CDHP: Insurance part 2 Study Questions with
Verified Correct Answers
Comprehensive Plans
covers all costs related to injuries and illness unless otherwise stated
Benefit Schedule
outlines how much to pay for accidents or illnesses
Health Maintenance Organizations (HMO)
pre-paid health contracts that provide preventative care. NOT INSURANCE.
Physicians and Patients
physicians of HMO receive compensation on a prepaid amount basis. Patients are known as
subscribers.
Service Area
based off of geographical location.
Health maintenance organizations (HMO) provide emergency care IN and OUT of service area,
but most require to be within geographical service area. Outside of the service area, claims are
paid on the usual reasonable basis.
Health Maintenance Organization (HMO) in dollars/amounts/dates
annual financial report filed on March 1st to the commissioner and the commissioner audits
HMO once every 3 years.
must hold open enrollment period of 31 days, every 12 months
Preferred Provider Organization (PPO)
fee for service
-NO service area and may obtain care wherever in the country.
IN-Network
, Doctors who offer discounts/lower rates or lowered out of pocket costs
Out-of-Network
DOES NOT provide lower rates/discounts. Has HIGHER out of pocket costs.
Major Medical Characteristics
deductibles, coinsurance
Deductibles
Specific amounts of money a patient must pay out of pocket before the insurance carrier begins
paying.
large impact on premiums- higher deductible =lower premium
Coinsurance
after meeting annual deductible, costs will be shared with insurer.
typically 80% / 20%
Managed Care
controlling costs by controlling insureds
EX: hospice is considered managed care because the person is terminally ill, they will only
receive pain management.
Prospective Review
asking the insurer for an estimate of covered costs before performing NON emergency
surgeries.
In simple terms- a pre-authorization
Consumer Driven Health Plan (CDHP)
A high-deductible health plan that carries a savings option to pay for routine health care
expenses.
Health Savings Account (HSA)
Verified Correct Answers
Comprehensive Plans
covers all costs related to injuries and illness unless otherwise stated
Benefit Schedule
outlines how much to pay for accidents or illnesses
Health Maintenance Organizations (HMO)
pre-paid health contracts that provide preventative care. NOT INSURANCE.
Physicians and Patients
physicians of HMO receive compensation on a prepaid amount basis. Patients are known as
subscribers.
Service Area
based off of geographical location.
Health maintenance organizations (HMO) provide emergency care IN and OUT of service area,
but most require to be within geographical service area. Outside of the service area, claims are
paid on the usual reasonable basis.
Health Maintenance Organization (HMO) in dollars/amounts/dates
annual financial report filed on March 1st to the commissioner and the commissioner audits
HMO once every 3 years.
must hold open enrollment period of 31 days, every 12 months
Preferred Provider Organization (PPO)
fee for service
-NO service area and may obtain care wherever in the country.
IN-Network
, Doctors who offer discounts/lower rates or lowered out of pocket costs
Out-of-Network
DOES NOT provide lower rates/discounts. Has HIGHER out of pocket costs.
Major Medical Characteristics
deductibles, coinsurance
Deductibles
Specific amounts of money a patient must pay out of pocket before the insurance carrier begins
paying.
large impact on premiums- higher deductible =lower premium
Coinsurance
after meeting annual deductible, costs will be shared with insurer.
typically 80% / 20%
Managed Care
controlling costs by controlling insureds
EX: hospice is considered managed care because the person is terminally ill, they will only
receive pain management.
Prospective Review
asking the insurer for an estimate of covered costs before performing NON emergency
surgeries.
In simple terms- a pre-authorization
Consumer Driven Health Plan (CDHP)
A high-deductible health plan that carries a savings option to pay for routine health care
expenses.
Health Savings Account (HSA)
