Study sets matching "health insurance"

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Study sets matching "health insurance"

255 terms
Life and Health Insurance Terms
Life insurance policy
Valid life insurance contracts must id…
Insurable interest
Indemnify
Written contract to transfer risk of premature death from one…
1: parties to contract; 2: insured party or life; 3: insurabl…
Financial interest in insured party that must exist @ time of…
To "make whole again" w/out benefit or detriment; neither mon…
Life insurance policy
Written contract to transfer risk of premature death from one…
Valid life insurance contracts must id…
1: parties to contract; 2: insured party or life; 3: insurabl…
15 terms
Chapter 3 - Health insurance
Physician who serves as the gatekeeper…
Law that lets you pay to keep your hea…
Health insurance for low-income families
The portability law
Primary Care Physician
COBRA
Medicaid
HIPAA
Physician who serves as the gatekeeper…
Primary Care Physician
Law that lets you pay to keep your hea…
COBRA
health insurance
what is health insurance
group paln
private
(public) medicare
what most people rely on type of insurance that covers cost o…
monthly fee
policy pays for services
provides all ppl hospital medical insurance
what is health insurance
what most people rely on type of insurance that covers cost o…
group paln
monthly fee
Health Insurance
Catastrophic Coverage
COBRA
Copayment
Disability Insurance
Health insurance is a type of medical coverage under the Affo…
requires most employers with group health plans to offer empl…
A small amount of money paid by a health insurance policy hol…
Designed to replace all or parts of your income if you cannot…
Catastrophic Coverage
Health insurance is a type of medical coverage under the Affo…
COBRA
requires most employers with group health plans to offer empl…
12 terms
Health Insurance
alternative
aspect
concern
emphasize
adj. 替代的,二選一的
n. 觀點,外表
n. 不安,擔心,影響
v. 強調,加強
alternative
adj. 替代的,二選一的
aspect
n. 觀點,外表
36 terms
UNDERSTANDING HEALTH INSURANCE CHAP 14
advance beneficiary notice of noncover…
benefit period (Medicare)
conditional primary payer status
coordinated care plan
document that acknowledges patient responsibility for payment…
begins with the first day of hospitalization and ends when th…
Medicare claim process that includes the following circumstan…
also called managed care plan; includes health maintenance or…
advance beneficiary notice of noncover…
document that acknowledges patient responsibility for payment…
benefit period (Medicare)
begins with the first day of hospitalization and ends when th…
Health Insurance
Disability Income Insurance
Social Security Disability Insurance (…
Supplemental Security Income
Business overhead expense (BOE)
- replaces 60-80% of lost income... -unlike workers' compensatio…
-can apply once out of work (and even if still recieving disa…
-federal income supplement funded by general tax $ ... -helps ag…
-business coverage if disability occurs for owner (or co-owne…
Disability Income Insurance
- replaces 60-80% of lost income... -unlike workers' compensatio…
Social Security Disability Insurance (…
-can apply once out of work (and even if still recieving disa…
5 terms
Health Insurance Terms 3
Capitated Payment Method
Case-based Payment
Global Payment Method
Per-diem Payment
An episode-of-care reimbursement methodology in which a provi…
A type of prospective payment method in which the third-party…
An episode-of-care reimbursement methodology in which the thi…
A type of prospective payment method in which the third-party…
Capitated Payment Method
An episode-of-care reimbursement methodology in which a provi…
Case-based Payment
A type of prospective payment method in which the third-party…
15 terms
Health insurance
Coinsurance
Copayment
Deductible
Exclusions
The amount you are required to pay for medical care in certai…
A way of sharing medical costs. You pay a flat fee everytime…
The ammount of money you must pay each year to cover your med…
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 everytime…
55 terms
Health insurance
Health maintenance organization (HMO)
Preferred provider organization (PPO)
Exclusive provider organization (EPO)
Point-of-service plans
organization that provides a comprehensive range of services…
agreement between managed care organization and physician to…
members must receive services within the network only
in-network combined with out-of-network
Health maintenance organization (HMO)
organization that provides a comprehensive range of services…
Preferred provider organization (PPO)
agreement between managed care organization and physician to…
23 terms
Insurance Final: Health Insurance
medical costs
disability costs
is disability or death more likely at…
what are private health (disability an…
additional expenses (direct losses) incurred due to health pr…
refer to the impairment of one's income-producing abilities (…
disability
only for non-work related injuries and illnesses
