Plan types
PPO-Preferred Provide organization is the only plan that pays the least out of pocket?
True
Coinsurance
Coinsurance is a set percentage of service costs that you will be expected to pay once you have met your annual deductible. When your annual deductible is met, your insurance provider pays for their portion of the full cost of the service and you pay the coinsurance, or remaining percentage.
This payer is a large health insurance company that offers various plans to individuals and employers. They negotiate rates with healthcare providers and offer additional services like wellness programs and preventive care incentives.
Private
Ecnarusnioc
Coinsurance
CHIP
Children's Health Insurance program, for families that earn too much money
List the PPO benefits
-Offers both in and out of network coverage
-Deductibles, co-insurance and copays
-Pay less out of pocket
Copay
Copayments or copays, are pre-set dollar amounts you are expected to pay for office visits, procedures or prescription drugs under your insurance plan. Once the copay has been met, typically, the insurance company pays all remaining costs.
This payer is a government-funded program that provideshealth insurance to individual aged 65 and older, as well ascertain younger individuals with disabilities. They cover awide range of services, including hospital stays, doctorvisits, and prescription dr
Public
Tnemllorne
Enrollment
Medicaid
is for low income populations run by the Federal and State government
What is the health savings account for on?
For individuals who do not have any form of insurance. They can use those funds for medical expenses
Deductible
A deductible is the amount you pay out of your pocket before your insurance starts to pay its share of the costs. It does not include your employee per pay contributions. The deductible runs from January 1 through December 31 each year. Once you have met that dollar amount, you have met the requirements for the plan year.
This payer is a health savings account (HSA) provider thatallows individuals to save money tax-free to be used formedical expenses. They offer various accountmanagement tools and resources to help individuals planand pay for healthcare
Other
Juadditionca
Adjudication
Medicare
is federally run and owned health insurance for U.S. citizens who are 65 and older and those with a permanent disability - Medicare is not income driven.
-EPO does not have OON coverage?
TRUE/FALSE and substantiate
TRUE except if it's an emergency
Allowed Amount
The maximum amount a plan will pay for a covered health service. May also be called "eligible expense," "payment allowance," or "negotiated rate."
This payer is a charitable organization that providesfinancial assistance for medical expenses to individualswho cannot afford healthcare. They partner with hospitalsand clinics to offer free subsidized care to those in need.
Public
Lciam
Claim
IHS
Indian Health services, for federally recognized American Indians and Alaskan natives
True or False
POS-Point Of Service plan does not require a referral?
False
-May require a referral
Balance Billing
When a provider bills you for the difference between the provider's charge and the allowed amount. For example, if the provider's charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30.
This payer is a managed care organization thatprovides health insurance through HMO plans. Theyfocus on coordinating care within a network ofproviders to control costs and improve patientoutcomes.
Private
Noitacfiveri
Verification
Open Enrollment
U.S. citizens must choose the plan they want, out of the plan options available during a period of time called Open Enrollment. Open enrollment (also known as Annual Enrollment) is a window of time that plan holders can select a different benefit plan or keep the same benefit plan