Chapter Exam 4: Health Insurance Providers

What is Medicare?

A hospital and medical expense insurance program

Medicaid was designed to assist individuals who are

Below a specific income limit

Which of these is considered a true statement regarding Medicaid?

Funded by both state and federal governments

What is the maximum Social Security Disability benefit amount an insured can receive?

100% of the Insured's Primary Insurance Amount (PIA)

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n):

Closed panel

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medial expenditures?

Commercial Insurer

Which of the following reimburses its insureds for covered medical expenses?

Commercial Insurers

Medicare Part A and Part B do NOT pay for:

Dental Work

Which of the following does social security not provide benefits for

Dismemberment

A medical care provider which typically delivers health services as its own local medical facility is known as a

Health Maintenance Organization (HMO)

Which type of provider is known for stressing preventative medical care?

Health Maintenance Organizations (HMO's)

A 66-year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?

Her group health plan

The health insurance program which is administered by each state and funded by both the federal and state governments is called:

Medicaid

Which of the following best describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?

More physicians to choose from

Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?

Obtain prior approval from the insurer for the medical service

Which of the following statements is true about most Blue Cross/ Blue Shield organizations?

They are nonprofit organizations

Medicare is intended for all of the following groups EXCEPT:

Those enrolled as a full-time student