Unit 2 Lesson 3: Other Third-Party Payers

Flashcards covering different types of third-party payers, including commercial, government, and other specialized insurance programs like TRICARE, Workers' Compensation, Auto insurance, and Homeowners insurance, as well as payment methods.

Commercial Insurance Plans

Health insurance available through private organizations, often including HMO and PPO options, like Kaiser, Blue Cross Shield, Aetna, Cigna, and Health Net.

Government Insurance Plans

Health insurance programs provided by the government, such as Medicare, Medicaid, Medigap, CHIP, TRICARE, and CHAMPVA.

Other Insurance Payers

Alternative insurance coverage types including Workers' Compensation, Automobile Insurance, and Homeowner Insurance, which can be primary payers in specific situations.

Uninsured/Self-Pay

A patient status where the individual is fully financially responsible for their medical care.

TRICARE

A health care program for military members, retirees, and their families, overseen by the U.S. Department of Defense, providing medical coverage through military and civilian providers.

DEERS system

The Defense Enrollment Eligibility Reporting System, which eligible TRICARE beneficiaries must be registered in.

TRICARE Prime

A managed care option similar to an HMO for active-duty service members and their families, requiring enrollment and referrals for specialty care, typically with the lowest out-of-pocket costs.

TRICARE Select

A self-managed, preferred provider option similar to a PPO for active-duty family members and retirees, offering greater flexibility in choosing doctors without referrals for specialists, but usually with higher costs than Prime.

TRICARE For Life (TFL)

Medicare-wraparound coverage for retirees who have Medicare Part A and Part B, where TRICARE acts as the secondary payer after Medicare.

Covered services

Preventive medical services designed to help detect or prevent illnesses or other health problems before they become serious, typically fully paid for (100%) even before the annual deductible is met.

Noncovered services

Medical procedures, such as cosmetic surgery, that are not covered by insurance and must be paid out of pocket by the patient.

Workers' Compensation

An insurance program that provides wage replacement and medical benefits to employees injured or made ill due to their job, in exchange for giving up the right to sue their employer for negligence.

Auto insurance

A contract providing financial protection against losses from vehicle accidents, theft, or other damage, overseen by the National Association of Insurance Commissioners (NAIC).

Liability Coverage (Auto)

A type of car insurance that covers bodily injury and property damage caused to others in an accident, often required by law.

Personal Injury Protection (PIP) or Medical Payments (MedPay)

Auto insurance coverage for medical expenses, hospital, surgery, testing, and ambulance services for the driver and passengers, regardless of who caused the accident, and in some states, also lost wages and rehab costs.

Uninsured/Underinsured Motorist Coverage (UMI)

Auto insurance that protects the policyholder if they are hit by a driver who has no insurance or not enough coverage.

Homeowners insurance

A type of property insurance that financially protects against damage or theft to a home or its belongings, and provides liability coverage if someone is injured on the property.

Health Savings Accounts (HSAs)

Employee benefits where a set amount is deducted from paychecks and placed on a medical card for tax-exempt medical expenses.