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Вопрос		Ответ
staff model HMO начать обучение		Physicians are employees of the HMO and paid a salary
Network model начать обучение		the HMO contracts with at least two groups medical practices described as in network 2
independent practice Association начать обучение		Marcus the health plan Physicians contract with the IPA to treat members of HMO
preferred provider organization PPO начать обучение		a delivery Network that manages and negotiate contracts on behalf of the providers
Health maintenance organizations HMO начать обучение		prepaid health plan
actuary начать обучение		a professional who calculates insurance and annuity risks premiums and dividends
exclusive provider organizations EPO начать обучение		delivery Network inwhich patients must use the services of those provided
copay начать обучение		the out-of-pocket expense you pay the doctor
deductible начать обучение		the amount of money the insurer paid before the insurance company will pay
subscriber начать обучение		Blue Cross Blue Shield known as subscribers rather than policyholders
premium начать обучение		the price paid by the insured for insurance coverage
capitation начать обучение		payment method under which each patient is entitled to receive a set dollar amount of services in each time period
Usual fee начать обучение		determined by whether a provider normally charges for that service
customary fee начать обучение		based on fee charged buy similar providers within geographic area
reasonable fee начать обучение		any special circumstance of this accident
cobra. consolidated Omnibus budget reconciliation Act начать обучение		provides that the employee may continue to be insured through employer plan even after being fired. employee picks up total cost
ERISA. Employee Retirement income Security Act начать обучение		Federal legislation the mandates how employer funded benefit plans must be in administered
coordination of benefits начать обучение		if a service is covered under more than one policy then the insurance companies determine who pays
third-party payer начать обучение		insurance company, government, and Managed Care Organization
Prepaid Plan начать обучение		all types of health plans in which fixed payments are made before services are rendered
pre-authorization начать обучение		Insurance requires that certain procedures be authorized by the insurer before they are performed. failure will result in denial of claim
gatekeeping начать обучение		process of restricting access to services
what is the uninsured statistic начать обучение		45.7 million people or 17% without insurance
Indemnity insurance начать обучение		one-party is exempt from incurred liabilities by the other party
self-insured начать обучение		employer pays for Employees Healthcare
third-party admin начать обучение		companies that manages the paperwork for an employer who establishes a self insured plan
Managed Care начать обучение		describes the combination of payment for Healthcare and delivery of services into one system
what did Blue Cross Blue Shield originally cover начать обучение		they prepaid Baylor University 2 hospitalized for 21 days. a group of teachers
what does a self-insuring employer do начать обучение		the employer pays for Employees Healthcare
what percentage of Americans are covered by some type of insurance начать обучение		78%

Chapter 3

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