Study guide for Health Insurance CMAA

What is premium? When is it paid?

Fee patients pay to be in a insurance plan monthly

What is a deductible? How often do you pay?

A deductible is a fee you pay before a service. Annually.

What are out of pocket expenses?

Payments out of your own pocket

What is the difference between copayment and coinsurance?

Copayment is a set cost while coinsurance is a set percantage

What is beneficiary?

People you put under your insurance

What is a policy?

The benefits that plans offer

What is health insurance carrier?

A company that provides health insurance plans

Medicare V. Medicaid

Medicare is for 65+ funded by the federal government. Medicaid is for low income people funded by the state government.

3 types of manages care

HMO - Health maintenance organization , based on monthly premium

POS - point of service, must have to have a primary care physician

PPO - Preferred provider organization, fee for service

Who uses capitation? Who use fee for service? Who uses 0 deductible?

HMO capitation, PPO fee for service, POS 0 deductible

Birthday plan?

When putting your child under an insurance, it must go to the parent whose birthday is first. If on the same day, the earlier affective date would be better.

When should insurances be verified?

Before patients are admitted to the hospital

What is the goal of manages care?

To prevent future diseases / illnesses

Group V. Individual

Group - everyone pays a certain amount, plan is picked out for you, by employers

Individual - Pays the whole premium & you can pick your own plan.

What is an exclusion?

Things that your insurance wont cover at all.

80/20 plan, what is this?

Once deductible is met, they pay 80% while you pay 20%.