MISSISSIPPI INSURANCE TEST COMPLETE QUESTIONS & ANSWERS (GRADED A).Buy Quality Materials!
Co-insurance
After the deductible has been met, the policyholder may need to pay a certain percentage of the bill and the insurance company pays the rest. A typical split is 80/20 - the insurance company...
Co-insurance
After the deductible has been met, the policyholder may need to pay a certain
percentage of the bill and the insurance company pays the rest. A typical split is 80/20 -
the insurance company pays 80%, and the policyholder pays 20%.
who qualifies for Medicaid
Low-income families • Qualified pregnant women and children • Recipients of
Temporary Assistance for Needy Families (TANF) • Individuals who receive
Supplemental Security Income (SSI) • Individuals who receive certain types of federal
and state aid • Individuals who are Qualified Medicare Beneficiaries (QMBs) - Medicaid
pays for Medicare Part B premiums, deductibles, and co-insurance for qualified low-
income elderly individuals • Individuals in institutions or receiving long-term care in
nursing facilities and intermediate-care facilities Vocabulary
provider network
An approved list of physicians, hospitals, and other providers. preauthorization needed
for expensive services
waiting period
The length of time a patient waits for disability insurance to pay after the date of injury.
beneficiary
A designated person who receives funds from an insurance policy.
online insurance web portal
An online service provided by various insurance companies for providers to look up a
patient's insurance benefits, eligibility, claims status, and explanation of benefits.
utilization management
A decision-making process used by managed care organizations to manage healthcare
costs. It involves case-by-case assessments of the appropriateness of care.
capitation
A payment arrangement for healthcare providers. The provider is paid a set amount for
each enrolled person assigned to him or her, per period of time, whether or not that
person has received services.
Exclusive Provider Organization (EPO)
Patients with EPO coverage will not be covered for services outside the designated
network of providers (unless emergency) no referral needed
2 types of TRICARE
TRICARE Prime and TRICARE Select
What is the requirements for a government health insurance plans patients to
qualify ?
-Age
-Income
-Government occupation
-Health condition
Medicare Part B is
80% of the allowed amount after deductible
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