Understanding Medical Plans

These flashcards cover key terminology and concepts related to various medical plans discussed in the lecture.

Medical Expense Plans

Plans that cover medical expenses, structured as fee for service or prepaid.

Fee for Service

A medical plan where providers are paid for each service provided.

Prepaid Plans

Plans where providers are compensated regularly, regardless of services provided.

Benefit Schedule

A specific list stating what is covered under a medical plan and the dollar amount for each procedure.

Usual, Customary, and Reasonable (UCR)

Payments based on the average charges for procedures in a specific geographic area.

Specified Coverage

Insurance limited to one illness or type of coverage.

Comprehensive Coverage

Insurance that covers most types of medical expenses including preventive care.

Major Medical Insurance

Coverage that includes deductibles and coinsurance, providing comprehensive medical benefits.

HMO (Health Maintenance Organization)

A type of health insurance that emphasizes preventive care and requires members to select a primary care physician.

Primary Care Physician (PCP)

The main doctor that HMO members must see first for services and referrals to specialists.

Capitated Plans

Plans where providers are paid a fixed fee per member, regardless of services provided.

PPO (Preferred Provider Organization)

A medical plan offering a larger selection of providers and does not require referrals for specialists.

Flexible Spending Account (FSA)

An account set up to allow employees to use pre-tax dollars for eligible medical and dependent care expenses.

Health Reimbursement Account (HRA)

An employer-funded plan that reimburses employees for qualified medical expenses.

Health Savings Account (HSA)

An account linked to a high deductible health plan that allows employees to save for medical expenses.

Patient Protection and Affordable Care Act (ACA)

Legislation aimed at increasing healthcare coverage affordability and access.

Qualified Health Plans (QHPs)

Health plans that must meet specific requirements set by the ACA.

Metal Levels

Categories of health insurance plans (Bronze, Silver, Gold, Platinum) that indicate the cost-sharing structure.

Catastrophic Plan

A health plan with low premiums and high deductibles, available to certain adults to ensure basic coverage.