Study sets matching "health insurance"

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Study sets matching "health insurance"

16 terms
Health Insurance
premium
co-pay
co-insurance
medical bill
Your monthly payment in order to keep health insurance. Somet…
The flat fee (usually $25 - 50) that you pay every time you s…
After you pay your deductible, you pay this percentage of the…
The cost of your healthcare expenses, usually sent in the mai…
premium
Your monthly payment in order to keep health insurance. Somet…
co-pay
The flat fee (usually $25 - 50) that you pay every time you s…
12 terms
Health Insurance
mandatory
provide
The Health Exchange
HMO
required by rule
to give; to offer
Obama Care USA
Health Maintenance Organization
mandatory
required by rule
provide
to give; to offer
10 terms
Health Insurance
Copayment
Deductible
Exclusion
Health Savings Account (HSA)
A way of sharing medical costs. You pay a flat fee every time…
The amount of money you must pay each year to cover your medi…
Specific conditions or circumstances for which the policy wil…
A type of medical savings account that allows you to save mon…
Copayment
A way of sharing medical costs. You pay a flat fee every time…
Deductible
The amount of money you must pay each year to cover your medi…
Health Insurance
Health Insurance
Pre authorization (proir apporoval)
Hold Harmless Clause
Health Care Provider
is the documentation submitted to a thrid- party payer or gov…
for treatment by specialists and documentation of post-treatm…
Patient is not responsible for paying what the insurance plan…
A physician or other healthcare practitioner (eg physician as…
Health Insurance
is the documentation submitted to a thrid- party payer or gov…
Pre authorization (proir apporoval)
for treatment by specialists and documentation of post-treatm…
15 terms
Health Insurance
Coinsurance
Copayment
Deductible
Exclusion
The amount you are required to pay for medical care in certai…
A way of sharing medical costs. You pay a flat fee every time…
The amount of money you must pay each year to cover your medi…
Specific conditions or circumstances for which the policy wil…
Coinsurance
The amount you are required to pay for medical care in certai…
Copayment
A way of sharing medical costs. You pay a flat fee every time…
16 terms
Health Insurance
premium
co-pay
co-insurance
medical bill
Your monthly payment in order to keep health insurance. Somet…
The flat fee (usually $25 - 50) that you pay every time you s…
After you pay your deductible, you pay this percentage of the…
The cost of your healthcare expenses, usually sent in the mai…
premium
Your monthly payment in order to keep health insurance. Somet…
co-pay
The flat fee (usually $25 - 50) that you pay every time you s…
23 terms
Health Insurance
premium
co-pay
co-insurance
medical bill
Your monthly payment in order to keep health insurance. Somet…
The flat fee (usually $25 - 50) that you pay every time you s…
After you pay your deductible, you pay this percentage of the…
The cost of your healthcare expenses, usually sent in the mai…
premium
Your monthly payment in order to keep health insurance. Somet…
co-pay
The flat fee (usually $25 - 50) that you pay every time you s…
Health Insurance
Health Skills
Interpersonal Communicaton
Refusal Skills
Conflict Resolution
specific tools and strategies that help you maintain, protect…
the process by which people exchange information, feelings, a…
a set of skills designed to help children avoid participating…
a way for two or more parties to find a peaceful solution to…
Health Skills
specific tools and strategies that help you maintain, protect…
Interpersonal Communicaton
the process by which people exchange information, feelings, a…
23 terms
Health/Health Insurance
premium
co-pay
co-insurance
medical bill
Your monthly payment in order to keep health insurance. Somet…
The flat fee (usually $25 - 50) that you pay every time you s…
After you pay your deductible, you pay this percentage of the…
The cost of your healthcare expenses, usually sent in the mai…
premium
Your monthly payment in order to keep health insurance. Somet…
co-pay
The flat fee (usually $25 - 50) that you pay every time you s…
20 terms
Health Insurance
Mandatory
Coinsurance
The Health Exchange
Health Maintenance Organization (HMO)
required by rule
