Table of Contents
What plan is comprehensive health care services to voluntary enrolled members on a prepaid basis?
Chapter 3
| Term | Definition |
|---|---|
| HMO is a health maintenance organization. It is an alternative to traditional group health insurance coverage provides | -Comprehensive healthcare services to -voluntarily enrolled members -on a prepaid basis |
Which of the following is an organization that provides health services on a prepaid basis?
HMOs finance health care services for their members primarily on a prepaid basis. They also organize and deliver the services.
What is an HMO and PPO?
To start, HMO stands for Health Maintenance Organization, and the coverage restricts patients to a particular group of physicians called a network. 1. PPO is short for Preferred Provider Organization and allows patients to choose any physician they wish, either inside or outside of their network.
Which of the following types of organizations are prepaid group health?
A Health Maintenance Organization (HMO) is a prepaid group health plan, where members pay in advance for the services of participating physicians and hospitals that have agreements.
What is a healthcare marketplace quizlet?
The Health Insurance Marketplace, or “Exchange,” offers standardized health insurance plans to individuals, families and small businesses. Offers people a way to compare health insurance plans, to help decide which one is the best for them, this was established by the ACA.
Who Receives Managed Health Care Plan services?
Health Insurance Claims Chapter 3
| Question | Answer |
|---|---|
| Which term best describes those who receive managed health care plan services? | enrollees |
| What was created in 1929? | the first managed care program |
| Which was the first nationally recognized health maintenance organization? | Kaiser Permanente |
What are examples of HMO?
An HMO develops its network by contracting primary care physicians (for example, internists and family doctors), specialists (for example, cardiologists and ophthalmologists), and clinical facilities (for example, hospitals and specialty clinics).
Is United Healthcare PPO or HMO?
The United Healthcare (UHC) Choice Plus plan is a PPO plan that allows you to see any doctor in their network – including specialists – without a referral. United Healthcare has a national network of providers; however, you may use any licensed provider you choose.
What is a prepaid group?
Prepaid group practices (PGPs) are complex organizations that directly combine prepayment for health care with a comprehensive health care delivery system. PGPs’ ability to manage their physician staffing efficiently must be placed in context with the cost and quality of their care.
How are PPOS funded?
A PPO is actually a group of doctors and/or hospitals that provides medical service only to a specific group or association. The PPO may be sponsored by a particular insurance company, by one or more employers, or by some other type of organization.
What is the purpose of the health Exchange quizlet?
What is the purpose of a Health Insurance Exchange? To give consumers a way to access and purchase health coverage that they may not otherwise have been able to obtain or afford.
How does medical insurance work on a prepaid basis?
Provides comprehensive healthcare services to voluntarily enrolled members on a prepaid basis. Patients can use the managed care panel of providers (paying discounted healthcare costs) or self-refer to out-of-network providers (and pay higher healthcare costs).
Who is the owner of a physician-hospital organization?
A physician-hospital organization (PHO) is owned by hospital(s) and physician groups that obtain managed care plan contracts. The physicians __________ and provide health care services to plan members. maintain their own practices A management service organization (MSO) is usually owned by physicians or a hospital and provides practice
What is a contracted network of healthcare providers?
Contracted network of healthcare providers that provide care to subscribers for a discounted fee. Organization of affiliated providers’ sites that offer joint healthcare services to subscribers. Provides benefits to subscribers who are required to receive services from network providers.
What does an organization of affiliated providers do?
Organization of affiliated providers’ sites that offer joint healthcare services to subscribers. Provides benefits to subscribers who are required to receive services from network providers. Provides comprehensive healthcare services to voluntarily enrolled members on a prepaid basis.