Healthcare Systems & Insurance Review

Flashcards for reviewing vocabulary related to healthcare systems and insurance.

Charity Hospitals

Non-profit hospitals that provide free or discounted care to people who can't pay for treatment, funded by donations and tax-exempt.

General Hospitals

Treat a wide range of conditions and age groups, providing diagnostic, medical, surgical, and emergency care services.

Specialty Hospitals

Care for certain conditions or age groups.

Teaching/University Hospitals

Provide services, research, and education.

Government Hospitals

Operated by federal, state, and local government agencies.

Non-profit Hospitals

Any money made is reinvested into the hospital or community.

For-profit Hospitals

Any money made is distributed to the owners/shareholders.

Satellite Clinics

A group of medical/dental doctors who share a facility and other personnel.

WHO (World Health Organization)

International agency sponsored by the United Nations that compiles statistics, publishes health information, and investigates health problems.

USDHHS (United States Department of Health & Human Services)

A national agency dealing with health problems in the United States.

CDC (Centers for Disease Control)

Concerned with causes, spread, and control of diseases in populations.

NIH (National Institute of Health)

Involved in research on disease and conducting & compiling scientific studies.

FDA (Food and Drug Administration)

Regulates food and drug products sold to the public.

OSHA (Occupational Safety and Health Administration)

Establishes and enforces safety standards that protect workers from job-related injuries and illnesses.

Hospice

Provide care for terminally ill people who usually have a life expectancy of six months or less.

Home Health Care

Provides medical care in a patient’s home.

The Joint Commission

A non-profit organization that evaluates and accredits healthcare organizations in the United States.

Deductible

Amounts that must be paid by the insured individual for medical services before the policy begins to pay.

Co-pay

Specific amount of money a patient pays for a particular service/visit.

Coinsurance

Requires that specific percentages of expenses are shared by the individual and the insurance company.

Out of pocket maximum

Maximum amount needed to be paid before insurance will cover 100% of the costs.

In-network

A health care provider that has a contract with your health plan to provide healthcare services to its plan members.

Out-of-network

Not part of a health insurance plan's network of healthcare services.

Qualifying life event

A significant life change that allows you to enroll in health insurance outside of the open enrollment period.

Medicare Part A

A health insurance plan that covers hospital stays, skilled nursing facilities, hospice care, and some home health care.

Medicare Part B

An optional medical insurance plan that helps cover medically necessary and preventive healthcare services.

Medicare Part C

Also known as Medicare Advantage, provides additional services to Parts A & B. Must meet certain health status requirements.

Medicaid

Helps people with limited incomes pay for medical care.

FSA [Flexible Spending Account]

Tax advantaged savings account for healthcare expenses. Accounts do not roll over at the end of the year.

Open Enrollment

Time frame to join an insurance plan.

HMO

Health Maintenance Organization that requires a primary care physician (PCP) and referrals to see a specialist. Doesn't cover out-of-network providers.

PPO

Preferred Provider Organization which is flexible, can see in or out-of-network providers, and doesn't need referrals to see specialists.

EPO

Exclusive Provider Organization that must remain within in-network providers and doesn't need referrals to see a specialist. Networks are generally larger than HMO’s and more cost friendly then PPO’s.

PPACA

Patient Protection and Affordable Care Act

Medicare

Federal government healthcare plan that covers those over 65 and those disabled under 65.

Medicare Part D

Prescription/medication coverage under Medicare.

TRICARE

Governmental health insurance for active military and veterans.

Managed Care

Manages health, focused on helping to reduce costs, while keeping quality of care high for those with disease.

Preventative Care

Helps detect potential health issues before they arise or become serious.

HSA [Health Savings Account]

Tax advantaged savings account to use for healthcare expenses with savings that roll over to the next year if not used. Employee sponsored benefit.