The amount you are required to pay for medical care in certai…
Obama Care USA
A health insurance plan that allows you to pay a monthly or q…
Mandatory
required by rule
Coinsurance
The amount you are required to pay for medical care in certai…
19 terms
Health Insurance
Mandatory
Coinsurance
The Health Exchange
Health Maintenance Organization (HMO)
required by rule
The amount you are required to pay for medical care in certai…
Obama Care USA
A health insurance plan that allows you to pay a monthly or q…
Mandatory
required by rule
Coinsurance
The amount you are required to pay for medical care in certai…
Health Insurance
premium
co-pay
co-insurance
medical bill
Your monthly payment in order to keep health insurance. Somet…
The flat fee (usually $25 - 50) that you pay every time you s…
After you pay your deductible, you pay this percentage of the…
The cost of your healthcare expenses, usually sent in the mai…
premium
Your monthly payment in order to keep health insurance. Somet…
co-pay
The flat fee (usually $25 - 50) that you pay every time you s…
Health Insurance
Health Skills
Interpersonal Communicaton
Refusal Skills
Conflict Resolution
specific tools and strategies that help you maintain, protect…
the process by which people exchange information, feelings, a…
a set of skills designed to help children avoid participating…
a way for two or more parties to find a peaceful solution to…
Health Skills
specific tools and strategies that help you maintain, protect…
Interpersonal Communicaton
the process by which people exchange information, feelings, a…
14 terms
Health/Health Insurance
premium
co-pay
co-insurance
medical bill
Your monthly payment in order to keep health insurance. Somet…
The flat fee (usually $25 - 50) that you pay every time you s…
After you pay your deductible, you pay this percentage of the…
The cost of your healthcare expenses, usually sent in the mai…
premium
Your monthly payment in order to keep health insurance. Somet…
co-pay
The flat fee (usually $25 - 50) that you pay every time you s…
42 terms
Health Insurance
1. High prices... 2. Excess administrativ…
higher administrative costs
other nations impose much stronger reg…
deductibles
3 highest sources of wasteful healthcare spending in the US:
one negative outcome of a private system of health insurance…
what is the primary reason prices of medical services and dru…
individuals face the full cost of their care but only up to s…
1. High prices... 2. Excess administrativ…
3 highest sources of wasteful healthcare spending in the US:
higher administrative costs
one negative outcome of a private system of health insurance…
HEALTH INSURANCE
emphasize
personal
regardless
suit
nhấn mạnh
cá nhân
bất chấp
phù hợp
emphasize
nhấn mạnh
personal
cá nhân
12 terms
Health insurance
Alternative
Concern
aspect
emphasize
thay thế (adj)
sự lo ngại (n)
khía cạnh (n)
nhấn mạnh (v)
Alternative
thay thế (adj)
Concern
sự lo ngại (n)
12 terms
Chapter 35 - Life and Health Insurance
life insurance
proceeds
beneficiary
cash-value insurance
Insurance that is paid to a person or people designated to re…
The value of an insurance policy (life insurance).
A survivor who receives part or all of the proceeds.
This type of permanent insurance provides both savings and de…
life insurance
Insurance that is paid to a person or people designated to re…
proceeds
The value of an insurance policy (life insurance).
Health Insurance Terms
Deductible
Out-Of-Pocket Maximum
In-Network Provider
Premium
amount you pay before insurance kicks in
A predetermined amount of money that an individual must pay b…
doctors or hospitals within the health insurance network
Bills
Deductible
amount you pay before insurance kicks in
Out-Of-Pocket Maximum
A predetermined amount of money that an individual must pay b…
19 terms
5comparing health Insurance
NHS aka? ... National Health Service in?
GP's in UK part of
In UK money flows where?... What % is pri…
Concerns of UK model
beveridge model in UK... Everyone pays and everyone benefits... Uni…
primary care trusts... -regulate services, pay etc.
it is needed... 12%
-long waits for elective surgery & specialist care... -Increasin…
NHS aka? ... National Health Service in?
beveridge model in UK... Everyone pays and everyone benefits... Uni…
GP's in UK part of
primary care trusts... -regulate services, pay etc.
