Solved

Match the Definition in the Left Column with Its Correct

Question 72

Matching

Match the definition in the left column with its correct term in the right column. Options will only be used once.

Premises:

Responses:

A cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses

group contract

Expense that must be incurred by an insured person before an insurer will assume any liability for the covered services

copayment

Approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both

prospective payment system

A prepaid plan that both finances and delivers health care

deductible

A group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee

HMO

Health insurance contract that is made with an employer and covers a group of employees

reimbursement

A payment system under which hospitals are paid a fixed sum per case

coinsurance

Payment made by a third party

managed-care system

Portion of the charge for medical services that the patient must pay

capitation

A predetermined fee paid per enrollee per month to the participating health care provider

PPO

Premises:

A cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses

Expense that must be incurred by an insured person before an insurer will assume any liability for the covered services

Approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both

A prepaid plan that both finances and delivers health care

A group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee

Health insurance contract that is made with an employer and covers a group of employees

A payment system under which hospitals are paid a fixed sum per case

Payment made by a third party

Portion of the charge for medical services that the patient must pay

A predetermined fee paid per enrollee per month to the participating health care provider

Responses:

group contract

copayment

prospective payment system

deductible

HMO

reimbursement

coinsurance

managed-care system

capitation

PPO

Correct Answer:

Premises:

Responses:

A cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses

Expense that must be incurred by an insured person before an insurer will assume any liability for the covered services

Approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both

A prepaid plan that both finances and delivers health care

A group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee

Health insurance contract that is made with an employer and covers a group of employees

A payment system under which hospitals are paid a fixed sum per case

Payment made by a third party

Portion of the charge for medical services that the patient must pay

A predetermined fee paid per enrollee per month to the participating health care provider