INSTITUTIONS
The three types of institutions that healthcare is provided
What are Voluntary Nonprofit Institutions, Government Institutions, and Proprietary Institutions?
Monthly amount paid to an insurance company for health insurance coverage.
What is Premium?
what does EPO (Exclusive provider organization) do/ have?
offers a local network of doctors and hospitals.
describe out-of-network plans
An out-of-network provider is one not contracted with the health insurance plan.
types of government plans and how are they funded in general
What is 4 government plans and they are health care plans funded by a government agency?
The three ways of healthcare payment methods
what are private insurance, government plans, and direct payment?
What is Deductible?
Fixed dollar amount you pay out of your own pocket before the insurance will pay for the remaining expenses.
what does PPO (preferred provider organization plan) do/ have?
allows patients to receive care from a non-plan provider, but requires them to pay a higher out of pocket price if they do.
explain in network providers
An in-network provider is one contracted with the health insurance company to provide services to plan members
funds for uninsured children.
What is CHIP?
A community facility that receives federal, state and local tax exemptions in exchange for providing a community benefit (must show that it is operated for a charitable purpose)
What is voluntary non-profit institution?
a fixed out-of-pocket amount paid to covered services, does not go towards the deductible (flat fee).
What is a co-payment?
what does POS (Point-of-Service-plan) do/ have?
physician coordinated plan that combines characteristics of both HMO and PPO plans
does a PPO Plan provide an out of network coverage, in network coverage or both?
Both in and out of network coverage, no limits on out of network coverage but it does cost more
offers health insurance to low income and disabled people.
What is Medicaid?
Public health facilities that receive most of its funding from local, state or federal sources.
What is government institutions?
Term used to describe plans that require the insured to share a portion of the costs for health care services (usually 80/20 %)
What is co-insurance?
what does HMO (Health maintenance organization plan) do/ have?
provides coverage only if the care is delivered by a hospital, physician, or pharmacy contracted with the insurance company.
does an HMO Plan provide an out of network coverage, in network coverage or both?
no out of network, only in network
provides medical coverage for active and retired service personnel and their dependents.
What is TRICARE?
It is a for-profit facility usually owned by a corporation. They must pay local, state and federal taxes.
What is Proprietary Institutions?
what do managed care plans do
plans save money by contracting with doctors and hospitals in the community to help control the fees they charge
also provides preventive health care services to help clients avoid serious health problems and providers manage a patient’s use of health care.
what parts of HMO and PPO plans does a POS plan have?
A POS plan has an HMO base with a PPO option to go out of network for care.
If a person wants a flexible network of healthcare providers and insurance, which plan should they choose and why?
PPO Plan because although it can be more expensive it allows coverage for both in and out of network care providers, making it the most flexible and common insurance plan option.
provides health care coverage for geriatrics (aged 65 or older) regardless of income or wealth.
What is Medicare?