Origin of Private Insurance
What is "...money that a client is required to pay for services and is often specified by a percentage?"
coinsurance
Do HMOs generally cost more or less than plans that offer greater choice of providers?
less
What is the "system that guarantees for payment for medical expenses for a work related injury or illness with the employee not being at fault?"
no-fault workers compensation
What "..established a preferential structure of return to work goals based on the highest probability of success due to the least amount challenges or barriers?"
medical only OR lost time
cost paid by the consumer in order access care
Define preferred provider organizations.
User may be able to get some coverage when they visit providers who are outside of the network, but they will receive more coverage from services via providers within the network.
What do state-run programs provide?
they provide fee schedules and published guidelines of approved services
What are three roles of OT as it relates to workers compensation?
identify return to work goals, ergonomic analyses, health promotion, environmental modifications, job analyses
What is the definition of work related injuries and illness?
"...medical conditions directed resulting from activities, incidents, or exposures related to the work place and occurring during the course of employment"
What is difference between deductible and copayment?
A deductible is the fixed amount of money that users will pay for the year, whereas the copayment is the fixed amount of money that users pay per visit (regardless of whether the deductible has been met)
When a patient has a point of service plan, what can they choose between each time they access medical care?
HMO or PPO
What led to a "...staggering increase in work-place deaths and work-related injuries and illness"?
industrialized
What did the Mental Healthy Parity Act of 1996 accomplish?
It "...established that large group plans must not impose lifetime maximum or annual limits on healthcare services to apply only to mental health benefits."
What are surprised medical bills?
"...significant out-of-pocket costs for involuntarily seeking services out of network"
Fee-for-service plans can also be referred to as _____ plans.
indemnity
Are larger or smaller employers required to offer health insurance to employees?
larger
What act "established workers compensation for all federal civil service employees?"
Federal Employees Compensation Act of 1960
53% of children are covered through ___?
private insurance
Blue Cross and Blue Shield
What happened following the Taft-Hartley Act of 1947?
All workers became entitled to health benefits as a "...condition of employment."
"Managed care stands in contrast" to which form of reimbursement "...which is commonly seen in publicly funded programs"?
fee-for-service
What are the four different types of workers compensation programs?
third party private insurance, employer self-insurance, state-run programs, federal programs
44% of children are covered through ___?
medicaid and CHIP
The list of medical and therapy services not covered by insurance, because the care they need may not be covered.