24 terms
Comparing Health Insurance
Health Care in the UK
Doctors in UK
Private sector in UK
UK - good news
• National Health Service (NHS) - "Beveridge model"... • Public…
• GPs part of Primary Care Trusts... - set budgets and services…
- 12% of the population has private health insurance... - less…
• coverage is universal... • services are comprehensive... • cost…
Health Care in the UK
• National Health Service (NHS) - "Beveridge model"... • Public…
Doctors in UK
• GPs part of Primary Care Trusts... - set budgets and services…
28 terms
Health Insurance 101
- Private insurance ... - Welfare Program…
First 'health insurance' used to pay f…
Prior to treatment (prepaid model)
1930
What are 3 types of health insurance?
1866, why was it important
In the 1920s how were hospital services paid for?
Blue Cross organization formed in what year?
- Private insurance ... - Welfare Program…
What are 3 types of health insurance?
First 'health insurance' used to pay f…
1866, why was it important
Health Insurance Glossary
Coinsurance
Copayment
Deductible
Exclusions
The amount you are required to pay for medical care in certai…
A way of sharing medical costs.
The amount of money you must pay each year to cover your medi…
Specific conditions or circumstances for which the policy wil…
Coinsurance
The amount you are required to pay for medical care in certai…
Copayment
A way of sharing medical costs.
12 terms
35 life and health insurance
life insurance
proceeds
beneficiary
cash-value insurance
insurance that is paid to a person or people designated to re…
the value of an insurance policy (life insurance)
a survivor who receives part or all of the proceeds
(permanent insurance) provides both savings and death benefits
life insurance
insurance that is paid to a person or people designated to re…
proceeds
the value of an insurance policy (life insurance)
12 terms
Lesson 48: Health Insurance
allow
alternative
aspect
concern
(v) cho phép, chấp nhận
n., adj. /ɔ:l'tə:nətiv/ sự lựa chọn; lựa chọn
(n) khía cạnh, mặt, diện mạo
(n) mối quan tâm
allow
(v) cho phép, chấp nhận
alternative
n., adj. /ɔ:l'tə:nətiv/ sự lựa chọn; lựa chọn
TOPIC 48: HEALTH INSURANCE
allow (v)
alternative (adj)
aspect (n)
concern (n)
cho phép, chấp nhận
thay thế nhau, xen nhau
khía cạnh, phương diện
sự lo lắng, sự lo âu, sự quan tâm
allow (v)
cho phép, chấp nhận
alternative (adj)
thay thế nhau, xen nhau
186 terms
Health Insurance, HS Foundations (Combination)
Mandatory
Coinsurance
The Health Exchange
Health Maintenance Organization (HMO)
required by rule
The amount you are required to pay for medical care in certai…
Obama Care USA
A health insurance plan that allows you to pay a monthly or q…
Mandatory
required by rule
Coinsurance
The amount you are required to pay for medical care in certai…
12 terms
L48 Health Insurance
allow
alternative
aspect
concern
(v) /ə'lau/ cho phép, để cho
(n) (adj) /ɔ:l'tə:nətiv/ sự lựa chọn; lựa chọn
n. /'æs.pekt/ vẻ bề ngoài, diện mạo
v., n. /kənˈsərn/ lo lắng, quan tâm, liên quan, dính líu tới;…
allow
(v) /ə'lau/ cho phép, để cho
alternative
(n) (adj) /ɔ:l'tə:nətiv/ sự lựa chọn; lựa chọn
Health Insurance, Wellness, and Alternative Medicine
Health Insurance Plans
How Health Insurance Works
Deductible
Co-insurance
-Helps pay for the cost of Health care... -Offered by several th…
-Patient Pays a premium... -Company pays for a portion of the…
-Amounts that must be paid by patient before policy begins to…
-Specific percentages of expenses are shared by the patient a…
Health Insurance Plans
-Helps pay for the cost of Health care... -Offered by several th…
How Health Insurance Works
-Patient Pays a premium... -Company pays for a portion of the…
13 terms
16.She gets health insurance.
