Insurance

Question 1

Medical insurance

Answer 1

• contract between the holder of a policy and an insurance company to reimburse a percentage of the cost of the policyholder’s medical bills, usually after the policy holder has paid a deductible

Question 2

Health insurance

Answer 2

• includes provisions for maintaining good health rather than simply paying for illnesses and injuries

Question 3

Accidents include (athletic accident insurance)

Answer 3

• acute, traumatic injuries, independent of any other cause or preexisting condition, that occur during practice and games

Question 4

catastrophic insurance

Answer 4

• first 75,000 in medical bills has been reached and provides lifetime medical rehab and disability coverage

Question 5

elective or diagnostic treatments

Answer 5

• can be excluded from health insurance policies

Question 6

UCR

Answer 6

usual customary and reasonable
reimbursement for medical services
- developed by the federal government to reimburse health care providers through the medicare system

Question 7

Self-insurance

Answer 7

• many national governing organizations such as the NCAA have rules that prevent educational institutions from paying da money
• no one has it because liability

Question 8

primary coverage

Answer 8

• medical or accident insurance that begins to pay for covered medical expenses as soon as the institution pays the deductible
• simplifies and accelerates claims processing because fam doesn’t need to be involved

Question 9

secondary coverage

Answer 9

• excess insurance
• pays for covered medical expenses only after all other insurance policies, including the athletes personal medical insurance have reached their limit

Question 10

third party reimbursement

Answer 10

• health care practitioners receive reimbursement from a policyholder’s insurance company for services they preform

Question 11

Health maintenance organizations

Answer 11

• provide participating health care practitioners with a fixed fee for services rendered to members

Question 12

capitation

Answer 12

system usually but not always determines fees

- patients insured by an HMO must use a primary care provider that participates in the HMO

Question 13

PPOs

Answer 13

• preferred provider organizations
• allow greater choice of health care providers and pay medical vendors on a fee for service rather than a captivated basis

Question 14

point of service plan

Answer 14

POS

- pos plans assign primary care physicians who act as gate keepers by coordinating patient care