Group Health Plans
In group health plans, the employer group is the
Policyholder
When was the Affordable Care Act enacted?
March 2010
What does PPO stand for?
Private Payers Organizations
What is revenue tracking?
Allows practices to track how much revenue they use
What does FHEB stand for?
Federal Employees Health Benefits Program
What is the goal of the ACA?
It provides affordable health insurance for uninsured legal citizens.
Which type of private payer is licensed by the state with guidelines?
Health Maintenance Organizations
Copayment amount can differ based on ____________.
The type of service.
Which plan has tax structures created by employers for employees to choose a health plan.
Section 125 cafeteria Plan
Public health exchanges are for who?
For people who don’t have insurance through their workplace.
Which type of private payer is typically charged annually and has slightly higher premiums/tier plans.
Points of service
Verification is needed to determine if a copayment is needed under the __________ plan.
Secondary
FHEB covers more than _____ million federal employees, retirees and their families.
8 Million
What is the highest level metal plan?
Platinum
Which private payer has deductibles needing to be met (up to 80% costs covered)?
Indemnity Plans
For billing purposes, emergency surgery must be __________.
Approved within a specific timeframe.
What is the plan called that is purchased by many large employers to save money.
Self- Funded (Self-Insured) Health Plans
Metal plans must offer what?
Essential health benefits
Name three Point of service carriers.
Aetna, Cigna, Blue Cross Blue Shield
What are the 5 main parts to a participation contract?
Intro
Contract service & covered medical services
Physician’s responsibilities
Managed care plan obligation
Compensation and billing guidelines