#1
What does the term 'premium' refer to in health insurance?
The amount paid annually for health insurance coverage
ExplanationAnnual payment for health insurance coverage
#2
What is a 'deductible' in health insurance?
The amount you owe for health care services before your health insurance begins to pay
ExplanationAmount to pay before insurance coverage starts
#3
Which type of health insurance plan requires you to choose a primary care physician (PCP)?
Health Maintenance Organization (HMO)
ExplanationRequires choosing a primary care physician
#4
Which term describes a network of healthcare providers that have agreed to lower their rates for plan members and meet quality standards?
Provider network
ExplanationNetwork offering discounted rates and quality
#5
What is the primary difference between 'in-network' and 'out-of-network' providers?
In-network providers have a contract with the insurance company to provide services at a discounted rate, whereas out-of-network providers do not
ExplanationIn-network: discounted rate with insurance; Out-of-network: no discounted rate
#6
What does 'out-of-pocket maximum' mean?
The most you have to pay for covered services in a plan year
ExplanationMaximum payment for covered services in a year
#7
What is 'coordination of benefits' in health insurance?
The process of determining the primary insurance when you have multiple health plans
ExplanationDetermining primary insurance with multiple plans
#8
What is 'balance billing'?
The process of billing a patient for the difference between what their health insurance chooses to reimburse and what the provider chooses to charge
ExplanationBilling patient for difference between insurance reimbursement and provider charge
#9
What does 'prior authorization' mean in the context of health insurance?
Approval needed from an insurance company before receiving certain services or medications
ExplanationInsurance approval required before certain services
#10
What is a 'formulary' in the context of health insurance?
A list of prescription drugs covered by a health insurance plan
ExplanationList of covered prescription drugs
#11
What is an 'Explanation of Benefits (EOB)'?
A document that outlines the costs covered by your insurance for a medical service
ExplanationDocument outlining covered medical costs
#12
What does the term 'capitation' refer to in healthcare?
A payment arrangement for health care service providers such as physicians, clinics, and hospitals
ExplanationPayment arrangement for healthcare providers
#13
In health insurance, what is meant by 'tiered network'?
A network of providers categorized based on the cost of care and quality of service
ExplanationProvider network categorized by cost and quality
#14
What is 'Utilization Management' in health insurance?
The process of evaluating the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities
ExplanationEvaluating necessity, appropriateness, and efficiency of healthcare services usage
#15
Which act requires the provision of emergency medical treatment regardless of the patient's ability to pay?
The Emergency Medical Treatment and Active Labor Act (EMTALA)
ExplanationRequires emergency medical treatment regardless of ability to pay