medical costs
additional expenses (direct losses) incurred due to health pr…
disability costs
refer to the impairment of one's income-producing abilities (…
15 terms
Health insurance
Health insurance
Coinsurance
Stop-loss provision
Co-payment
A form of protection that eases the financial burden people m…
The percentage of the medical expenses the policyholder must…
Requires the policyholder to pay all costs up to a certain am…
A flat fee that you pay every time you receive a covered
Health insurance
A form of protection that eases the financial burden people m…
Coinsurance
The percentage of the medical expenses the policyholder must…
6 terms
Health Insurance
Co-Pay
Group Insurance
You will pay the entire bill yourself
Individual Insurance
Your responsibility of the doctor's bill
Provided to you by employer, covers your immediate family
What happens if the doctor you want to see is not in the prov…
Insurance for the self employed or those who do not have full…
Co-Pay
Your responsibility of the doctor's bill
Group Insurance
Provided to you by employer, covers your immediate family
Health Insurance
Co-payment
Deductible
Diagnostic Services
Gross National Product
A co-payment is an amount paid by the patient for a certain s…
The amount that must be paid by the patient before the insura…
Organized services for the purpose of providing diagnosis to…
The total amount spent on goods and services in one year
Co-payment
A co-payment is an amount paid by the patient for a certain s…
Deductible
The amount that must be paid by the patient before the insura…
23 terms
Health Insurance
Affordable Care Act; Health Care Refor…
Health Insurance Marketplace
eligibility requirements
open enrollment
Reforma de salud; Obamacare
Mercado de seguro de salud
requisitos de elegibilidad
inscripcion abierta
Affordable Care Act; Health Care Refor…
Reforma de salud; Obamacare
Health Insurance Marketplace
Mercado de seguro de salud
15 terms
health insurance
premium
deductible
co payment
private insurance
cost you pay each month for the insurance policy
amount the patient pays for a medical service before the insu…
specific amount a patient pays for a particular service
purchased by an individual sometimes called 3rd party payer
premium
cost you pay each month for the insurance policy
deductible
amount the patient pays for a medical service before the insu…
6 terms
Health Insurances
Medicare
Medicaid
Military Healthcare
Workers' Compensation
provides health insurance to people who are at least 65 years…
a health insurance for certain low-income people; provides in…
government provides healthcare benefits for families of curre…
insurance that covers accidents, injuries, or diseases that o…
Medicare
provides health insurance to people who are at least 65 years…
Medicaid
a health insurance for certain low-income people; provides in…
Unit Health Insurance
Coinsurance
Copayment
Deductible
Exclusions
The portion of covered medical expenses you must pay after me…
A fixed fee paid by the patient at the time of an office visit.
Specified amount of money that the insured must pay for cover…
Specific hazards listed in an insurance policy for which the…
Coinsurance
The portion of covered medical expenses you must pay after me…
Copayment
A fixed fee paid by the patient at the time of an office visit.
9 terms
Health Insurance
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Deductible
Co-pay
insurance plan provides care for the delivery of health service
care by large companies to their employees
amounts paid by the patient for medical services before the p…
amount of money and patient pays for a particular service
Health Maintenance Organization (HMO)
insurance plan provides care for the delivery of health service
Preferred Provider Organization (PPO)
care by large companies to their employees
15 terms
Health insurance
CMS
EOB
health insurance claim
Hold harmless clause
centers for medicare and medicaid services
explanation of benefit sent by insurance companys
documentation for health care service submitted to a third pa…
patients is not responsible for what the insurance company do…
CMS
centers for medicare and medicaid services
EOB
explanation of benefit sent by insurance companys
51 terms
Life and Health Insurance
What are the stages of the financial l…
Actuaries
Deductible
Patient Protection and Affordable Care…
Stage 1: Securing Basics ... Stage 2: Financial Foundation ... Stag…
statisticians who specialize in estimating the probability of…
the amount that you are responsible for paying before insuran…
signed into law in 2010 and put in place comprehensive health…
What are the stages of the financial l…
Stage 1: Securing Basics ... Stage 2: Financial Foundation ... Stag…
Actuaries
statisticians who specialize in estimating the probability of…
Health Insurance
A&H
Absolute Assignment
Accident
Accidental Death Insurance
Accident and Health
Assignment by the party owner of all control and rights to a…
Fortuitous event, unintended.
