HAN 300 FINAL REVIEW QUESTIONS
WITH COMPLETE SOLUTIONS
health care - CORRECT ANSWER✔✔-the treatment of illness and maintenance of
| | | | | | | | | | |
health
finance - CORRECT ANSWER✔✔-funding
| | |
health care financing - CORRECT ANSWER✔✔-funding for the treatment of illness
| | | | | | | | | |
and maintenance of health
| | | |
insurance - CORRECT ANSWER✔✔-protects against risk
| | | | |
insured - CORRECT ANSWER✔✔-(also called beneficiary) some who is covered by
| | | | | | | | | | |
insurance
beneficiary - CORRECT ANSWER✔✔-a person who derives advantage from
| | | | | | | | |
something, especially a trust, will or life insurance policy
| | | | | | | |
insurer - CORRECT ANSWER✔✔-a person or company that underwrites an
| | | | | | | | | |
insurance risk; the party in an insurance contract undertaking to pay
| | | | | | | | | | |
compensation
,underwriting - CORRECT ANSWER✔✔-process that insurer does to evaluate,
| | | | | | | | |
selecting or rejecting classifying and rating risk
| | | | | |
o 4 types:
| | |
| Risk is unpredictable for the individual insured
| | | | | |
| Reasonable can be predicted with a reasonable degree of accuracy
| | | | | | | | |
| Insurance can transfer risk from group to individual through pooling of resources
| | | | | | | | | | |
| Losses are shared by all members
| | | | |
experience rating - CORRECT ANSWER✔✔-premium can be unaffordable for high-
| | | | | | | | |
risk groups most commonly associated with worker's compensation insurance
| | | | | | | |
community rating - CORRECT ANSWER✔✔-good risks subsidize poor risks
| | | | | | | |
adjusted community rating - CORRECT ANSWER✔✔-(required by ACA): takes into
| | | | | | | | | |
account individual vs. family enrollment, geographic area, age, tobacco use
| | | | | | | | |
benefits - CORRECT ANSWER✔✔-services covered by an insurance plan
| | | | | | | |
copayment - CORRECT ANSWER✔✔-flat amount paid per service
| | | | | | |
coinsurance - CORRECT ANSWER✔✔-set proportion of medical costs insured pay
| | | | | | | | | |
out of pocket
| |
o Ex. you pay 20% the insurance pays 80%
| | | | | | | |
,deductible - CORRECT ANSWER✔✔-amount the insured pays first before benefits
| | | | | | | | | |
are paid by the plan
| | | |
o Applied annually
| |
service description - CORRECT ANSWER✔✔-a description of the health care
| | | | | | | | | |
services you received, like a medical visit, lab tests, or screenings
| | | | | | | | | |
provider charges - CORRECT ANSWER✔✔-is the amount your provider bills for
| | | | | | | | | | |
your visits |
allowed charges - CORRECT ANSWER✔✔-is the amount your provider will be
| | | | | | | | | | |
reimbursed; this may not be the same as the provider charges.
| | | | | | | | | |
paid by the insurer - CORRECT ANSWER✔✔-the amount your insurance plan will
| | | | | | | | | | | |
pay to your provider
| | |
payee - CORRECT ANSWER✔✔-the person who will receive any reimbursement
| | | | | | | | | |
for over-paying the claim
| | |
what you owe - CORRECT ANSWER✔✔-the amount the patient or insurance plan
| | | | | | | | | | | |
member owes after your insurer has pay everything else. You may have already
| | | | | | | | | | | | |
paid a portion of this amount, and payments made directly to your provider may
| | | | | | | | | | | | | |
not be subtracted from this amount
| | | | |
remark code - CORRECT ANSWER✔✔-a note from the insurance plan that
| | | | | | | | | | |
explains more about the costs, charges and paid amounts for your visit.
| | | | | | | | | | |
, premium - CORRECT ANSWER✔✔-amount charged by the insurer per month to
| | | | | | | | | | |
prevent risk |
deductible - CORRECT ANSWER✔✔-annual payment for insurance price based on
| | | | | | | | | |
the plan you choose before they cover something
| | | | | | |
health savings account - CORRECT ANSWER✔✔-accounts you can draw from to
| | | | | | | | | | |
cover health expenses | |
minimal essential coverage - CORRECT ANSWER✔✔-complies with the coverage
| | | | | | | | |
for the Affordable Care Act that covers free preventative care
| | | | | | | | |
o Ex. preventative care, birth control
| | | | |
group insurance - CORRECT ANSWER✔✔-the risk is spread out among all who are
| | | | | | | | | | | |
insured, anticipates that a significant number of people will purchase insurance
| | | | | | | | | | | |
through the sponsor | |
o Money is pooled between a large number of people
| | | | | | | | |
o Multiple services can be provided because its al most unlikely everyone will
| | | | | | | | | | | | |
need serious coverage all at once
| | | | |
| Ex. Insurance from employers or through a union
| | | | | | |
self insurance - CORRECT ANSWER✔✔-employer acts as its own insurer instead
| | | | | | | | | | |
of obtaining insurance through an insurance company.
| | | | | |
o Employers pay for each out of pocket claim as they are incurred, rather than
| | | | | | | | | | | | | | |
paying a fixed premium to an insurance carrier.
