RMIN 4000 UGA Brown Test 4
fee-for-serive - answer a separate fee is paid for each service
copayment - answer flat amount the insured must pay each time health services are
received
calendar year deductible - answer an aggregate deductible that has to be satisfied only
once during the calendar year
coinsurance - answer the percentage of the medical expenses the policyholder must
pay in addition to the deductible amount
Out-of-pocket maximum (stop-loss limit) - answer the most the insured will have to pay
out-of-pocket in a calendar year
managed care plan - answera health care plan that is designed to lower costs for both
the insurer and the consumer while maintaining a high standard of care
health maintenance organization (HMO) - answer system that provides healthcare to its
members on a prepaid basis in a particular area
capitation fee - answera fixed annual payment for each plan member regardless of the
frequency or type of service provided
advantages of HMO - answerlow cost sharing, good communication between providers
disadvantages of HMO - answerno out of network coverage, must get referrals
preferred provider organizations (PPO) - answerplan that contracts with healthcare
providers to provide certain medical services at discounted fees
advantages of PPO - answerno referral needed, can see out of network providers
disadvantages of PPO - answermore cost-sharing, less efficient communication, more
complicated billing
point of service plan (POS) - answerhybrid of HMO and PPO
consumer directed health care plan (CDHP) - answerplan that combines a high-
deductible plan with a health savings account
, health savings account (HSA) - answertax exempt account established exclusively for
the purpose of lying medical expenses - high deductible plans only
flexible spending account (FSA) - answerpermits employees to pay for certain
unreimbursed medical expenses with before tax dollars - cannot be used with high
deductible plan
long-term care insurance - answerpays a daily/monthly benefit for medical or custodial
care received in a nursing facility, hospital, or at home
disability-income insurance - answerprovides income payments when the insured is
unable to work because of sickness or injury
total disability - answerinability to perform the material and substantial duties of your
regular occupation
partial disability - answeryou can perform some but not all of the duties of your
occupation
residual disability - answerapplies when you are gainfully employed and not totally
disabled but, solely because of sickness or injury, our loss of income is at least 15
percent of your prior income
dental insurance - answerpays the cost of norma dental care, orthodontics not usually
covered
vision insurance - answercoverage for routine eyesore, usually does not cover the full
cost of glasses or contacts
types of legal wrongs - answercrime, breach of contract, tort
tort - answera legal wrong for which the court allows a remedy in the form of monetary
damages
3 categories of tort - answerintentional, strict liability, negligence
intentional tort - answerintentional act or omission resulting in harm or injury to another
person or damage to their property
strict liability - answerliability imposed regardless of negligence or fault (ex: defective
products, workers comp)
negligence - answerfailure to exercise the standard of care required by law to protect
others from an unreasonable risk of harm
fee-for-serive - answer a separate fee is paid for each service
copayment - answer flat amount the insured must pay each time health services are
received
calendar year deductible - answer an aggregate deductible that has to be satisfied only
once during the calendar year
coinsurance - answer the percentage of the medical expenses the policyholder must
pay in addition to the deductible amount
Out-of-pocket maximum (stop-loss limit) - answer the most the insured will have to pay
out-of-pocket in a calendar year
managed care plan - answera health care plan that is designed to lower costs for both
the insurer and the consumer while maintaining a high standard of care
health maintenance organization (HMO) - answer system that provides healthcare to its
members on a prepaid basis in a particular area
capitation fee - answera fixed annual payment for each plan member regardless of the
frequency or type of service provided
advantages of HMO - answerlow cost sharing, good communication between providers
disadvantages of HMO - answerno out of network coverage, must get referrals
preferred provider organizations (PPO) - answerplan that contracts with healthcare
providers to provide certain medical services at discounted fees
advantages of PPO - answerno referral needed, can see out of network providers
disadvantages of PPO - answermore cost-sharing, less efficient communication, more
complicated billing
point of service plan (POS) - answerhybrid of HMO and PPO
consumer directed health care plan (CDHP) - answerplan that combines a high-
deductible plan with a health savings account
, health savings account (HSA) - answertax exempt account established exclusively for
the purpose of lying medical expenses - high deductible plans only
flexible spending account (FSA) - answerpermits employees to pay for certain
unreimbursed medical expenses with before tax dollars - cannot be used with high
deductible plan
long-term care insurance - answerpays a daily/monthly benefit for medical or custodial
care received in a nursing facility, hospital, or at home
disability-income insurance - answerprovides income payments when the insured is
unable to work because of sickness or injury
total disability - answerinability to perform the material and substantial duties of your
regular occupation
partial disability - answeryou can perform some but not all of the duties of your
occupation
residual disability - answerapplies when you are gainfully employed and not totally
disabled but, solely because of sickness or injury, our loss of income is at least 15
percent of your prior income
dental insurance - answerpays the cost of norma dental care, orthodontics not usually
covered
vision insurance - answercoverage for routine eyesore, usually does not cover the full
cost of glasses or contacts
types of legal wrongs - answercrime, breach of contract, tort
tort - answera legal wrong for which the court allows a remedy in the form of monetary
damages
3 categories of tort - answerintentional, strict liability, negligence
intentional tort - answerintentional act or omission resulting in harm or injury to another
person or damage to their property
strict liability - answerliability imposed regardless of negligence or fault (ex: defective
products, workers comp)
negligence - answerfailure to exercise the standard of care required by law to protect
others from an unreasonable risk of harm
