10 services that need to be covered by all Qualified Health Plans (QHP's) offered through the Marketplace.
What is Essential Health Benefits
100
A monthly payment to the insurance company to have health insurance
What is Premium
100
Name the two plans that have limits on the providers consumers and see and services must be in-network.
What is Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO)
100
QHP
What is Qualified Health Plan
100
Every plan sold in the marketplace must contain
What is The 10 Essential Health Benefits
200
Which one of the 10 Essential Health Benefits offers "free" services. (e.g. immunizations)
What is Preventive Services
200
A fixed amount for covered services
What is Co-Pay
200
These two plans offer more freedom by allowing consumers to seek out of network services.
What is Point of Service (POS) Preferred Provider Organization (PPO)
200
PCP
What is Primary Care Provider or Primary Care Physician
200
A list of prescription drugs that are covered by a specific health care plan
What is Formulary
300
Name 4 of the 10 Essential Health Benefits
What is Outpatient Care, Emergency Services, Hospital, Baby Care, Mental Health/Substance Abuse, Prescriptions, Disability Care, Lab Tests, Preventive Services, Dental and Vision for Kids
300
A set amount paid per person or per family before claims are covered
What is Deductible
300
Name the four types of plans listed in the marketplace.
What is Point of Service (POS), Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO)
300
SBC
What is Summary of Benefits and Coverage
300
An important document need to provide services and typically provides Consumer Name, Deductible, Coinsurance, and Co-payment for general services.
What is Insurance Card
400
A service that was traditionally not covered under insurance prior to ACA.
What is Mental Health/Substance Abuse
400
A percentage of the total bill typically paid after the deductible
What is Co-Insurance
400
The plan that consumers pay less using in-network providers, but requires a referral from the PCP to see a specialist
What is Point of Service (POS)
400
EHB
What is Essential Health Benefits
400
A list of doctors, hospitals, and facilities that are contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates.
What is In-Network
500
Generally this medical service that does not require an overnight stay. Examples might include routine services such as checkups or visits to a clinic.
What is Ambulatory or Outpatient Care
500
The most consumers will pay for covered services annually
What is Out-of-Pocket Maximum
500
This plan costs less to see in-network providers, but consumers can seek outside networks at an additional cost
What is Preferred Provider Organization (PPO)
500
EPO
What is Exclusive Provider Organization
500
The least expensive prescription drugs or another name for tier on formulary