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Answer-Integrated Exam Hmap 163 Health Insurance 2024/2025 CA$19.32
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Exam (elaborations)

Answer-Integrated Exam Hmap 163 Health Insurance 2024/2025
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Premium Answer: Amount the policy holder pays to the insurance company to keep the policy in effect Subscriber/Policy Holder Answer: the person who owns the policy insured/beneficiaries Answer: the persons covered under the insurance policy guarantor Answer: ...

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  • August 28, 2024
  • 6
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

  • hmap 163
  • answer integrated exam hmap 163 health insurance 2
  • hmap 163 health insurance 2
  • answer integrated exam hmap 163
  • hmap 163 health insurance 2

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Answer-Integrated Exam Hmap 163 Health
Insurance 2024/2025

Premium Answer: Amount the policy holder pays to the insurance company to keep the policy in
effect



Subscriber/Policy Holder Answer: the person who owns the policy



insured/beneficiaries Answer: the persons covered under the insurance policy



guarantor Answer: person who is responsible for the out of pocket expenses and is not always the
same as the insured



In Network/Participating Provider Answer: Provider who has a contract with the insurance company
and agrees to accept the allowed payment amounts by the insurance as full payment.



Out of Network/Non Participating Provider Answer: Not under contract. Can balance bill



balance bill Answer: patient is billed for the difference between what the services costs and what
insurance will pay



deductible Answer: it is the amount of expenses that must be paid out of pocket before an insurer
will cover any expenses



coinsurance Answer: percentage of services that the patient is responsible for paying

, copayment Answer: specific charge that your health insurance plan may require that you pay for a
specific medical service or supply



pre-existing condition Answer: a medical condition that existed before you obtained health
insurance



exclusions Answer: items that may or may not be paid for by insurance



precertification Answer: confirming that the procedure is covered under the policy



preauthorization Answer: prior approval from the insurance company that they will pay for the
services and that medical necessity has been met



predetermination Answer: determining the maximum dollar amount that the insurance company
will pay



Coordination of benefits Answer: used to establish the order in which health insurance plans pay
claims when more than one plan exists



UCR Answer: usual, customary, and reasonable (amount paid for the medical service in a geographic
area based on what providers in the area usually charge for the same or similar medical service)



What is the Blue Cross Blue Shield Answer: it is a commercial health insurance owned and run by
private companies that control the price of premiums paid and specify the benefits they will provide



Blue cross Answer: hospital



blue shield Answer: providers

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