| | | | | | |
WITH COMPLETE SOLUTIONS
health care - CORRECT ANSWER✔✔-the treatment of illness and maintenance of
| | | | | | | | | | |
health
finance - CORRECT ANSWER✔✔-funding
| | |
health care financing - CORRECT ANSWER✔✔-funding for the treatment of illness
| | | | | | | | | |
and maintenance of health
| | | |
insurance - CORRECT ANSWER✔✔-protects against risk
| | | | |
insured - CORRECT ANSWER✔✔-(also called beneficiary) some who is covered by
| | | | | | | | | | |
insurance
beneficiary - CORRECT ANSWER✔✔-a person who derives advantage from
| | | | | | | | |
something, especially a trust, will or life insurance policy
| | | | | | | |
insurer - CORRECT ANSWER✔✔-a person or company that underwrites an
| | | | | | | | | |
insurance risk; the party in an insurance contract undertaking to pay
| | | | | | | | | | |
compensation
,underwriting - CORRECT ANSWER✔✔-process that insurer does to evaluate,
| | | | | | | | |
selecting or rejecting classifying and rating risk
| | | | | |
o 4 types:
| | |
| Risk is unpredictable for the individual insured
| | | | | |
| Reasonable can be predicted with a reasonable degree of accuracy
| | | | | | | | |
| Insurance can transfer risk from group to individual through pooling of resources
| | | | | | | | | | |
| Losses are shared by all members
| | | | |
experience rating - CORRECT ANSWER✔✔-premium can be unaffordable for high-
| | | | | | | | |
risk groups most commonly associated with worker's compensation insurance
| | | | | | | |
community rating - CORRECT ANSWER✔✔-good risks subsidize poor risks
| | | | | | | |
adjusted community rating - CORRECT ANSWER✔✔-(required by ACA): takes into
| | | | | | | | | |
account individual vs. family enrollment, geographic area, age, tobacco use
| | | | | | | | |
benefits - CORRECT ANSWER✔✔-services covered by an insurance plan
| | | | | | | |
copayment - CORRECT ANSWER✔✔-flat amount paid per service
| | | | | | |
coinsurance - CORRECT ANSWER✔✔-set proportion of medical costs insured pay
| | | | | | | | | |
out of pocket
| |
o Ex. you pay 20% the insurance pays 80%
| | | | | | | |
,deductible - CORRECT ANSWER✔✔-amount the insured pays first before benefits
| | | | | | | | | |
are paid by the plan
| | | |
o Applied annually
| |
service description - CORRECT ANSWER✔✔-a description of the health care
| | | | | | | | | |
services you received, like a medical visit, lab tests, or screenings
| | | | | | | | | |
provider charges - CORRECT ANSWER✔✔-is the amount your provider bills for
| | | | | | | | | | |
your visits |
allowed charges - CORRECT ANSWER✔✔-is the amount your provider will be
| | | | | | | | | | |
reimbursed; this may not be the same as the provider charges.
| | | | | | | | | |
paid by the insurer - CORRECT ANSWER✔✔-the amount your insurance plan will
| | | | | | | | | | | |
pay to your provider
| | |
payee - CORRECT ANSWER✔✔-the person who will receive any reimbursement
| | | | | | | | | |
for over-paying the claim
| | |
what you owe - CORRECT ANSWER✔✔-the amount the patient or insurance plan
| | | | | | | | | | | |
member owes after your insurer has pay everything else. You may have already
| | | | | | | | | | | | |
paid a portion of this amount, and payments made directly to your provider may
| | | | | | | | | | | | | |
not be subtracted from this amount
| | | | |
remark code - CORRECT ANSWER✔✔-a note from the insurance plan that
| | | | | | | | | | |
explains more about the costs, charges and paid amounts for your visit.
| | | | | | | | | | |
, premium - CORRECT ANSWER✔✔-amount charged by the insurer per month to
| | | | | | | | | | |
prevent risk |
deductible - CORRECT ANSWER✔✔-annual payment for insurance price based on
| | | | | | | | | |
the plan you choose before they cover something
| | | | | | |
health savings account - CORRECT ANSWER✔✔-accounts you can draw from to
| | | | | | | | | | |
cover health expenses | |
minimal essential coverage - CORRECT ANSWER✔✔-complies with the coverage
| | | | | | | | |
for the Affordable Care Act that covers free preventative care
| | | | | | | | |
o Ex. preventative care, birth control
| | | | |
group insurance - CORRECT ANSWER✔✔-the risk is spread out among all who are
| | | | | | | | | | | |
insured, anticipates that a significant number of people will purchase insurance
| | | | | | | | | | | |
through the sponsor | |
o Money is pooled between a large number of people
| | | | | | | | |
o Multiple services can be provided because its al most unlikely everyone will
| | | | | | | | | | | | |
need serious coverage all at once
| | | | |
| Ex. Insurance from employers or through a union
| | | | | | |
self insurance - CORRECT ANSWER✔✔-employer acts as its own insurer instead
| | | | | | | | | | |
of obtaining insurance through an insurance company.
| | | | | |
o Employers pay for each out of pocket claim as they are incurred, rather than
| | | | | | | | | | | | | | |
paying a fixed premium to an insurance carrier.
| | | | | | |
