Answer-Integrated Exam Hmap 163 Health Insurance 2024/2025
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Course
HMAP 163
Institution
College Of The Rockies (COTR
)
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: ...
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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College of the Rockies (COTR
)
HMAP 163
HMAP 163
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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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