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3rd Degree
100
A fixed amount a member will pay for a covered health care service, usually due at the time services is received.
What is Copay?
100
The policy holder of an insurance plan or group of insurance plans.
What is a Subscriber?
100
A person covered under an insurance plan or group of insurance plans. This person can be the policy holder or a dependent of the policy holder.
What is a Member?
100
Healthcare rendered to a patient outside of the health insurance company's network of preferred providers.
What is Out of Network care?
100
There are four applications mentioned on the FJA website which make up the Unified Product Platform. The two other applications not currently mentioned are ____________ and ___________.
What are User Management Module (UMM) and Rating Configurator
200
These types of products do not require a member to have primary care physician (PCP).
What is an Preferred Provider Organization (PPO)?
200
This federally mandated document is commonly known as an SBC.
What is a Summary of Benefits & Coverage?
200
This type of plan does not have a Network of service providers.
What is an Indemnity (Fee for Service) plan?
200
The meaning of the acronym HIPAA.
What is Health Insurance Portability and Accountability Act (of 1996)
200
There is a saying which states, one of these a day will keep the doctor away.
What is an apple?
300
A member’s share of the cost after a member has met their deductible.
What is Coinsurance?
300
There are Essential Health Benefits which most health care plans must cover. Name at least three of the ten categories.
What is: - Ambulatory patient services - Emergency services - Hospitalization - Maternity and newborn care - Mental health and substance use disorder services - Prescription drugs - Rehabilitative and habilitative services and devices - Laboratory services - Preventive and wellness services and chronic disease management - Pediatric services
300
These two values are commonly used as the Benefit Period in FJA’s Healthcare products.
What is Calendar and Benefit year?
300
This item represents a specific instance of a product.
What is a Plan?
300
A unique identifier used to report a specific type of service.
What is a Procedure Code?
400
This is a Health insurance marketplace set up to facilitate the purchase of health insurance.
What is a Healthcare Exchange?
400
The meaning of the acronym CMS.
What is Centers for Medicare and Medicaid Services?
400
These codes are used on healthcare claims to specify the entity where service(s) were rendered.
What is Place of Service?
400
The rules which govern the allowed medical need and usage of applicable health benefits.
What are Utilization Management Rules?
400
These are adverse reactions to many prescription drugs.
What are side effects?