Insurance 1
Insurance 2
Plans
Payments
MISC
100

Medical illnesses or injuries that a patient has before the purchase of a health insurance policy are called

Preexisting conditions

100

Long-term care insurance covers nursing home care (T or F)

True

100

SSDI is and insurance only individuals older than 65 can qualify for

False

100

The monthly (or periodic) fee paid for health insurance is commonly called a 

Premium

100

Most third-party payers pay for medical services only if they are

Medically necessary

200

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)

True
200

TRICARE is

The US military's comprehensive healthcare program for active duty and retired personnel

200

An insurance contract made with a business entity that covers its employees under a single policy is called a/an

Group plan
200

UCR fees for commercial insurers are established by the federal government (T or F)

False

200

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

300

The form that is most commonly used today for insurance claims submitted on paper is the 

CM-1500

300

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

300

The level of health plan which is most like the former "basic" coverage is called the 

Bronze plan

300

The dollar amount that a patient must pay each year before his or her insurance benefits begin is called a/an

Deductible

300

People who are covered under managed care plans are commonly referred to as 

enrollees

400

The "birthday rule"

An informal procedure used to determine which plan is "Primary" when individuals are listed as dependents on more than one policy

400

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

400

Flexible spending accounts are "cafeteria" plans, meaning premiums are deducted from 

The employee's wages before withholding taxes are deducted

400

Health insurance payments are sometimes based on what is referred to as

UCR rates

400

A special tax shelter set up for the purpose of paying medical bills is a/an

health savings account

500

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

500

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

500

HRA's

"Health reimbursement accounts" are a type of healthcare plan that reimburses employees for certain qualifying medical expenses
500

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

500

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