Health Insurance Plans

You have reached your $5000 out-of-pocket maximum limit. You need to go to the emergency room and it cost $1700. How much will your insurance pay?

• $1700

• $0

• $1360

A fixed amount you pay for a service at a healthcare provider's facility:

• co-insurance

• co-pay

• premium

• claim

The cost of your insurance you pay each month:

• co-pay

• deductible

• premium

• co-insurance

The amount you owe before your health insurance begins to pay for services.

• deductible

• premium

• owed amount

Insured

• The policy holder or subscriber
• Fee paid for the health insurance
• A person designated to receive the benefits of an insurance policy
• The insurance company

Group Insurance

• Insurance coverage offered to employees by the employer
• Insurance policy an individual must purchase on their own
• Insurance offered by the government
• Insurance offered to a special group of people

HMO

• Health Maintenance Organization
• Health Managed Organization
• Health Maintained Operation
• Health Managed Operation

Managed Care Plan

• Insurance plans designed specifically to control the cost of healthcare

• Also known as PPO

• Also known as HMO

• A referral to see a specialist

Health Insurance

• Portion of the cost of service to be paid by the employer
• Protection against financial lost by unplanned health related events
• Treatments for conditions not covered by insurance policies
• Services rendered by providers

A 30 year woman broke her arm and went to the ER for treatment. Her health insurance plan has a $1,500 deductible. What does this mean

• She can deduct $1,500 from the hospital bill, but must pay the rest
• The hospital will only charge her $1,500
• She is resoponsible for paying, $1,500 of her medical expenses before her insurance starts to pay
• Her insurance company will only pay $1,500 and she must pay the rest