Private Insurance pt.1

the price paid in advance (monthly, usually) for purchasing an insurance policy

the amount you pay for health care services before your health insurance begins to pay

your share of the costs of a health care service. Usually figured as a percentage of the amount we allow to be charged for services.

a fixed amount you pay for a health care service, usually when you receive the service. Amount can vary by the type of service

Insurance protects against _______ by establishing contractual relations between the insured and the provider and spreading the risk across a larger population

Health insurance is a misnomer. T/F?

Health care payment system is more appropriately described as ____

-a mechanism for people to protect themselves from the potentially extreme financial costs of medical care if they become severely ill

-ensure that they have access to health care when they need it

the process of assuming risk for health services in return for premiums paid by an individual or an employer

health insurance coverage is offered through one's own employment or a relatives'. It may be offered by an employer or by a union.

health insurance coverage through a plan purchased by an individual from a private company

a plan in which the sponsor ( or employer) purchases health coverage from a state-licensed insurer (also referred to as an insurance carrier)

The _____ assumes the risk of providing covered services to the sponsor's enrolled members.

refer to health coverage that is provided directly by the organization (e.g., employing firm) seeking coverage for its members (e.g., employees)

Which type of plans are NOT subject to state insurance regulations

A large employer that self-funds employee health benefits acts as both _____ and ______ for that coverage

handle administrative duties such as member services, premium collections, and utilization review

-the manner in which self-insured groups can limit their exposure to risk by purchasing insurance against excessive claims

-tax-advantaged medical savings account

-contributions are tax-deductible

-affords patients maximum control over health care spending

What must someone do in order to be eligible for a HSA?

HDHPs typically have lower ____ with higher _____

Which is better; indemnity program or service-benefit program?

-subscribers do not need to pay as much up-front money for health care services

-insurers can decrease administrative costs associated with providing the health insurance

-providers are better assured of receiving most of the payment for services rendered

The RBRVS is divided into 3 components, what are they?

-payment is set based on number of patients managed, irrespective of their condition or type/intensity of services provided