HAN 300 Chapter 6 Vocab questions and
answers 100% correct answers
adjusted community rating - correct answer ✔✔A method of determining health insurance premiums
that takes into account demographic factors such as age, gender, geography, and family composition,
while ignoring other risk factors.
adverse selection - correct answer ✔✔A phenomenon in which individuals who are likely to use more
health care services than others due to poor health enroll in health insurance plans in greater numbers,
compared to people who are healthy.
balance bill - correct answer ✔✔The practice in which the provider bills the patient for the leftover sum
after insurance has only partially paid the charge initially billed.
beneficiary - correct answer ✔✔anyone covered under a particular health insurance plan
benefit period - correct answer ✔✔The period of illness beginning with hospitalization and ending when
the beneficiary has not been an inpatient in a hospital or a skilled nursing facility for 60 consecutive days
benefits - correct answer ✔✔services covered by an insurance plan
capitation - correct answer ✔✔A reimbursement mechanism under which the provider is paid a set
monthly fee per enrollee, regardless of whether or not an enrollee sees the provider and regardless of
how often an enrollee sees the provider.
case mix - correct answer ✔✔An aggregate of the severity of conditions requiring clinical intervention. It
is determined by an assessment of each patient's condition and an estimate of the amount of resources
the patient will need.
categorical programs - correct answer ✔✔Public health care programs designed to benefit only a certain
category of people.
, charge - correct answer ✔✔the amount a provider bills for rendering a service
churning - correct answer ✔✔a phenomenon in which people gain and lose health insurance
periodically
claim - correct answer ✔✔a demand for payment of covered medical expenses sent to an insurance
company
coinsurance - correct answer ✔✔a set proportion of the medical costs that the insured must pay out of
pocket when healthcare services are received
community rating - correct answer ✔✔a system in which all members of a community are charged the
same insurance rate
consumer-directed health plans - correct answer ✔✔high-deductible health plans that include a savings
option to pay for routine healthcare expenses
copayment - correct answer ✔✔a flat amount the insured must pay each time health services are
received
cost shifting - correct answer ✔✔shifting of costs from one entity to another as a way of making up
losses in one area by charging more in other areas
cost-plus reimbursement - correct answer ✔✔a payment scheme in which reimbursement to a provider
is based on cost plus a factor to cover the value of capital
deductible - correct answer ✔✔the portion of health care costs that the insured must first pay (usually
an annual limit) before insurance payments kick in
entitlement - correct answer ✔✔a healthcare program to which certain people are entitled by right
answers 100% correct answers
adjusted community rating - correct answer ✔✔A method of determining health insurance premiums
that takes into account demographic factors such as age, gender, geography, and family composition,
while ignoring other risk factors.
adverse selection - correct answer ✔✔A phenomenon in which individuals who are likely to use more
health care services than others due to poor health enroll in health insurance plans in greater numbers,
compared to people who are healthy.
balance bill - correct answer ✔✔The practice in which the provider bills the patient for the leftover sum
after insurance has only partially paid the charge initially billed.
beneficiary - correct answer ✔✔anyone covered under a particular health insurance plan
benefit period - correct answer ✔✔The period of illness beginning with hospitalization and ending when
the beneficiary has not been an inpatient in a hospital or a skilled nursing facility for 60 consecutive days
benefits - correct answer ✔✔services covered by an insurance plan
capitation - correct answer ✔✔A reimbursement mechanism under which the provider is paid a set
monthly fee per enrollee, regardless of whether or not an enrollee sees the provider and regardless of
how often an enrollee sees the provider.
case mix - correct answer ✔✔An aggregate of the severity of conditions requiring clinical intervention. It
is determined by an assessment of each patient's condition and an estimate of the amount of resources
the patient will need.
categorical programs - correct answer ✔✔Public health care programs designed to benefit only a certain
category of people.
, charge - correct answer ✔✔the amount a provider bills for rendering a service
churning - correct answer ✔✔a phenomenon in which people gain and lose health insurance
periodically
claim - correct answer ✔✔a demand for payment of covered medical expenses sent to an insurance
company
coinsurance - correct answer ✔✔a set proportion of the medical costs that the insured must pay out of
pocket when healthcare services are received
community rating - correct answer ✔✔a system in which all members of a community are charged the
same insurance rate
consumer-directed health plans - correct answer ✔✔high-deductible health plans that include a savings
option to pay for routine healthcare expenses
copayment - correct answer ✔✔a flat amount the insured must pay each time health services are
received
cost shifting - correct answer ✔✔shifting of costs from one entity to another as a way of making up
losses in one area by charging more in other areas
cost-plus reimbursement - correct answer ✔✔a payment scheme in which reimbursement to a provider
is based on cost plus a factor to cover the value of capital
deductible - correct answer ✔✔the portion of health care costs that the insured must first pay (usually
an annual limit) before insurance payments kick in
entitlement - correct answer ✔✔a healthcare program to which certain people are entitled by right
