GBA 3 Test Questions Well Answered Graded A+

GBA 3 Test Questions Well Answered Graded A+ originally covered catastrophic (inpatient) then added outpatient, diagnostic, physican services no permission needed.. pay a % of treatment. - Answers indemnity plan / traditioanl / fee for service insurance carriers have a role in steering health services and care while prepaying some portion of health care services., all but replaced indemnities - Answers managed care hmo, ppo, pos, hdhp - Answers common types of health plans: pcp, he chooses speciality care, copays for oop and specialist visits, no claim for reimbursement, no oon except for emergency - Answers HMO description primary care provider requirement by a POS but not by a PPO, lower copay amounts for preferred care in a POS than in a PPO, and a smaller network of providers to choose from in a POS than in a PPO. - Answers ppo vs pos limited beneifts outside of network, no referral or pcp requirement, sometimes have tiers within preferred network - Answers ppo description hybrid of ppo hmo, individual may need to select pcp to obtain referrals , no reimbursent file, oop is copays in netork, oon is % - Answers pos plan catastrophic insurance, lower premium costs for higher deductible, by paying after insured has lot of oop expenses, high deductible with lots of - Answers hdhp plan fsa: select $ from pre tax basis for IRS-qualified medical expenses. can enroll regardless of health plan insurance and employers may contribute, usually lost $ hra: employer funded to pay health care expenses as determined by employer, rarely roll over contribution hsa: owned by employer, grows and keeps with you, tax free until 65 when take out for non medical expenses its for income tax - Answers fsa, hra and hsa you know these.. but referral is An authorization or prior approval from a primary care provider to receive medical care from another provider - Answers deductible, coinsurance, copay, pcp, referral some plans may have tiered network with varying oop expenses , but in network provider has contract with insurance, oon doesn't - Answers in network provider vs oon provider (preferred vs nonpreferred) most a member can pay during the plan year (or CY) before health insurance pays 100% (never includes insurance premiums paid, balance-billed charges or expenses for care services not covered by the health plan.) - Answers Out-of-pocket expense maximum terms used by health plans to determine the maximum amount the plan will pay for covered health care service, also "eligible expense, payment allowance or negotiated rate For OON, if the provider charges more than the allowed amount by the health plan, the provider can charge the member for the difference. - Answers ucr & allowed amount covered under health plans without having any deductibles, copayments or coinsurance apply when provided by in-network providers. (Under the Affordable Care Act - Answers special consideration for preventative care