Chapter 12 Health Insurance Essentials

The amount of money the policy holder pays per claim on per accident torward the totally amount of an insured loss before the company will pay on the claim is known as the

Deductible

Medigap policies cover which of the following?

Difference between major medical reimbursement and patient financial responsibilities

The tricare option that is similar to a preferred provider network is tricare

Extra

Which of the following is not an advantage of managed care

Access to specialized care and referrals is limited

Health insurance benefits are determined by?

All the above

The medical assistant should verify which of the following prior to the patients appointment?

All the above

The maximum amount of money third-party layers will pay for a specific procedure or service is called the

Allowable amount

Which of the following is not a disadvantage of managed care ?

Authorized services usually are covered

The amount payable by an insurance company for a monetary loss to an individual insured by that company under each coverage is called the

Benefits

Most of today's health insurance policies cover which of the following?

Both A and B

Which of the following plans require healthcare providers to become participating providers?

Both A and B

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether he person sees the provider that month, is called a. plan.

Capitation

Veterans of the US armed forces may be covered by

ChampVA

The amount of money paid to keep an insurance policy in force is the?

Co-pay

Which type of HMO model consist of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

Independent practice association

The federal and state sponsored health insurance program for the medically indigent is called

Medicaid

Which part of Medicare covers prescription services?

Part D

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a Providers

Participating

Which of the following expenses would be paid by Medicare Part B?

Physicians office visits

Which type of referral is usually processed immediately?

STAT

Employee sponsored group policies usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However there employee sponsored group health insurance plans offer limit benefits and healthcare access is limited to health care providers that are contracted with them

The first statement is false, the second is true

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called

Third party payers

Health insurance designed for military dependents and military personnel is called?

Tricare

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called

Utilization review

A type of insurance that protects workers from loss of wages after an industrial accident that happened on he job is called?

Workers compensation

Which of the following individuals would not normally be eligible for Medicare?

A 23 year old recipient of AFDC

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called?

Group policy

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

HMOs

Which of the following pays the hospital surgical room fee?

Hospital

Organizations that fund their own insurance programs offer their employees

Self-funded plans

Which of the following HMO modes hires physicians and pays them a salary rather than contracting the physicians to create a network?

Staff model