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Medical Insurance

Mrs. Meeks

Intro Unit 3

Premium the cost of the plan is deducted from the employees wages before taxes to allow employees to pay for medical expenses and childcare
Medicare monthly fee for insurance
Medicaid a physical or mental condition that existed before the insurance policy was issued
Indigent people who are covered under the managed care plan
Managed Care a tax shelter set up for the purpose of paying medical bills when the person has a high deductible low cost insurance plan
Group plan AKA indemnity plan- the patient can go to any provider or hospital and bills are sent to the carrier and the patient is reimbursed according to plan rules
Indemnity charges that are proper and meet the standards of good medical practice in the local area
HIPPA the money the patient pays up front each year towards their medical expenses before the insurance company pays
Copay the amount you pay when you see physician if you have managed care
PAR law enacted in 1996 that requires group plans to accept transfers from other plans without imposing a preexisting condition clause
NonPAR the amount the patient pays when they meed their deductible and share the bill with the insurance company
Coinsurance has no contractual agreement with the insurance provider
preexisting condition the patient can go to any participating physician within the plan without having a referral from a primary care physician
UCR insurance for low income and certain disabled individuals
Deductible When a certain amount has been paid by the patient each year, the insurance company then pays the full UCR benefits
Our-of-pocket maximum poor or low-income individuals
CMS 1500 an insurance policy that covers a group of people
Enrollees contracts with third party payer and agrees to abide by rules and regulations of that carrier
Policy Holders the insured person
FSA The patient has a primary care physician who directs their care within the plan
MSA insurance for elderly and certain other disabled individuals
Medical Necessity traditional health care policy where patients can choose any provider they wish.
Fee-for-service medical care established by a corporation established under state and federal laws
HMO the standard insurance form
PPO the part of the provider's charge that the insurance carrier allows as a covered expense
policy a written agreement between two parties whereby one entity agrees to pay a specific amount to the second entity if certain undesirable events occur

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