BAR Benefits Jeopardy

This term means to use your own money to pay for health care services.

• Coinsurance

• Out-of-pocket max

• Coexist

Cost sharing is another way to this about this term that means when the insurance company and member each contribute to the cost of health care.

• Benefit

• Co-pay

• Coinsurance

This is the most the member can expect to pay for health care in a given year.

• Out-of-pocket Maximum

• Lifetime Maximum

• Designated Maximum

This term is not required for family therapy, individual therapy, or group therapy.

• Treatment

• Authorization

• Deductible

Which term is NOT appropriate to indicate the date the policy renews?

Some policies renew on a Calendar year (January 1st), while others renew on a plan year.

• Calendar Year

• Plan Year

• Term Year

Indicate the health plan that is most affordable. The plan requires the member to have a primary care physician, uses in network benefits, referrals are required to see a specialist, and includes emergency coverage.

• Exclusive Provider Organization (EPO)

• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

Identify the plan that has deductibles, co-pays, coinsurance, preventive care, and out-of-pocket maximum

• Preferred Provider Organization (PPO)

• Exclusive Provider Organization (EPO)

• Point of Service (POS)

This term is used to describe providers, specialists, laboratories, and pharmacies who have agreed to a contracted rate with Optum that the member benefits from and receives a discounted rate.

• Out of network

• In-Network

• Contracted

This term describes providers who have not contracted with Optum for lower rates.

Members who use these providers will often pay more to obtain services with these providers and facilities.

• In Network

• Independent

• Out of Network

This insurance plan does not require the member to have a referral to see a specialist and covered covers

the member for non-emergency out of network services.

• Point of Service (POS)

• Preferred Provider Organization (PPO)

• Exclusive Provider Organization (EPO)