health
insurance
want
call up
健康
n.保險
想要
打電話給某人
health
健康
insurance
n.保險
Understanding Health Insurance ch4
Processing and Insurance Claim
CMS-1500 claim
Accepting Assignment
Assignment of Benefits
-CMS-1500 claim is used to report Professional and technical…
-Requires responses pertaining to patient's condition and if…
when provider agrees to what the insurance company allows and…
-Patient or insured authorizes the payer to reimburse the pro…
Processing and Insurance Claim
-CMS-1500 claim is used to report Professional and technical…
CMS-1500 claim
-Requires responses pertaining to patient's condition and if…
24 terms
4: Private Health Insurance 1
Economic function of health insurance
HEALTH risks
Average Medical care expenditures
Insurance
1. Risk Transfer and Distribution ... 2. provider networks, plan…
Health is inherently risky (unpredictable) for an individual…
are reasonably predictable over 12-18 months for large groups…
transfers and spreads financial risk associated with medical…
Economic function of health insurance
1. Risk Transfer and Distribution ... 2. provider networks, plan…
HEALTH risks
Health is inherently risky (unpredictable) for an individual…
23 terms
5: Private Health Insurance 2
55%
Who pays?
Adverse selection in employer plans an…
Adverse selection in employer plans re…
of all firms offer health benefits
Employers and employees contribute ( a few plans do not requi…
higher risk buys more insurance
-insurance is ancillary to the purpose of the group (the grou…
55%
of all firms offer health benefits
Who pays?
Employers and employees contribute ( a few plans do not requi…
12 terms
Vocabulary Review: Drones - Amazon - Health Insurance
being held accountable
task force
exempted
unmanned
expected to show results
group of people trying to do something
let out of
not controlled by humans
being held accountable
expected to show results
task force
group of people trying to do something
13 terms
TOEIC Unit 12 - Health Insurance
insurance
alter
alternative
aspect
(n) bảo hiểm
(v) thay đổi, biến đổi
(n) phương án thay thế
(n) khía cạnh
insurance
(n) bảo hiểm
alter
(v) thay đổi, biến đổi
12 terms
Maioni 3. Comparing health insurance
Average health care spending per capit…
Pharmaceutical spending per capita
Number of practising physicians per 10…
NHS (Beveridge model)
Unusually steep trends in the US
Above OECD median (highest in the world) in the US
Below OECD median in the US
Public control over most hospitals, regulation of physicians…
Average health care spending per capit…
Unusually steep trends in the US
Pharmaceutical spending per capita
Above OECD median (highest in the world) in the US
12 terms
HealthCare Insurance & HealthCare Agencies
Department Of Health
Environmental Protection Agency- helps…
Center For Disease Control
Occupational Safety Health Administrat…
DHHS
EPA
CDC
OSHA
Department Of Health
DHHS
Environmental Protection Agency- helps…
EPA
36 terms
Louisiana Laws (Life/Health Insurance Exam)
Commissioner of Insurance
5
30 days
Reciprocal Agreement
Who is responsible for making sure the provisions of the Loui…
The Commissioner may conduct a financial examination of any i…
The Commissioner may call and hold hearings if a producer is…
A producer who holds a resident license in a different state…
Commissioner of Insurance
Who is responsible for making sure the provisions of the Loui…
5
The Commissioner may conduct a financial examination of any i…
7 terms
FSA GROUP HEALTH SPECIALTY 32 - 34 - Health Insurance Risks
32 Regulatory actions levels for Healt…
