RMIN 4000 UGA Brown Test 4 Questions and Answers (GRADED A)

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 - ANSWER-a 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 - ANSWER-a fixed annual payment for each plan member regardless of the frequency or type of service provided advantages of HMO - ANSWER-low cost sharing, good communication between providers disadvantages of HMO - ANSWER-no out of network coverage, must get referrals preferred provider organizations (PPO) - ANSWER-plan that contracts with healthcare providers to provide certain medical services at discounted fees advantages of PPO - ANSWER-no referral needed, can see out of network providers disadvantages of PPO - ANSWER-more cost-sharing, less efficient communication, more complicated billing point of service plan (POS) - ANSWER-hybrid of HMO and PPO