NHA CBCS Module 2: Insurance
Eligibility and Other Payer
Requirements
Capitation - ANSAn settlement with a issuer to receive a pre-mounted charge for health care
services to enrollees over a time frame.
Coinsurance - ANSPredetermined percent the patient is responsible to pay for protected
offerings as soon as the yearly deductible has been met.
Copayment (copay) - ANSFlat, fixed amount that a patient pays for specific offerings (e.G.,
office or emergency branch encounters).
Blanketed benefits - ANSServices mentioned in the policy that are payable by using the
fitness plan.
Deductible - ANSAnnual amount the patient should pay before the insurance will start to pay
for covered benefits.
Guarantor - ANSThe character who's liable for paying any affected person duty after the
coverage has processed a declare.
Health maintenance company (HMO) - ANSA group of gotten smaller carriers that conform
to the payment agreement for its participants.
In-community (INN) - ANSA issuer who has signed an settlement with the coverage plan.
Noncovered services - ANSServices that are not payable by the health plan.
Out-of-network (OON) - ANSA provider who does no longer have a signed settlement with
an insurance plan.
Policyholder - ANSThe individual who signs a touch with a medical health insurance
organisation.
Favored provider employer (PPO) - ANSa sort of controlled care organisation in which
providers join the community and are taken into consideration favored whilst a affected
person seeks treatment.
Premium - ANSThe amount a affected person can pay each month to receive advantages.
, Electronic scientific document (EMR) - ANSA affected person's clinical file in a virtual layout
that is living within a fitness care business enterprise.
Digital health file (EHR) - ANSa collective of scientific statistics that is used and shared with
the aid of more than one organisation or company.
People' repayment - ANSProvides benefits and wages replacements to employees who
need hospital therapy because of a piece-related harm.
Automobile insurance - ANSProtects the diver and passengers and will pay for medical
expenses and other prices (wage replacement, rental motors) related to an coincidence.
National Association of Insurance Commissioners (NAIC) - ANSIdentifies the insurance
necessities for auto coverage. Each kingdom develops their own laws as long as the minimal
requirements are met.
House owners insurance - ANSCovers the policyholder for activities that arise to the house
or non-public belongings shape, consisting of fire, water damage, robbery, or different
disasters. Also cover any liability for accidents to the owner of a house or others even as at
the assets.
Out-of-pocket fees should be paid by way of which of the following?
A) Provider
B) Patient
C) Health plan
D) Guarantor - ANSD) Guarantor
Out-of-pocket prices are the obligation of the guarantor. The health plan does now not pay
out-of-pocket fees, and the issuer and the patient won't continually be the responsible
birthday celebration for health fees.
A patient is worried in a multi-automobile twist of fate. What sort of coverage corresponds to
the situation?
A) Workers' Compensation
B) Auto coverage
C) Medical health plan
D) Homeowners coverage - ANSB) Auto insurance
Auto insurance covers the driver and/or passengers in car accidents.
A affected person falls off roof even as placing up holiday lighting fixtures. What sort of
insurance corresponds to the scenario?
A) Auto coverage
B) Homeowners insurance
C) Workers' Compensation
D) Medical fitness plan - ANSB) Homeowners coverage
Homeowners insurance covers incidents on personal property.
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