33 Formula for Health RBC after covari…
34 Formulas for the H2 (Underwriting r…
Claims Fluctuation Risk
"Actions are based on the Health RBC ratio (defined in separa…
"1. RBCAC = H0 + { H1^2 + H2^2 + H3^2 + H4^2 }^1/2... a. H0 is t…
"1. Underwriting risk = Claim experience fluctuation risk + O…
o 𝑅𝑖𝑠𝑘 𝑐ℎ𝑎𝑟𝑔𝑒 = Premium x Incurred ClaimsPremium x Risk Facto…
32 Regulatory actions levels for Healt…
"Actions are based on the Health RBC ratio (defined in separa…
33 Formula for Health RBC after covari…
"1. RBCAC = H0 + { H1^2 + H2^2 + H3^2 + H4^2 }^1/2... a. H0 is t…
Chapter 21 Health Insurance Claim Form
Instruction
Hard Copy (Paper) Claims
Intelligent Character Recognition
Rules for Paper CMS-1500 Form
-Universal claim form (CMS-1500 Health Insurance Claim Form)…
-Advantages: ... Minimal start-up costs... Ability to attach docume…
-System that scans documents and captures claims information…
-Entries should be clear and sharp; carbon copies are not acc…
Instruction
-Universal claim form (CMS-1500 Health Insurance Claim Form)…
Hard Copy (Paper) Claims
-Advantages: ... Minimal start-up costs... Ability to attach docume…
45 terms
Economic Aspects of Health Care Delivery: Health Economics and Private Health Insurance
4 Basic Types of Market Structure
In perfect competition, the demand cur…
In perfect competition, prices are set..
Characteristics of Perfect Competition
(1) Perfect Competition... (2) Monopolistic Competition... (3) Olig…
Horizontal (perfectly elastic)
by the market (firms are not price takers or price makers)
(1) Many buyers and sellers... (2) Freedom of entry and exit... (3)…
4 Basic Types of Market Structure
(1) Perfect Competition... (2) Monopolistic Competition... (3) Olig…
In perfect competition, the demand cur…
Horizontal (perfectly elastic)
28 terms
11-12 Health Insurance (OT610)
Government Funding
Privately Funded
Medicare
Medicare A & B
•Federal:... -Medicare... -TRICARE... -VA... •Federal/State:... -Medicaid... -…
•Insurance (Blue Cross, Premera, Aetna, etc.)... •Private Pay
•Medicare is the federal health insurance program for people…
•Part A - covers ALL recipients. Includes:... - inpatient hospit…
Government Funding
•Federal:... -Medicare... -TRICARE... -VA... •Federal/State:... -Medicaid... -…
Privately Funded
•Insurance (Blue Cross, Premera, Aetna, etc.)... •Private Pay
Lecture 78,79 - Comparing health insurance
Describe how the US relates to other h…
Generally describe the health care in…
Describe doctors in the UK
Describe private sector health insuran…
--Average health care spending per capita: Increasing more…
--Beveridge model... --Tax based, everyone eligible (universal…
Part of Primary Care Trusts (like IPAs)... --Set budgets/servi…
--About 12% have private insurance... --Pay EXTRA premiums... --Cho…
Describe how the US relates to other h…
--Average health care spending per capita: Increasing more…
Generally describe the health care in…
--Beveridge model... --Tax based, everyone eligible (universal…
25 terms
BHS Maioni Lecture 3: Comparing Health Insurance
Health Care in the UK. What model do t…
Doctors in UK are part of what?
Private sector in UK... a) How much of po…
UK- Good news (4)
National Health Service (NHS) follows the Beveridge model. Th…
GPs part of primary care trust. They set budgets and services…
a) ~12% of population has private health insurance... b) Offers…
1) Coverage is universal... 2) Services are comprehensive... 3) Eff…
Health Care in the UK. What model do t…
National Health Service (NHS) follows the Beveridge model. Th…
Doctors in UK are part of what?
