Insurance Vocabulary Flashcards

(54 cards)

1
Q

deductible

A

able to be deducted, especially from taxable income or tax to be paid

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2
Q

out of pocket

A

paid for directly rather than being put on account

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3
Q

co-pay

A

a fixed out-of-pocket amount paid by an insured for covered services

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4
Q

co-insurance

A

a type of insurance in which the insured pays a share of the payment made against a claim

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5
Q

premium

A

an amount to be paid for an insurance policy.

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6
Q

PPO

A

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network.

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7
Q

HMO

A

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency.

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8
Q

CMS

A

CMS is computer software or an application that uses a database to manage all content, and it can be used when developing a website.

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9
Q

medicare

A

People who are 65 or older. Certain younger people with disabilities. People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

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10
Q

medicaid

A

It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program.

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11
Q

marketplace

A

A service that helps people shop for and enroll in health insurance.

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12
Q

rehabilitation

A

the process of helping a person achieve the highest level of function, independence, and quality of life possible.

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13
Q

disability

A

any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities

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14
Q

SCHIP

A

State Children’s Health Insurance Program - meant to broaden a state’s medicaid program, start up or expand state-sponsored or private insurance programs, support a combination or programs

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15
Q

home health care

A

a wide range of health care services that can be given in your home for an illness or injury

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16
Q

industrial health care

A

A branch of public health concerned with the health and well-being of workers.

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17
Q

rehabilitation facility

A

type of specialty hospital that focuses on treating people recovering from debilitating injuries, illnesses, surgeries, and chronic medical conditions

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18
Q

long term care

A

Services that include medical and non-medical care provided to people who are unable to perform basic activities of daily living such as dressing or bathing.

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19
Q

SNIF - skilled nursing facility

A

Skilled nursing facilities provide mostly short-term nursing or rehabilitation services.

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20
Q

clinic

A

a health care center where you receive routine preventative care when you are healthy or visit your Doctor/Primary Care Provider when you are sick.

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21
Q

life insurance

A

a contract between an insurance policy holder and an insurance company, where the insurer promises to pay a sum of money in exchange for a premium, upon the death of an insured person or after a set period

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22
Q

worker’s compensation

A

provide partial medical care and income protection to employees who are injured or become ill from their job

23
Q

TRICARE

A

the uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.

24
Q

liability insurance

A

helps cover medical and legal fees if you’re held legally responsible for someone else’s injury, or damage to someone else’s property

25
appeal
A request for your health insurance company or the Health Insurance Marketplace ® to review a decision that denies a benefit or payment.
26
allowed amount
The maximum amount a plan will pay for a covered health care service.
27
DME - durable medical equipment
Equipment and supplies ordered by a health care provider for everyday or extended use.
28
network
a list of the doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members
29
out of network
a doctor or physician does not have a contract with your health insurance plan provider.
30
preauthorization
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary
31
ambulatory care
care provided by health care professionals in outpatient settings. medical offices and clinics, ambulatory surgery centers, hospital outpatient departments, and dialysis centers
32
HSA high deductible
any plan with a deductible of at least $1,400 for an individual or $2,800 for a family.
33
local health department
work with healthcare and community partners to prevent and target the cause of disease outbreaks, and then determine the appropriate response
34
state health department
prevent, identify, and respond to outbreaks of foodborne illness
35
gatekeepers
response to a shortage of specialists and a need to control healthcare expenditure
36
fee-for-service
A method in which doctors and other health care providers are paid for each service performed
37
center for mental health services
a facility providing services for the prevention or diagnosis of mental illness, the care and treatment of mentally ill patients, the rehabilitation of mentally ill individuals, or any combination of these services
38
medicare part D
a voluntary outpatient prescription drug benefit for people with Medicare provided through private plans that contract with the federal government
39
medicare part A
covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care
40
residential care facilities
small private facilities, usually with 20 or fewer residents, Residents receive personal care and meals and have staff available around the clock. Nursing and medical care usually are not provided on site.
41
BLS - bureau of labor statistics
measures labor market activity, working conditions, price changes, and productivity in the U.S. economy to support public and private decision making
42
PhRMA - Pharmaceutical Research and Manufacturers of America
represents research-based pharmaceutical and biotechnology companies
43
NCHS - National Center for Health Statistics
providing data to identify and address health issues. NCHS compiles statistical information to help guide public health and health policy decisions
44
professional associations
a group of individuals who share an interest in a specific area of health
45
AHCA - The Agency For Health Care Administration
deliver the resources skilled nursing centers, assisted living communities, and other long term care providers need to provide high quality care
46
AHA - American Hospital Association
national organization that represents and serves all types of hospitals, health care networks, and their patients and communities
47
duty to treat
when a physician ordinarily would provide care to a patient, the duty to treat would preclude a physician from refusing to treat on account of the risk to self
48
home healthcare services
less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF)
49
per capita
the average cost per person to different payers for various health care services
50
life expectancy rates
an estimate of the expected average number of years of life (or a person's age at death) for individuals who were born into a particular population
51
generic drugs
A prescription drug that has the same active-ingredient formula as a brand-name drug
52
EMTALA - Emergency Medical Treatment and Labor Act
requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat someone
53
COBRA - Consolidated Omnibus Budget Reconciliation Act
gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss
54
GDP
measures the value of goods and services produced in each state