PPHS Exam #2 Questions and answers, Graded A+// / latest Exam prediction paper 2024/25 APPROVED/

PPHS Exam #2 Questions and answers, Graded A+ Your ___________ is the amount of money you pay to your health insurance company each month to stay enrolled in your plan and keep your coverage. Premium Your __________ is the amount of money you must pay out-of-pocket before your health insurance starts paying for health care services. Deductible Your ___________ is a type of cost-sharing payment you may have to make out-of-pocket when you receive certain health care services or medications. They’re typically a flat rate. Co-pay Your _________ is another type of cost-sharing payment that you may have to make out-of-pocket when receiving certain health care services or Medications. These are usually in the form of a percentage. Co-insurance What is the main difference between copay and coinsurance payments? Copays are a flat fee and coinsurances are usually in the form of a percentage. The ______________ is a cap on how much you’ll have to pay out of pocket for health care in one year. After you reach this amount your insurer will pay for your covered care in full for the rest of the year. Out of pocket maximum A ____________ is a type of healthcare plan that gives you access to a network of providers/hospitals/healthcare providers in your area. Typically, HMO plans require you to choose a primary care physician (PCP). If you need additional healthcare services, your PCP will refer you to a specialist within the HMO’s network. If you go to an out-of-network doctor or hospital, you’ll most likely have to pay all costs out of pocket for non-emergency healthcare costs. HMO - health maintenance organization A ___________ is like an HMO in that they both consist of a network of healthcare providers and facilities. Although you must choose a primary care physician, you don’t need a referral from PCP to have access to a specialist—unlike an HMO. It’s network can also be more extensive than an HMO network. EPO - exclusive provider organization What is the main similarity between HMOs and EPOs? They both generally require you to pay all costs for any out of network care. A __________ is a health insurance plan that has a network of healthcare providers and facilities in your area and around the country that it works with and would “prefer” you seek out. If you go to these providers, a larger portion of your costs will be paid for by the plan. Unlike EPOs and HMOs, this plan will cover some out-of-network costs as long as they are for covered services. The network often includes providers in different states, and you won’t need a referral from a primary care physician to see a specialist. PPO - preferred provider organization What is the main similarity between PPOs and EPOs? You don't need a referral from a PCP to see a specialist. Between HMOs, PPOs, and EPOs, which one offers the least flexibility but the lowest monthly costs? HMOs Between PPOs and EPOs, which one offers a little bit more flexibility than HMOs but is typically more expensive? EPOs Between HMOs, PPOs, and EPOs, which one offers the most flexibility but is typically the most expensive? PPOs A __________ HMO model is a healthcare delivery system in which the HMO directly employs physicians and other healthcare providers. The HMO owns or controls the facilities where the providers work and manages all aspects of the healthcare delivery process, including contracting with hospitals and other facilities for services. Vertical A __________ HMO model is a healthcare delivery system in which the HMO contracts with independent physician groups and hospitals to provide healthcare services to its members. The HMO acts as a middleman between the patient and the healthcare providers, negotiating fees and overseeing care coordination. Horizontal What is the main difference between vertical and horizontal H