Healthcare Insurance Basics Quiz

Study Notes

Insurance Policy Basics

Policy: The insurance product offered by a company.
Benefits: Perks, life insurance benefits include financial payouts, medical coverage benefits include payment towards healthcare.
Claims: When you need the insurance to cover a cost, a request is made for the insurer to pay.
Premiums: The monthly payment made to the insurance company.
Deductible: The amount of money you pay before your insurer starts paying for covered expenses.
Allowable Amount: The standard fee set for each healthcare service by insurers.

Types of Healthcare Plans

PPO (Preferred Provider Organization): A managed care plan that encourages but does not require using providers within the network.
Indemnity Plan: A plan that allows you to choose any provider or healthcare facility.
HMO (Health Maintenance Organizations): A managed care plan that requires members to use providers within the HMO system.

Managed Care

Providers agree to provide discounted prices and dismiss any additional costs.
Co-insurance: A type of insurance where both the insured and insurer share the cost of covered expenses.

Coverage and Costs

Out-of-Pocket Maximum: The highest amount an insured person will need to pay for healthcare costs during a coverage period.
Person Days: The amount of days covered by a health insurance plan for covered healthcare services per year. After reaching the maximum, the insurance pays the remaining cost.
Dependents: Family members or individuals under the care of the policy holder.

Additional Information

Guarantor: The person financially responsible for paying medical bills.
EOB (Explanation of Benefits): A summary of coverage received by policyholders.
RA (Remittance Advice Statement): A provider form outlining dates of service, charges, and the amount the patient pays.
Medicare: A federal government program providing healthcare services to adults, children, pregnant women, elderly, low-income adults, and individuals with disabilities.
Tricare: Insurance for US Military members, former members, and their families.

Policy Additions and Practices

Riders: Additions to an insurance policy that modify the policy's terms.
Gatekeeper: Your primary care provider (PCP), who acts as a gatekeeper to specialists in the managed care system.

Description

Test your knowledge on the fundamentals of healthcare insurance policies. This quiz covers important topics such as policy details, types of healthcare plans, and common insurance terms. Perfect for anyone looking to understand their health coverage better!