A form of insurance that provides payment if death from the i…
A&H
Accident and Health
Absolute Assignment
Assignment by the party owner of all control and rights to a…
Health Insurance
How much does insurance rise every year
How much do salaries rise by
Average cost of insurance
Single coverage is approx
8-9%
3%
$1400/mos $16800/yr
$500/mos $6000/yr
How much does insurance rise every year
8-9%
How much do salaries rise by
3%
Health Insurance
Alternative
Aspect
Emphasize
Incur
Thay thế
Khía cạnh, mặt
Nhấn mạnh
Chịu đưngj
Alternative
Thay thế
Aspect
Khía cạnh, mặt
16 terms
Health Insurance
Market Model
Fee for Service FFS
Per Diem, Per Visit
Case Rate
seller sets the price for good or service ... buyer decides if…
providers sells the service, third party pays... insurer assume…
all inclusive, each day, each visit ... Insurer bears LOS volum…
All inclusive for LOS... Gives providers the freedom to deliver…
Market Model
seller sets the price for good or service ... buyer decides if…
Fee for Service FFS
providers sells the service, third party pays... insurer assume…
17 terms
Group Health Insurance
Conversion Privilege
Coordination of Benefits Provision
Primary Insurance
Secondary Insurance
allows an employee to convert from a group policy to an indiv…
Eliminates the duplication of payments when an employee, spou…
insurance company that pays first, if the patient has more th…
This is the insurance company that is billed for any remainin…
Conversion Privilege
allows an employee to convert from a group policy to an indiv…
Coordination of Benefits Provision
Eliminates the duplication of payments when an employee, spou…
Health Insurance Study Notes
Medicare
Medicaid
Premium
Deductible
A federal system of health insurance for people over 65 years…
A federal system of health insurance for those requiring fina…
Amount regularly to purchase insurance coverage
Money you must pay yourself for health services before your h…
Medicare
A federal system of health insurance for people over 65 years…
Medicaid
A federal system of health insurance for those requiring fina…
17 terms
Health Insurance
guild fund
fraternal societies
mutual benefit associations
contract practice
form of health insurance set up in Europe (Germany)... -covers t…
voluntary health insurance
...
voluntary health insurance
guild fund
form of health insurance set up in Europe (Germany)... -covers t…
fraternal societies
voluntary health insurance
Health Insurance
Basic Coverage
Major Medical Plans
Comprehensive Medical Plans
Health Maintenance Organizations (HMO)
Covers hospitalization, diagnostic services; surgical care; a…
Covers health care costs after the deductible [money upfront,…
Combines basic coverage with a major medical plan. Reduces ou…
Provided their members with services rather than reimbursing…
Basic Coverage
Covers hospitalization, diagnostic services; surgical care; a…
Major Medical Plans
Covers health care costs after the deductible [money upfront,…
38 terms
Group Health Insurance
In group insurance, the owner of the p…
The individuals covered under a group…
The same as group life insurance, grou…
What is defined as noncontributory
In group insurance the policy is called the master policy, an…
The individuals covered under a group insurance plan are issu…
Contributory and Noncontributory
the participants do not pay part of the premium.
