Financial Planning Chapter 9

Individual practice association (IPA)

A form of HMO in which subscribes receive services from physicians practicing from their own offices and community hospitals affiliated with the IPA

Management Care Plan

A health care plan in which subscribers/users contract with the provider organization, which uses a designated group of providers meeting specific standards to furnish health care services for a monthly fee

Medicare

A health insurance plan administered by the federal government to help persons age 65 and over, and others receiving monthly Social Security disability benefits, to meet their health care costs

Preferred Provider Organization

A health provider that combines the characteristics of the IPA form of HMO with an indemnity plan to provide comprehensive health care services to its subscribers within a network of physicians and hospitals

Preferred provider organization (PPO)

A health provider that combines the characteristics of the IPA of HMO with an indemnity plan to provide comprehensive health care services to its subscribers within a network of physicians and hospitals

Point-of-Service plan

A hybrid form of HMO that allows members to go outside the HMO network for care and reimburses them at a specified percentage of the cost

Exclusive Provider Organization

A managed care plan that is similar to a PPO but reimburses members only when affiliated providers are used

Medicaid

A state-run public assistance program that provides health insurance benefits only to those who are unable to pay for health care

Health Savings Account (HAS)

A tax-free savings account—funded by employees, employer, or both—to spend on routine medical costs. Usually combined with a high deductible policy to pay for catastrophic care.

Prescription drug coverage

A voluntary program under Medicare (commonly called Part D), insurance that covers both brand-name and generic prescription drugs at participating pharmacies

Supplementary Medical Insurance

A voluntary program under Medicare that provides payments for services not covered under basic hospital insurance

Group HMO

An HMO that provides health care services from a central facility; most prevalent in large cities

Health Reimbursement Account (HRA)

An account into which employers place contributions that employees can use to pay for medical expenses. Usually combined with a high-deductible health insurance policy.

Major Medical Plan

An insurance plan designed to supplement the basic coverage of hospitalization, surgical, and physician expenses; used to finance more catastrophic medical costs

Health maintenance organization (HMO)

An organization of hospitals, physicians, and other health care providers who have joined to provide comprehensive health care services to its members, who pay a monthly fee

Indemnity (fee-for-service) plan

Health care insurance plan in which the health care provider is separate from the insurer, who pays the provider or reimburses you for a specified percentage of the expenses after a deductible amount has been met

Group Health Insurance

Health insurance consisting of contracts written between a group, and the health care provider

Workers' Compensation Insurance

Health insurance required by state and federal governments and paid nearly in full by employers in most states; it compensates workers for job-related illness or injury

Blue Cross/Blue Shield plans

Prepaid hospital and medical expense plans under which health care services are provided to plan participants by member hospitals and physicians