Insurance 1
Medical illnesses or injuries that a patient has before the purchase of a health insurance policy are called
Preexisting conditions
Long-term care insurance covers nursing home care (T or F)
True
SSDI is and insurance only individuals older than 65 can qualify for
False
The monthly (or periodic) fee paid for health insurance is commonly called a
Premium
Most third-party payers pay for medical services only if they are
Medically necessary
The Affordable Care Act now makes it illegal for health insurance companies to deny coverage to any applicant with a preexisting condition (T or F)
TRICARE is
The US military's comprehensive healthcare program for active duty and retired personnel
An insurance contract made with a business entity that covers its employees under a single policy is called a/an
UCR fees for commercial insurers are established by the federal government (T or F)
False
A network of doctors and hospitals that shares responsibility for managing healthcare needs of a minimum of 5000 Medicare beneficiaries for at least 3 years
Accountable Care Organization
The form that is most commonly used today for insurance claims submitted on paper is the
CM-1500
The Affordable Care Act has set limits on what a patient must pay on their own, which is referred to as the
Out-of-pocket maximum
The level of health plan which is most like the former "basic" coverage is called the
Bronze plan
The dollar amount that a patient must pay each year before his or her insurance benefits begin is called a/an
Deductible
People who are covered under managed care plans are commonly referred to as
enrollees
The "birthday rule"
An informal procedure used to determine which plan is "Primary" when individuals are listed as dependents on more than one policy
A health insurance model intended to create a more organized and competitive market by offering consumers plan choices with common rules as to how the plan is offered, its cost, etc. defines a/an
Health insurance exchange
Flexible spending accounts are "cafeteria" plans, meaning premiums are deducted from
The employee's wages before withholding taxes are deducted
Health insurance payments are sometimes based on what is referred to as
UCR rates
A special tax shelter set up for the purpose of paying medical bills is a/an
health savings account
The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is (two answers)
Indemnity
Fee-for-service
When an individual is eligible for cover age under two different health insurance policies, ___ limits the total benefits an insured individual can receive from both plans to not cover more that 100% of the allowable expenses
Coordination of benefits
HRA's
New cost controls, called ____, require insurers to spend at least 80%of individual plan premium dollars (85% for group plans) on actual medical care rather than administrative costs and profits
Medical loss ratios
The difference between a participating provider and a nonparticipating provider and how the difference affects fees are
PAR contracts with the third-party payer but non-PAR has no contractual agreement
PAR must accept the insurance carrier's allowable fee as payment in full but non-PAR does not have to accept an insurance company's reimbursement as payment in full