Biomed I: Chapter 19 Test

Co-insurance

the part of the medical costs a patient may still have to pay once the insurance plan’s deductible has been met

Co-pay

a flat fee that many health insurance plans require patients to pay each time they receive health service

Deductible

the money a person must pay before an insurance policy provides benefits

Diagnosed related groups

a classification system used by Medicare and Medicaid to determine payment for health services based on diagnosis, surgical processing, age, and other information

Direct payment

the act of paying for health care with one’s own money

Flexible spending account

A monetary account, offered through an employer, into which money is put through payroll deductions before it is taxed. Funds can be withdrawn for qualified medical expenses as needed, but the funds must be spent each year.

Gatekeeper

a physician who not only delivers primary care services but also makes referrals for specialty care

Government institution

a public health care facility that receives most of its funding from local, state, or federal sources

Government plan

a health care plan funded by a government agency. Government plans are available for active military personnel and their dependents and for veterans. Medicaid and Medicare are also government-funded healthcare programs

Healthcare cost containment

measures designed to lower healthcare costs that aim to create an affordable healthcare system for all Americans

Health maintenance organization plan

a health insurance plan that provides coverage only if the care is delivered by a member of the plan’s hospital, physician, or pharmacy panel

Health savings account

a monetary account commonly paired with a high deductible health insurance plan that allows individuals to pay for qualified medical care using tax-free HSA dollars until they meet their deductibles. Any funds remaining in an HSA at the end of teach year are rolled over and can be saved for future use.

In-network provider

a health care provider who has contracted with the managed care insurance plan

Managed care

a type of health insurance plan that establishes predetermined rates for services with health care providers such as doctors and hospitals, and puts providors in the position of managing patients’ use of healthcare

Medicaid

a government program that offers health insurance to many low-income and disabled people

Medicare

the federally-funded health care program for older Americans

Out-of-network provider

a health care provider who is not in a particular managed care health insurance plan

Point-of-service plan

a physician-coordinated health insurance plan that combines the characteristics of both HMO and PPO plans

Preferred provider organization plan

a health insurance plan that allows patients to receive care

from a non-plan provider, but requires them to pay a higher out-of-pocket price if they do

Premium

The monthly amount paid to an insurance company for health insurance coverage

Private insurance

primarily an employment-based insurance system in the US

Propriety institution

for-profit healthcare facility, usually owned by a corporation

Prospective payment system

a system that pays the provider a fixed amount that’s based on the medical diagnosis or a specific procedure, rather than on the actual cost of hospitalization or care

Resource utilization

all healthcare workers need to ask themselves how they can best use healthcare resources

TRICARE

system that provides medical coverage for active and retired service personnel and their dependents

Utilization review

a process in which an insurer reviews decisions by physicians and other providers about how much care to provide

Voluntary nonprofit institution

community facility that receives federal, state, and local tax, exemptions in exchange for providing a community benefit (such as services to Medicaid patients and those unable to pay)