GPs part of primary care trust. They set budgets and services…
5 terms
FSA GROUP HEALTH SPECIALTY 13 - 17 - disability income insurance
13 Types of reserves and disability in…
14 Factors that stimulate product deve…
15 Areas that participate in the produ…
16 Types of disability income claim ex…
1. Active life reserve-exist for policies price on a level-pr…
"1. Responding to the competition- Because the marketplace is…
"1. Sales and marketing - these individuals are closest to th…
"1. Actual-to-expected morbidity - This is the most preferabl…
13 Types of reserves and disability in…
1. Active life reserve-exist for policies price on a level-pr…
14 Factors that stimulate product deve…
"1. Responding to the competition- Because the marketplace is…
45 terms
Economic Aspects of Health Care Delivery: Health Economics and Private Health Insurance
4 Basic Types of Market Structure
In perfect competition, the demand cur…
In perfect competition, prices are set..
Characteristics of Perfect Competition
(1) Perfect Competition... (2) Monopolistic Competition... (3) Olig…
Horizontal (perfectly elastic)
by the market (firms are not price takers or price makers)
(1) Many buyers and sellers... (2) Freedom of entry and exit... (3)…
4 Basic Types of Market Structure
(1) Perfect Competition... (2) Monopolistic Competition... (3) Olig…
In perfect competition, the demand cur…
Horizontal (perfectly elastic)
12 terms
FSA GROUP HEALTH SPECIALTY 103 - 114 - Insurance industry mergers and acquisitions
103 Challenges in determining the valu…
104 Techniques used by investment bank…
105 Formulas for using a discounted ca…
106 Component of the actuarial apprais…
"1. Long duration of liabilities... 2. Sensitivity to interest r…
"1. Comparable company analysis- the value of the company is…
"1. An actuarial appraisal is a discounted cash flow analysis…
"1. Adjusted book value- this is the net worth of the insuran…
103 Challenges in determining the valu…
"1. Long duration of liabilities... 2. Sensitivity to interest r…
104 Techniques used by investment bank…
"1. Comparable company analysis- the value of the company is…
12 terms
FSA GROUP HEALTH SPECIALTY 60 - 71 - reinsurance for group accident& health insurance
60 Financial uses of reinsurance (1)
61 Nonfinancial uses of reinsurance (5)
62 Limitations of reinsurance (7)
63 Types of reinsurers (9)
"1. Increase financial capacity- enables the insurer to write…
"1. Increase intellectual capacity- useful for a new line of…
"1. It cannot make an uninsurable risk insurable... 2. It cannot…
"1. Reinsurance companies-offer products and services to othe…
60 Financial uses of reinsurance (1)
"1. Increase financial capacity- enables the insurer to write…
61 Nonfinancial uses of reinsurance (5)
"1. Increase intellectual capacity- useful for a new line of…
6 terms
FSA GROUP HEALTH SPECIALTY 120 - 121 - ASOP #19 appraisal of casualty, health, and life insurance businesses
120 Recommended practices for performi…
121 Items included in an actual apprai…
Actuarial Appraisal
Cost of Capital
"An actuarial appraisal is an appraisal of an insurance busin…
"1. The scope of the assignment and any limitations as to the…
Actuarial Appraisal - Distributable Cash Flow = After-Tax Ear…
o 𝐶𝑜𝑠𝑡 𝑜𝑓 𝐶𝑎𝑝𝑖𝑡𝑎𝑙(𝑡) = 𝑅𝑒𝑞𝑢𝑖𝑟𝑒𝑑 𝐶𝑎𝑝𝑖𝑡𝑎𝑙(𝑡−1) 𝑥 (𝑑𝑖𝑠𝑐𝑜𝑢𝑛𝑡 𝑟𝑎𝑡𝑒…
120 Recommended practices for performi…
"An actuarial appraisal is an appraisal of an insurance busin…
121 Items included in an actual apprai…
"1. The scope of the assignment and any limitations as to the…
71 terms
Health Insurance Specialist Career Chapter 1- 4 Vocabulary
EOB
remit
AAPC
ICD-9-CM
explanation of benefits
remittance advice
American Academy of Professional Coders
3 to 5 places may be Alpha or Numeric as 1st place holder
EOB
explanation of benefits
remit
remittance advice
1 of 10