In group insurance, the owner of the p…
In group insurance the policy is called the master policy, an…
The individuals covered under a group…
The individuals covered under a group insurance plan are issu…
Health Insurances
Premium
Co-payment
Deductable
Medicaid
monthly or bimonthly PERIODIC PAYMENT
Insurance determines what IT WILL pay and WILL NOT pay for HO…
An amount the subscriber must pay BEFORE the insurance pays.…
Benefits people with Disablities
Premium
monthly or bimonthly PERIODIC PAYMENT
Co-payment
Insurance determines what IT WILL pay and WILL NOT pay for HO…
health insurance concepts
adhesion
Cobra
Conditional receipt
claims experience rating
makes insurance provisions in favor of the insured due to the…
- Provision... -Requires the employer to offer coverage to a ter…
insured gives premium along with application ... insurer gives w…
premium renewal for group insurance are based on
adhesion
makes insurance provisions in favor of the insured due to the…
Cobra
- Provision... -Requires the employer to offer coverage to a ter…
Health Insurance and Disability Income Insurance
Partial Disability
Individual Mandate
Discrimination
Cancelable Policy
the inability of the insured to perform one or more important…
a portion of the recently passed health reform legislation th…
a term that refers to how the insurance industry differentiat…
policy that gives the insurer the right to refuse to renew th…
Partial Disability
the inability of the insured to perform one or more important…
Individual Mandate
a portion of the recently passed health reform legislation th…
62 terms
UNDERSTANDING HEALTH INSURANCE CHAP 9
All-Patient diagnosis-related group (A…
All-Patient Refined diagnosis-related…
allowable charge
ambulance fee schedule
DRG system adapted for use by third-party payers to reimburse…
adopted by Medicare in 2008 to reimburse hospitals for inpati…
maximum fee a provider may charge.
payment system for ambulance services provided to Medicare be…
All-Patient diagnosis-related group (A…
DRG system adapted for use by third-party payers to reimburse…
All-Patient Refined diagnosis-related…
adopted by Medicare in 2008 to reimburse hospitals for inpati…
Health Insurance
What does the consumer pay to the insu…
Sum of premiums will exceed
Why buy health insurance?
Strong association between health insu…
A premium
the sum of medical expenses
Minimize risk in an uncertain future (likelihood and magnitud…
primary and preventive care... treatment of acute conditions... man…
What does the consumer pay to the insu…
A premium
Sum of premiums will exceed
the sum of medical expenses
47 terms
Health Insurance Chapter 2
ASCA
HIPAA
Blue Cross
Base Period
Administrative Simplification Compliance Act; establishes a s…
Health Insurance Portability and Accountability Act; 1996 man…
B/C; Insurance plan created in 1929 to cover hospitalization…
A period of time from which weekly disability benefits are ca…
ASCA
Administrative Simplification Compliance Act; establishes a s…
HIPAA
Health Insurance Portability and Accountability Act; 1996 man…
61 terms
Health Insurance Glossary of Terms
account number
accounts receivable
adjudication:
advance beneficiary notice
the number a patient is given by the doctor or hospital which…
the total amount of money owed for professional services prov…
the final determination of the issues involving settlement of…
an agreement given to the patient to read and sign before pro…
account number
the number a patient is given by the doctor or hospital which…
accounts receivable
the total amount of money owed for professional services prov…
Health Insurance Final Part 1
Local coverage determination (LCDs) co…
When a provider documents justificatio…
An acceptable reason to delay a docume…
HCPCS level II modifers are added to w…
covered and noncovered codes
health status code
provide additional information for clarification
CPT and HCPCS codes
Local coverage determination (LCDs) co…
covered and noncovered codes
When a provider documents justificatio…
health status code
10 terms
Health Insurance Study Set
health insurance policy
premium
deductible
co-payment
contract between an insurance company and an individual; can…
amount of money an insurance policy holder pays monthly to pu…
amount of money a person pays for health care expenses before…
amount paid by insured person for each health care service e.…
health insurance policy
contract between an insurance company and an individual; can…
premium
amount of money an insurance policy holder pays monthly to pu…
56 terms
Health Insurance
insurance
risk
insurer
premium
mechanism for protection against risk
possibility of substantial financial loss from some event... -me…
agency that assumes the risk... -insurance company, employer
amount charged for insurance coverage
insurance
mechanism for protection against risk
risk
possibility of substantial financial loss from some event... -me…
16 terms
MAS Health Insurance Review
policy holder
premium
insured
provider
person in whose name the policy is written
the rate charged for an insurance policy
the person who is covered by an insurance policy
health care professional who supplies the health care to the…
policy holder
person in whose name the policy is written
premium
the rate charged for an insurance policy
36 terms
Health Insurance
Which of these circumstances is a Busi…
K becomes ill after traveling overseas…
Which type of provider is known for st…
S wants to open a tax-exempt Health Sa…
"Business owner becoming disabled" A Business Disability Buy-…
"Disability Income". Disability Income would reimburse an ins…
"Health Maintenance Organizations (HMO's)". The health provid…
"High-deductible health plan". To be eligible for a Health Sa…
Which of these circumstances is a Busi…
"Business owner becoming disabled" A Business Disability Buy-…
K becomes ill after traveling overseas…
"Disability Income". Disability Income would reimburse an ins…
Health Insurance
What has happened to medical costs in…
What are the two types of health organ…
How much do Fee for Service Plans usua…
What do Fee for Service Organization c…
They have risen significantly.
