HSC 310 Exam 3 Questions and Correct Answers
What is the typical amount for stop loss provision? - Answer- Typically $2,500
HMO stands for _____ - Answer- Health Maintenance Organization
HMO definition - Answer- - must use in-network providers
-Must get a referral to a specialist
- no...
What is the typical amount for stop loss provision? - Answer- Typically $2,500
HMO stands for _____ - Answer- Health Maintenance Organization
HMO definition - Answer- - must use in-network providers
-Must get a referral to a specialist
- no deductibles
- more affordable due to restrictions
- less choice
Do HMO's have deductibles? - Answer- No, HMO's don't have deductibles
PPO stands for ____. - Answer- Preferred Provider Organization
PPO definition - Answer- Most common
Can seek care outside of network but it will cost more
Don't need a referral
Does a PPO need a referral? - Answer- Yes
What has more freedom of choice? HMO or PPO? - Answer- PPO
What is the most common managed care in the United States? - Answer- PPO
Risk - Answer- Refers to the possibility of a substantial financial loss from some event
Ensured - Answer- Somebody who is protected by insurance against the financial loss
Enrollee/Beneficiary - Answer- Usually parents because they own insurance account
Underwriting - Answer- Systematic technique for evaluating, selecting (or rejecting),
classifying, and rating risks
Cost Sharing - Answer- Sharing of costs of health care so that the insurer assumes at
least part of the risk
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