: Chapter 12 – Health Insurance Essentials 1. Define the following terms in your own words (3.5pts): a. Policy b. Premium c. Deductible d. Co-insurance e. Copayment f. Subscriber g. Medically necessary 2. According to the federal government, there are 10 categories of essential health benefits. let 4 of them. (2pts) 3. Name the are 4 divisions of Medicare and explain what they cover. (2pts) 4. List and explain in your words, the three models of MCO’s. (3pts) 5. Explain what is common and difference between a precertification, referrals and preauthorization. (4pts) 6. Explain what is the purpose of the utilization management and utilization review committee (2pts) 7. In your own words, define the following health insurance plans. include who does the insurance plans cover. (5pts) a. Worker’s Compensation b. TriCare c. Civilian Health and Medical Program of the Veterans Administration d. CHIP e. Medicaid 8. What does abbreviations stand for and define the term in your own words? (2pts) a. QMB b. UCR c. EOB d. RBRVS 9. When setting up a fee schedule what three factors are considered? (1.5pts) 10. What program will a MA use to verify, insurance eligibility, benefits, and exclusion prior to a patient’s appointment? (Ipt) 11. In your own words, describe 4 other types of insurance. (4pts)
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