ALLIED HEALTH UPDATED TEST PAPER QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔Deductible - ✔✔Amount you must pay before you begin receiving any benefits from
your insurance company
✔✔Co-payment - ✔✔The predetermined amount defined by the health insurer that must
be paid each time a health service is accessed.
✔✔Coinsurance - ✔✔Splitting the cost between individuals and their insurance carrier
✔✔Government plans - ✔✔1. Federal Employees Health Benefits (FEHB)
2. Indian Health Service (IHS) for those of Native American descent.
3. Veterans Health Administration for military veterans
4. Program of All-Inclusive Care for the Elderly (PACE)
✔✔Medicare - ✔✔Established 1965, federal program of health insurance for persons 65
years of age and older, certain younger people with disabilities, and people with kidney
failure.
✔✔Diagnosis-related groups (DRGs) - ✔✔statistical system of classifying any inpatient
stay into groups for the purposes of payment. There are two types:
1. Principal diagnosis - the primary condition that led to the patient being admitted to the
hospital.
2. Secondary diagnosis - complications that may affect the patient's course of treatment
or probing the length of hospital stay.
✔✔Medicaid - ✔✔A federal and state assistance program that pays for health care
services for people who cannot afford them.
✔✔CHIP - ✔✔Children's Health Insurance Program
✔✔Tricare - ✔✔U.S. government health insurance plan for
a. All military personnel, unmarried children, spouses,
b. Medal of Honor recipients and their families
3. Reservists and their families.
It is managed and regulated by the department of defense.
✔✔Types of Private Health Insurance: - ✔✔1. HMO
2. PRO
✔✔Health Maintenance Organization (HMO) - ✔✔Provide preventative health care
options at reduced costs.
It provides and arranges managed care for health insurances, self-funded healthcare
benefit plans, individuals, and other entities in the United States.
, It acts as a liaison with healthcare providers on a prepaid basis.
- Low or no premium
- Lower out-of-pocket cost
- Lower co-payments
- Smaller network
- Does not cover out of network
✔✔Preferred Provider Organization (PPO) - ✔✔an agreement between entities such a
hospitals, doctors, surgery centers, and insurance agencies to provide healthcare at a
reduced amount.
- Out of network coverage
- State or Nationwide
- Provider network
- No referral to see specialist
- Easy to use.
✔✔Affordable Care Act (ACA) - ✔✔- along with the Health Care and Education
Reconciliation Act of 2010 amendment represents the most significant policy expansion
and regulatory overhaul to the United States healthcare since 1965.
- brought changes such as insurance for people with preexisting conditions, allowing
adults to stay on their parent's insurance to age 26, increased MEdicaid eligibility and
more.
- children cannot be denied health insurance because of preexisting conditions.
- seeks to increase accountability for insurance company.
- includes preventive services to seniors.
- current and future healthcare reform will focus on reducing discrimination.
- several challenges claiming provisions contained in ACA are unconstitutional have
been filed in federal courts.
- aims to reduce disparities and provide health insurance for all citizens in the United
State.
✔✔Practice Act - ✔✔National and state laws that govern used to govern healthcare
professionals.
✔✔scope of practice - ✔✔a set of regulations and ethical considerations that define the
scope - procedures, actions, and processes, permitted
✔✔Protocols - ✔✔A set of rules that explain how a task or procedure should be
completed
✔✔Ethics - ✔✔the principles and standards that govern behavior
✔✔Bioethics - ✔✔the ethical implications related to research in healthcare
SOLUTIONS GUARANTEE A+
✔✔Deductible - ✔✔Amount you must pay before you begin receiving any benefits from
your insurance company
✔✔Co-payment - ✔✔The predetermined amount defined by the health insurer that must
be paid each time a health service is accessed.
✔✔Coinsurance - ✔✔Splitting the cost between individuals and their insurance carrier
✔✔Government plans - ✔✔1. Federal Employees Health Benefits (FEHB)
2. Indian Health Service (IHS) for those of Native American descent.
3. Veterans Health Administration for military veterans
4. Program of All-Inclusive Care for the Elderly (PACE)
✔✔Medicare - ✔✔Established 1965, federal program of health insurance for persons 65
years of age and older, certain younger people with disabilities, and people with kidney
failure.
✔✔Diagnosis-related groups (DRGs) - ✔✔statistical system of classifying any inpatient
stay into groups for the purposes of payment. There are two types:
1. Principal diagnosis - the primary condition that led to the patient being admitted to the
hospital.
2. Secondary diagnosis - complications that may affect the patient's course of treatment
or probing the length of hospital stay.
✔✔Medicaid - ✔✔A federal and state assistance program that pays for health care
services for people who cannot afford them.
✔✔CHIP - ✔✔Children's Health Insurance Program
✔✔Tricare - ✔✔U.S. government health insurance plan for
a. All military personnel, unmarried children, spouses,
b. Medal of Honor recipients and their families
3. Reservists and their families.
It is managed and regulated by the department of defense.
✔✔Types of Private Health Insurance: - ✔✔1. HMO
2. PRO
✔✔Health Maintenance Organization (HMO) - ✔✔Provide preventative health care
options at reduced costs.
It provides and arranges managed care for health insurances, self-funded healthcare
benefit plans, individuals, and other entities in the United States.
, It acts as a liaison with healthcare providers on a prepaid basis.
- Low or no premium
- Lower out-of-pocket cost
- Lower co-payments
- Smaller network
- Does not cover out of network
✔✔Preferred Provider Organization (PPO) - ✔✔an agreement between entities such a
hospitals, doctors, surgery centers, and insurance agencies to provide healthcare at a
reduced amount.
- Out of network coverage
- State or Nationwide
- Provider network
- No referral to see specialist
- Easy to use.
✔✔Affordable Care Act (ACA) - ✔✔- along with the Health Care and Education
Reconciliation Act of 2010 amendment represents the most significant policy expansion
and regulatory overhaul to the United States healthcare since 1965.
- brought changes such as insurance for people with preexisting conditions, allowing
adults to stay on their parent's insurance to age 26, increased MEdicaid eligibility and
more.
- children cannot be denied health insurance because of preexisting conditions.
- seeks to increase accountability for insurance company.
- includes preventive services to seniors.
- current and future healthcare reform will focus on reducing discrimination.
- several challenges claiming provisions contained in ACA are unconstitutional have
been filed in federal courts.
- aims to reduce disparities and provide health insurance for all citizens in the United
State.
✔✔Practice Act - ✔✔National and state laws that govern used to govern healthcare
professionals.
✔✔scope of practice - ✔✔a set of regulations and ethical considerations that define the
scope - procedures, actions, and processes, permitted
✔✔Protocols - ✔✔A set of rules that explain how a task or procedure should be
completed
✔✔Ethics - ✔✔the principles and standards that govern behavior
✔✔Bioethics - ✔✔the ethical implications related to research in healthcare
