NWM PT 2 Chapter 2 questions n
answers graded A+
Service Providers
offer benefits to subscribers in return for the payment of a premium. Benefits are in the form of services
provided by hospitals and physicians in the plan.
Blue Cross and Blue Shield
are the dominant health insurers of the United States. The nation's Blue Cross and Blue Shield plans are
loosely affiliated through the national Blue Cross and Blue Shield Association but are independently
managed. The Blues provide the majority of their benefits on a service basis rather than on a
reimbursement basis. This means that the insurer pays the provider directly for the medical treatment
given to the subscriber, instead of reimbursing the insured. As participating providers, the doctors and
hospitals contractually agree to specific costs for the medical services provided to subscribers. Members
of Blue Cross and Blue Shield are known as subscribers. Blue Cross and Blue Shield plans are called
prepaid plans because the subscribers pay a set fee (usually each month) for medical services covered
under the plan.
Health Maintenance Organization
an organization that provides comprehensive medical care to subscribers for a fixed fee
Preferred Provider Organization
A managed care organization structured as a network of health care providers who agree to perform
services for plan members at discounted fees; usually, plan members can receive services from non-
network providers for a higher charge.
The federally administered Medicare program
answers graded A+
Service Providers
offer benefits to subscribers in return for the payment of a premium. Benefits are in the form of services
provided by hospitals and physicians in the plan.
Blue Cross and Blue Shield
are the dominant health insurers of the United States. The nation's Blue Cross and Blue Shield plans are
loosely affiliated through the national Blue Cross and Blue Shield Association but are independently
managed. The Blues provide the majority of their benefits on a service basis rather than on a
reimbursement basis. This means that the insurer pays the provider directly for the medical treatment
given to the subscriber, instead of reimbursing the insured. As participating providers, the doctors and
hospitals contractually agree to specific costs for the medical services provided to subscribers. Members
of Blue Cross and Blue Shield are known as subscribers. Blue Cross and Blue Shield plans are called
prepaid plans because the subscribers pay a set fee (usually each month) for medical services covered
under the plan.
Health Maintenance Organization
an organization that provides comprehensive medical care to subscribers for a fixed fee
Preferred Provider Organization
A managed care organization structured as a network of health care providers who agree to perform
services for plan members at discounted fees; usually, plan members can receive services from non-
network providers for a higher charge.
The federally administered Medicare program
