AETNA FINAL PAPER UPDATED
COMPLETE QUESTIONS AND CORRECT
ANSWERS BUNDLED REVIEW GUIDE
●● Health Maintenance Organization (HMO)
Answer: Insurance plan -plan members must stay in network of
providers for care; lower costs; requires referral for specialists and
preauthorization for surgery
●● Preferred provider organization (PPO)
Answer: Network provides lower costs to plan members; Less
restrictions on seeing a specialist; Can go to out of network providers
but will cost patient more
●● Accountable Care Organization (ACO)
Answer: Network of doctors & hospitals that share financial & medical
responsibility; coordinated care to limit spending; For Medicare patients
●● Capitation (full or partial)
Answer: Fixed prepayment per unit of time; paid in advance to physician
for delivery of health care services; based on age, sex, medical history,
etc.
, ●● premium
Answer: Amount paid for insurance coverage (paid monthly) and
expense is usually shared between employer & employee
●● Benefits
Answer: Payments for medical services over specified time
●● Deductible
Answer: Fixed dollar amount that must be paid before insurance begins
to cover expenses
●● Coinsurance
Answer: Fixed percentage of covered charges after the deductible is met
●● Copayment
Answer: Fixed fee collected at time of visit
●● Preferred provider
Answer: Provider on the insurance list that accepts a contracted rate for
services
●● Patient Centered Medical Home (PCMH)
COMPLETE QUESTIONS AND CORRECT
ANSWERS BUNDLED REVIEW GUIDE
●● Health Maintenance Organization (HMO)
Answer: Insurance plan -plan members must stay in network of
providers for care; lower costs; requires referral for specialists and
preauthorization for surgery
●● Preferred provider organization (PPO)
Answer: Network provides lower costs to plan members; Less
restrictions on seeing a specialist; Can go to out of network providers
but will cost patient more
●● Accountable Care Organization (ACO)
Answer: Network of doctors & hospitals that share financial & medical
responsibility; coordinated care to limit spending; For Medicare patients
●● Capitation (full or partial)
Answer: Fixed prepayment per unit of time; paid in advance to physician
for delivery of health care services; based on age, sex, medical history,
etc.
, ●● premium
Answer: Amount paid for insurance coverage (paid monthly) and
expense is usually shared between employer & employee
●● Benefits
Answer: Payments for medical services over specified time
●● Deductible
Answer: Fixed dollar amount that must be paid before insurance begins
to cover expenses
●● Coinsurance
Answer: Fixed percentage of covered charges after the deductible is met
●● Copayment
Answer: Fixed fee collected at time of visit
●● Preferred provider
Answer: Provider on the insurance list that accepts a contracted rate for
services
●● Patient Centered Medical Home (PCMH)
