Uno
It's a bomb! Choose another group now
That group will receive 100 points and it'll be deducted from your accumulated points.
What do we call a plan if the plan starts with the coverages effective date and runs one full year?
Plan Year
It's a bomb! Please choose another group now!
That group will receive 100 points and it'll be deducted from your accumulated points.
What do we call the monthly payment the member is paying to retain the insurance coverage?
Premium
What do we call a plan if the plan starts/renews every 1st day of January?
Calendar Year
_____ is an amount that member needs to satisfy before the insurance coverage cover for the member?
Deductibles
It's a bomb! Please choose another group now!
That group will receive 200 points, and it'll be deducted from your accumulated points.
____ is another term we use for Out-Of-Network Providers.
Non-Participating Provider (Non-PAR)
____ is the percentage of healthcare costs that you pay after you have met your deductible. Your insurance company pays the remaining percentage.
Coinsurance
____ is another term we use for In-Network Providers.
Participating Providers (PAR)
What is the maximum amount the member needs to pay for covered expenses during a specific period, usually within a year and payment will be paid by the member from their own pocket?
MOOP (Maximum Out-Of-Pocket)
What does CMS stand for?
Centers for Medicare & Medicaid
What is a U.S. federal health insurance program that helps cover medical expenses for people aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions.
Medicare
What is a government health insurance program that helps low-income individuals and families pay for healthcare services.
Medicaid
It's a bomb! Please choose another group now!
That group will receive 300 points, and it'll be deducted from your accumulated points.
What do we call a provider who practices general medicine?
Primary Care Physician (PCP)
What do we call the list of prescription drugs covered by a particular drug benefit plan?
Formulary
It's a bomb! Please choose another group now!
That group will receive 400 points, and it'll be deducted from your accumulated points.
What is a fixed amount of money that you pay for a healthcare service or prescription medication, while your health insurance pays the remaining covered cost?
Copay/Copayment
What are the 2 types of sector in US Health Care System?
Private & Public
What are US Healthcare Stakeholders?
Provider
Payers
Patient
Companies
What is the federal law that restricts access to an individual's private medical information?
Health Insurance Portability and Accountability Act
What are the 4 types of Insurance Health Plans?
ESI
HMO
PPO
EPO
How can an individual apply for an insurance coverage?
Thru an Agent/Broker
Online Marketplace
State-Based Facilities
Over the Phone (DMS)
What are the qualifications for an individual to have Medicare Coverage?
You are 65 years old or older
have a qualifying disability
You have End-Stage Renal Disease (ESRD)
Spouse with Medicare