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Health Care Jeopardy Traditional Consumer Health Care Health Care Terminology Directed Pot Luck Trends Plans Health Plans 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 What is a PPO? Traditional Health Care Plans: 100 This plan offers the most flexibility, usually at a higher cost. What is an indemnity plan? Traditional Health Care Plans: 200 This plan does not contain a network of doctors. What is a point of service (POS) plan? DAILY DOUBLE !! Traditional Health Care Plans: 300 This plan is a hybrid of an HMO and a PPO. What is a fully-funded plan? Traditional Health Care Plans: 400 This insurance funding option is for employers that want to transfer the risk. What are consumer directed health plans (CDHP)? Traditional Health Care Plans: 500 These insurance plans are designed to give consumers greater financial control over their health care. What is a summary plan description? Terminology: 100 This is a booklet containing the benefits, terms and features of a health insurance plan. What is a deductible? Terminology: 200 This is the amount of money a member must pay before insurance benefits begin. What is the out-of-pocket maximum? Terminology: 300 This is the set limit of costs paid by the member that are not covered by insurance. What is a pre-existing condition? Terminology: 400 This is an injury of illness for which a member was treated within the 6 months prior to obtaining health insurance coverage. This injury or illness might be excluded from coverage for a designated period of time. What is Usual, Customary & Reasonable (UCR)? Terminology: 500 This is the amount commonly charged for a particular medical service by the physicians within a particular geographic region. Who are healthy individuals and those who are not on maintenance medication? Consumer-Directed Health Plans: 100 Consumer-directed health plans benefit these types of individuals. What is a health savings account (HSA)? Consumer-Directed Health Plans: 200 This plan is portable and owned by the employee. (i.e., the employee can take this plan with him/her to another employer). What is a health reimbursement account (HRA)? Consumer-Directed Health Plans: 300 This plan is owned by the employer, and contributions are made solely by the employer. What is a health reimbursement account (HRA)? Consumer-Directed Health Plans: 400 This consumer-directed plan can be paired with any type of health insurance plan (i.e., it does not have to be paired with a high-deductible health plan). What is $1,100 (single coverage)? or What is $2,200 (family coverage)? Either answer is sufficient. Consumer-Directed Health Plans: 500 In 2008, a health insurance plan must have a minimum deductible of this amount to be considered a High Deductible Plan. What are indemnity plans? Health Care Trends: 100 These plans were popular in the ‘80s, but are not commonly offered by employers today. What is an increase of nearly double? DAILY DOUBLE !! Health Care Trends: 200 According to a Blue Cross survey, national expenditures are expected to increase by how much over the next ten years? What is 3 – 5 times as much? Health Care Trends: 300 On average, employers spend as much as _____ times as much as employees on health care. What is 10% of the employers who offer health insurance? Health Care Trends: 400 According to the Kaiser survey, this percentage of employers offer a consumer-directed health plan to their employees. Increase the amount workers contribute to premiums Increase deductible amounts Increase office visit cost sharing Health Care Trends: 500 According to the Kaiser survey, employers are doing these three things to cut the cost of health care. What are educate members and work with management to select a health plan? Pot Luck: 100 These are two things affiliate leaders can do to be health care activists for their locals. What are generic drugs? Pot Luck: 200 These are FDA-approved, equivalent versions of brand-name drugs that are offered to consumers when the patent of the brand name drug expires. What is a formulary? Pot Luck: 300 This is a list of generic and brand-name drugs that are approved by a health insurance plan. What is an explanation of benefits (EOB)? Pot Luck: 400 This is a document provided to a member in response to filing a claim for a medical service. This document lists the costs associated with this service. What is stop loss or reinsurance? Pot Luck: 500 If an employer decides to self-fund an insurance plan, it must purchase this type of insurance to cover catastrophic events.
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