Integrated Health Systems - ANSWERComprised of physicians, multi-specialty physicians, entire hospitals and ancillary service providers.
HIPAA - ANSWERImportant role in protecting sensitive patient information.
Delta Dental Plans - ANSWERCover the largest share of the dental benefits populati...
Integrated Health Systems - ANSWERComprised of physicians, multi-specialty physicians, entire
hospitals and ancillary service providers.
HIPAA - ANSWERImportant role in protecting sensitive patient information.
Delta Dental Plans - ANSWERCover the largest share of the dental benefits population
Restorative Treatment - ANSWERRepair of a natural tooth
Local Community - ANSWERLargest Impact on Healthcare delivery
Life-style drug benefits? - ANSWERRoutinely exluded from all plans
Preadmission testing - ANSWERImpacts hospitol operations by allowing for more effective use of
beds and personnel.
Plan Sponsor Self-Funded HMO - ANSWEREPO-Exclusive Provider Organization
Subrogation clause - ANSWERClause that allows an employer(insurer) to recieve reimbursement
when a covered employee receives money in a civil action.
Managed Care - ANSWERMostly used when referring to Health Maintenance Organizations HMOs
Pharmacy Spread - ANSWERDifference between the amount the PBM-Pharmacy Benefit Manager
collects and the amount the IBM pays out to the pharmacy.
, MBHO-Managed Behavioral Health Care Organization - ANSWERA behavior health care carve-out
program operates with a separate contract from a company.
Which risk techniques are being used if a co. decides not to produce something dangerous and
instead gets insurance and installs a sprinkler system? - ANSWERAvoidance, retention, insurance and
control.
Total Compensation - ANSWERAll forms of direct and indirect compensation from the employer.
Rx Drug Rebates - ANSWERAn agreement between a PBM and the drug manufacturer
Insurance rating technique used by HMOs - ANSWERAdjusted Community Rating uses utilization
patterns in a geographical area and then modifies for better rates.
Standard Indemnity - ANSWERNo steerage, no restrictions and no utilization management.
Benefit-orientated Philosophy - ANSWERFocuses its design on the needs of employees.
Indemnification - ANSWERMakes victims of losses whole again.
Deductible - ANSWERAmount the participant must incur before the plan kicks in.
Control - ANSWERSomeone attempts to either prevent or reduce the probability of a loss. (Reduce
the severity)
Grand Accreditation to MBHOs by the NCQA - ANSWERThe National Commitee of Quality Assurance
grants a Full accreditation and it is effective for 3 years.
HSA Maximum - ANSWERA fixed indexed amount -Annual
FSAs - ANSWERContributions may be held in the company's general asset account.
Tangible Incentive Award - ANSWERAvoidance of costs -deductibles or premiums.
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