Network Types Flashcard

Front

Which of the following is NOT a type of network? HMO (Health Maintenance Organization), POS (Point of Service), PPO (Preferred Provider Organization), BHP (Basic Health Plan)

Back

BHP (Basic Health Plan)

Front

What is a deductible?

Back

The amount you pay for covered services before your insurance starts to pay.

Front

Why would a company prefer to be Self Funded? Options: Higher potential savings, They prefer higher risk, Simplicity of administration, The lack of flexibility

Back

Higher potential savings

Front

What is a copayment?

Back

A fixed amount you pay for a covered healthcare service.

Front

What is the purpose of an Incurred but not Reported (IBNR) report?

Back

Estimate a company's reserve to cover "runout" claims.

Front

What goes first in the claim life cycle?

Back

Incurred

Front

Co. A has $100K ISL and $50K Aggregating Spec. Two members have claims of $120K and $140K. How much is Co. A reimbursed?

Back

$10,000

Front

My son was born in March. We didn't receive a bill for his birth until June. This is an example of...

Back

Claims lag

Front

Nebula has a $2,500 deductible, 80% coinsurance, and $6,000 OOPM. She has a $750K Arm Transplant. How much does she pay?

Back

$6,000

Front

Avengers co. Pays $2,000 per employee per month to Cigna. Cigna pays for all claims. What type of funding is this?

Back

Fully Insured