Health Insurance HC

Deductible

amount you pay each year before health plan beings to pay

Premium

amount you pay to belong to a health plan

COBRA (Consolidated Omnibus Budget Reconciliation Act)

Employee can pay to keep group health insurance for 18-36 months after leaving the job

Co-insurance

% of medical cost a person must pay after meeting deductible (80/20)

Tort reform

laws that limit medical malpractice (kind of confusing);

a set of laws that changes the way lawsuits work, usually to limit the amount of money someone can get from a medical malpractice or personal injury case.

In the context of healthcare:

• It’s meant to reduce excessive lawsuits against doctors or hospitals.

Without tort reform: a patient could sue a doctor for $5 million for a mistake.

• With tort reform: the law might cap that at $500,000, even if the damages are higher.

Medicaid

federal state healthcare plan for people with low income

DRGs (Diagnosis-Related Groups)

Medicare pays for a set amount for a specific diagnosis regardless of actual cost

Claim

Request to insurance companies to pay for services rendered

Pre-existing

disease/condition one had before enrollment

SCHIP (State Children's Health Insurance Program)

Coverage for low income children who don’t qualify for medicaid; provide health coverage to children in families that earn too much to qualify for Medicaid but cannot afford private insurance

PPO (Preferred Provider Organization)

a healthcare plan that doesn’t require a referral to see a specialist

Medicare

federal medical program that covers people over 65

Worker’s Comp

Covers medical care for on job injuries

HMO (Health Maintenance Organization)

Cheaper healthcare plan but must use in network providers

Disability Insurance

Insurance that covers your paycheck should you become injured/unable to come to work

Tricare/Champus

Federal medical program for active and retired military

Co-pay

A set amount of money paid at time of service at the time of medical care

Hospice

Comfort care/palliative care for terminally ill patients

Long term care

provides 24 hour care for elderly

Rehabilitation facility

helps patient maximize self care after illness or injury

Industrial HC

 Healthcare centers located inside of large corporations

Home Health Care

provides care for patients in own home

EMTALA

Hospitals are required to treat any patient in an emergency regardless of ability to pay

Spends the most money on healthcare

US

Government sets medical prices

Japan

Country that believes healthcare is a human right

Switzerland

Country that took the best ideas from other countries

Taiwan