Managed care plan
A type of healthcare plan providing members with comprehensive services and incentives to use providers belonging to the plan
Health maintenance organization (HMO)
An organization that provides all the care needed by its members in exchange for a fixed fee
Preferred provider organization (PPO)
An administrative organization that meets the common needs of healthcare providers and clients and that identifies networks of providers and contracts for their medical services at discounted rates
Point-of-Service (POS) plan
Managed care plan that combines the characteristics of an HMO and a PPO; has a network of preferred providers who, if used by the member, charge little or nothing for services; healthcare received out of the network is covered, but members must pay substantially higher coinsurance charges and a deductible
Medicare
Social insurance program that covers the medical expenses of most individuals age sixty-five and older
Medicare Advantage plans
Health insurance plan options that provide benefits in addition to basic Medicare; offered by private insurers that contract with Medicare and available to beneficiaries currently enrolled in Medicare Part A and Part B.
Coinsurance
An insurance-to-value provision in many property insurance policies providing that if the property is underinsured, the amount that an insurer will pay for a covered loss is reduced
Elimination period
Initial time period in a health insurance or disability income policy during which benefits are not paid