The flashcards below were created by user itzlinds on FreezingBlue Flashcards.

  1. the internal/family medicine physician responsible for coordinating the care of his or her pt.
    primary care physican
  2. amount paid by the subscriber for the policy is called:

    often paid by the employer
  3. the amount the subscriber is responsible for paying prior to the insurance company taking responsibility  for the claim is called:

    premium and deductible have an inverse relationship
  4. the amount paid by the subscriber upon visit to the provider prior to receiving services:
    co pay

    some policies limit the total amount of co pay per year
  5. applied after the deductible amount has been met by another subscriber is called:
    co insurance 

    a % of the remaining balance
  6. services provieded by perapproved providers for which the insurance company negotiates a fee for that service
    in network benefits

    cost savings due to lower fees from negotiation
  7. an agreement b/w insurer and a network
  8. allows flexibility for the pt; patient does not need referral for a physican
  9. the type of insurance plan in which similar to PPO, but funded by individuals or employer groups, & uniquely arranged from company to company
    HSA  Health Savings Account

  10. provides health insurance to retired individuals, regardless of their medical conditions, over the age of 65 is
  11. joint fed-state program; that mets two eligibility requirements called:
  12. cost containment considerations:

    can be difficult to coordinate due to:
    • timing of injury
    • where the athletes is from
    • type of insurance plan the student carries
  13. list 2 problems with mandating primary insurance:
    • some students do not have insurace
    • some insurance (HMO, PPO) many not cover the athlete at the school
  14. what are the benefits to changing the PCP:
    if possible, change the students PCP to a campus physician; this makes the college resources in network

    some insurances allow exemption for out of network  issues
Card Set
405 insurance
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