NR 222 HEALTH AND WELLNESS COMPREHENSIVE
UPDATED QUESTIONS AND ANSWERS SURE A+
✔✔Health maintenance organizations (HMOs) - ✔✔A prepaid health plan delivering
comprehensive care to members through designated providers, having a fixed monthly
payment for health care services, and requiring members to be in a plan for a specified
period
✔✔indemnity insurance plans - ✔✔- A person would choose a physician or care
provider and receive care
- the provider would either bill the individual's insurance company or be paid on a fee-
for-service basis.
-Has PCP
✔✔Indemnity - ✔✔Monies paid by an insurer to a provider, in a predetermined amount
in the event of a covered loss by a beneficiary
✔✔Independent practice association (IPA) - ✔✔An organization that physicians in
private
practice can join so that the organization can represent them in the negotiation of
managed care contract
✔✔Out-of-pocket expenditures: - ✔✔The portion of medical expenses an individual is
responsible for paying includes all health care goods and services, co-insurance fees,
deductibles, and any amounts not covered as part of a health insurance plan
✔✔Point-of-service (POS) plan - ✔✔A plan that contains elements of both HMOs and
PPOs. They resemble HMOs for in-network services in that they both require co
payments and a PCP. Services received outside the network are usually reimbursed on
a fee-for-service basis
, ✔✔Preferred provider organization (PPO) - ✔✔A health plan generally consisting of
hospital and physician providers. The PPO provides health care services to plan
members usually at discounted rates in return for expedited claims payment.
✔✔Self-insured plan - ✔✔Plan offered by employers and other groups that directly
assume the major cost of health insurance for their employees or member
✔✔Third-party payer - ✔✔In health care finance, this is an insurance carrier, Medicare,
and Medicaid or their government-contracted intermediary, managed-care organization,
or health plan that pays for hospital or medical bills instead of the individual
✔✔Underinsured - ✔✔Refers to people who have some type of health insurance, such
as catastrophic care, but not enough insurance to cover all their health care cost
✔✔Uninsured - ✔✔Individuals or groups with no or inadequate health insurance
coverage
✔✔Blue Cross/Blue Shield - ✔✔A combined medical plan offered through a worker's
place of employment that combines both hospital and physician coverage.
✔✔Capitation - ✔✔A fixed amount of payment per individual, per year, regardless of the
volume or cost of the services each client requires
✔✔copayments - ✔✔fixed dollar payment that is made by the individual to the provider
at the time of service
✔✔deductible - ✔✔A fixed dollar amount that the individual must pay before
reimbursement begins.
✔✔Medicare - ✔✔federal health insure plan for people over the age of 65
✔✔American Nurses Association's (ANA, 2010) definition of nursing - ✔✔Nursing is the
protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response,
and advocacy in the care of individuals, families, communities, and populations
✔✔Health defined by The World Health Organization (WHO) - ✔✔state of complete
physical, mental, and social well-being, not merely the absence of disease or infirmity
✔✔holistic health models - ✔✔rely heavily on the individual's beliefs and subjective
experience about health and wellness.
Accepts alternative and complementary ideas to maintain wellness
UPDATED QUESTIONS AND ANSWERS SURE A+
✔✔Health maintenance organizations (HMOs) - ✔✔A prepaid health plan delivering
comprehensive care to members through designated providers, having a fixed monthly
payment for health care services, and requiring members to be in a plan for a specified
period
✔✔indemnity insurance plans - ✔✔- A person would choose a physician or care
provider and receive care
- the provider would either bill the individual's insurance company or be paid on a fee-
for-service basis.
-Has PCP
✔✔Indemnity - ✔✔Monies paid by an insurer to a provider, in a predetermined amount
in the event of a covered loss by a beneficiary
✔✔Independent practice association (IPA) - ✔✔An organization that physicians in
private
practice can join so that the organization can represent them in the negotiation of
managed care contract
✔✔Out-of-pocket expenditures: - ✔✔The portion of medical expenses an individual is
responsible for paying includes all health care goods and services, co-insurance fees,
deductibles, and any amounts not covered as part of a health insurance plan
✔✔Point-of-service (POS) plan - ✔✔A plan that contains elements of both HMOs and
PPOs. They resemble HMOs for in-network services in that they both require co
payments and a PCP. Services received outside the network are usually reimbursed on
a fee-for-service basis
, ✔✔Preferred provider organization (PPO) - ✔✔A health plan generally consisting of
hospital and physician providers. The PPO provides health care services to plan
members usually at discounted rates in return for expedited claims payment.
✔✔Self-insured plan - ✔✔Plan offered by employers and other groups that directly
assume the major cost of health insurance for their employees or member
✔✔Third-party payer - ✔✔In health care finance, this is an insurance carrier, Medicare,
and Medicaid or their government-contracted intermediary, managed-care organization,
or health plan that pays for hospital or medical bills instead of the individual
✔✔Underinsured - ✔✔Refers to people who have some type of health insurance, such
as catastrophic care, but not enough insurance to cover all their health care cost
✔✔Uninsured - ✔✔Individuals or groups with no or inadequate health insurance
coverage
✔✔Blue Cross/Blue Shield - ✔✔A combined medical plan offered through a worker's
place of employment that combines both hospital and physician coverage.
✔✔Capitation - ✔✔A fixed amount of payment per individual, per year, regardless of the
volume or cost of the services each client requires
✔✔copayments - ✔✔fixed dollar payment that is made by the individual to the provider
at the time of service
✔✔deductible - ✔✔A fixed dollar amount that the individual must pay before
reimbursement begins.
✔✔Medicare - ✔✔federal health insure plan for people over the age of 65
✔✔American Nurses Association's (ANA, 2010) definition of nursing - ✔✔Nursing is the
protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response,
and advocacy in the care of individuals, families, communities, and populations
✔✔Health defined by The World Health Organization (WHO) - ✔✔state of complete
physical, mental, and social well-being, not merely the absence of disease or infirmity
✔✔holistic health models - ✔✔rely heavily on the individual's beliefs and subjective
experience about health and wellness.
Accepts alternative and complementary ideas to maintain wellness