Fee for Service Plans and Health Maintenance Organizations.
Around 80% after a deductible is met.
Major medical costs, but sometimes cover routine care.
What has happened to medical costs in…
They have risen significantly.
What are the two types of health organ…
Fee for Service Plans and Health Maintenance Organizations.
100 terms
Health Insurance General Knowledge
Five Renewability Provisions
Participating vs. Non Participating He…
Types of claims payments
Blue Cross vs Blue Shield
1. Non-cancelable - as long as you pay premium, they cannot c…
Participating - Chance to receive dividends... Non-participating…
-Contracts of reimbursement... -Indemnity/valued contracts: spec…
Blue Cross = hospital coverage... Blue Shield = doctor and medic…
Five Renewability Provisions
1. Non-cancelable - as long as you pay premium, they cannot c…
Participating vs. Non Participating He…
Participating - Chance to receive dividends... Non-participating…
health insurance
what is an important feature of Dental…
what is an accident-only policy?
Accidental Death and Dismemberment (AD…
Accidental Death and Dismemberment: Pr…
Dental insurance includes diagnostic and preventative care (t…
limited policies that provide coverage for death, dismember…
-Can be written as rider or separate policy... -Provides for the…
-Paid for accidental death... -Amount=amount of coverage under t…
what is an important feature of Dental…
Dental insurance includes diagnostic and preventative care (t…
what is an accident-only policy?
limited policies that provide coverage for death, dismember…
Health Insurance
Which of the following are NOT managed…
An agent takes an individual Disabilit…
Which of the following statements abou…
A prepaid application for individual D…
Medical Information Bureau (MIB)
determine if the applicant is an acceptable risk by completin…
Substandard applicants are occasionally declined by underwrit…
Send a notice to the MIB that the applicant was declined
Which of the following are NOT managed…
Medical Information Bureau (MIB)
An agent takes an individual Disabilit…
determine if the applicant is an acceptable risk by completin…
Health Insurance
What are the 5 types of medical insura…
What is hospital expense insurance
What is surgical expense insurance
What is regular medical expense insura…
hospital expense, surgical expense, regular medical expense,…
most common, pays for room, food. . . not doctor fees
usually bought with hospital expense insurance, pays for surg…
bought wil hospital and surgical expens insurance, pauys for…
What are the 5 types of medical insura…
hospital expense, surgical expense, regular medical expense,…
What is hospital expense insurance
most common, pays for room, food. . . not doctor fees
46 terms
Health Insurance
Major medical care covers:
Major medical care requires ____ and _…
Somw policies allow you to ____ any ho…
(HMO) stands for?
Hospital and expenses... Doctor visits ... Perscription drugs... Healt…
Deductible and coinsurance
Choose
Health Maintenance Organization
Major medical care covers:
Hospital and expenses... Doctor visits ... Perscription drugs... Healt…
Major medical care requires ____ and _…
Deductible and coinsurance
25 terms
Health Systems and Insurance
medicare
medicaid
HMO
PPO
insurance coverage for those individuals over the age of 65
insurance coverage for individuals with a low income.
health maintenance organization focus is to prevent illness a…
preferred provider organization individuals get to choose a d…
medicare
insurance coverage for those individuals over the age of 65
medicaid
insurance coverage for individuals with a low income.
Health Science Insurance Terms
Health Maintenance Organization
Preferred Provider Organization
Preferred Provider
Managed Care
HMO
PPO
restricts participant to certain providers that are contracte…
developed in response to rising health care costs. Ensures th…
Health Maintenance Organization
HMO
Preferred Provider Organization
PPO
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