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Health Insurance Words
Provider Networks
Insurance Card
Essential Health Benefits
Non-Marketplace Coverage
100
The amount you pay to have health insurance each month, even if you do not use it.
What is a premium?
100
This is a list of doctors and hospitals that you have to use to get the best price. It’s important to understand that if you choose to see someone on this list, you will pay less money than if you choose to see someone that is not.
What is a provider network?
100
This is abbreviated with the acronym "P.C.P." on a typical health insurance card.
What is a Primary Care Provider?
100
Which of the following is NOT an Essential Health Benefit under the Affordable Care Act? A. Oral and vision care for adults B. Mental health and substance use disorder service C. Laboratory services D. Rehabilitative and habilitative services and devices
What is Oral and vision care for adults?
100
________ is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) who either qualify for such benefits based on payment of payroll taxes or pay a premium for such coverage.
What is Medicare?
200
Health insurance plans often give you a discount on doctor visits and drugs—only making you pay a small amount called a _________ for these things.
What is a co-pay?
200
This type of plan may pay for services by any provider, even providers who aren’t in-network. It’s often more expensive for consumers to go to doctors who aren't in their network (that is, out-of-network).
What is Point of Service (POS) OR Preferred-Provider Organization (PPO)?
200
Jane's health insurance card says she has an HMO. She must go to this person first, before she can see a specialist.
What is a Primary Care Provider (PCP)?
200
ALL __________ must cover the ten essential health benefits in order to be certified and offered in the Health Insurance Marketplace.
What is "Marketplace Qualified Health Plans (QHPs)"? Also Acceptable: insurance policies, insurance plans
200
When consumers apply for coverage through the Marketplace, their applications will be reviewed to see if they’re eligible for public health coverage through both of these programs (TWO answers).
What is Medicaid and the Children's Health Insurance Program (CHIP)?
300
The total amount of money you might have to pay in a year if you get all of your health care in-network
What is an out-of-pocket maximum per person?
300
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the plan. It generally won't cover out-of-network care except in an emergency.
What is a Health Maintenance Organization (HMO)?
300
Randy's health insurance card has the following information: PCP: $25/ $30 SPC: $35/50 HO: DED/ COINS ER: $150 Randy overindulges on Thanksgiving dinner and has a stroke. His family rushes him to the hospital. This is how much money they owe up-front before receiving medical care.
What is $150?
300
Three categories of benefits are not included in many traditional (pre-ACA) health insurance plans. These include all of the following EXCEPT: A. pediatric oral services B. hospitalization C. pediatric vision services D. habilitative services
What is hospitalization?
300
If consumers do not apply for coverage using the Marketplace, they will not be able to receive _______ ___ _______ (APTCs) or ____ _______ __________ (CSRs) to help them pay for health coverage-- EVEN if they have a low income.
What is Advanced Premium Tax Credits & Cost-Sharing Reductions?
400
The amount you have to pay each year before health insurance helps pay your medical bills.
What is a deductible?
400
Nearly all health insurance companies use managed care to manage quality, cost, and access to health care services. Under this system, health insurance companies develop contracts with providers to create provider networks that will deliver care to consumers. Which one of the following types of health insurance plans is NOT a type of managed care plan? A. Fee-for-service (FFS) B. Point of service (POS) C. Health maintenance organization (HMO) D. Preferred provider organization (PPO)
What is Fee-for-service (FFS)?
400
John can't figure out what tier 2 drugs cost under his plan by looking at his insurance card, so he goes to his insurance company's website to pull up this document and check.
What is a Formulary (also acceptable: Summary of Benefits and Coverage/SBC)?
400
These are services and devices to help you recover if you are injured, or have a disability or chronic condition— things like physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation
What is disability care? (rehabilitative and habilitative services and devices)
400
Some products that help pay for medical services don't qualify as _______ ________ ________. If you have only this kind of product, you may have to pay the individual responsibility fine when you file your taxes. Examples include: •Coverage only for vision care or dental care •Workers' compensation •Coverage only for a specific disease or condition •Plans that offer only discounts on medical services
What is minimum essential coverage?
500
Uncle Junior has a bad accident lighting off fireworks on the Fourth of July. It costs $50,000 to cover all of the medical bills. But because Uncle Junior has health insurance and goes to an in-network hospital, his insurance company will pay for 80 percent of the bills, and he will only owe 20 percent. What is the term for that 20 percent he still owes?
What is co-insurance?
500
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
What is a formulary?
500
Uncle Junior sprained his ankle while skiing and racked up $2,000 in medical bills. He has already spent $3,000 in qualifying medical expenses this year, and has a $6,000 out-of-pocket maximum. His deductible is $1,800. If Uncle Junior's cost-sharing is 20 percent, how much will he pay for the sprained ankle?
What is $400?
500
This is the kind of care you get without being admitted to a hospital.
What is ambulatory care (outpatient care)?
500
A _________________ is a type of health plan that features higher deductibles than traditional insurance plans, in exchange for lower monthly premiums. HDHPs can be combined with a health savings account (HSA) or a flexible spending account (FSA). HSAs and FSAs let a consumer pay for qualified out-of-pocket medical expenses on a pre-tax basis.
What is a High Deductible Health Plan (HDHP)?