Health Insurance

Premium

a fee the individual pays for insurance coverage

Deductibles

amount that must be paid by the patient for medical services before the policy begins to pay

Co-insurance

requires that specific percentages of expenses are shared by the patient and insurance company

Co-payment

a specific amount of money the patient pays for a particular service

Health Maintenance Organization (HMO)

a monthly fee is paid for membership, and the fee stays the same regardless of the amount of health care used (restricted to a specific network)

Preferred Provider Organization (PPO)

forms a contract with certain health care agencies to provide care at reduced rates, usually require deductible and co-payment

Medicare

federal government program that provides health care for almost all individuals over 65, for any person receiving Social Security services over 2 years, and for any person with end-stage kidney disease (hospital, medical, pharmaceutical expenses)

Medigap

health insurance plan that helps pay expenses not covered by Medicare

Medicaid

medical assistance program that is jointly funded by the federal and state governments, but is operated by individual states. for low-income, disabled, and children needing public assistance

Children’s Health Insurance Program (CHIP)

1997 provides health care to uninsured children of working families who earn too little to afford private health care, but make too much for Medicaid services

Workers’ Compensation

provides treatment for workers injured on the job

TRICARE

provides care for active duty members and their families, survivors of military personnel, and retired members of the Armed Forces

Health Insurance Portability and Accountability Act (HIPAA)

1996 regulations have provided consumers with more access to insurance and greater confidentiality in regard to medical records (standardization of electronic health care records, reduction in administrative costs, increased tax benefits, decreasing fraud)

Five HIPAA components

Health care access, portability, and renewability

Preventing health care fraud and abuse; administrative simplification, and medical liability reform

Tax related health provisions

Application and enforcement of group health plan requirements

Regulations have provided consumers with more access to insurance and greater confidentiality in regard to medical records

Fee-for-service compensation

health payment plan in which doctors or providers are paid for each service they render

Value-based compensation

health payment plan in which doctors are paid for their performance