Health Insurance Provides

What is Medicare?

A hospital and medical expense insurance program

J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a preset price. What type of plan does J belong to?

Health Maintenance Organization A Health Maintenance Organization (HMO) contracts with doctors and hospitals to provide medical benefits to subscribers at a predetermined price

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

Health Maintenance Organization Health Maintenance Organizations (HMO's) traditionally provide services to its members at its own local health care facilities.

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

Health Maintenance Organizations (HMO's)

Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?

PPO

Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?

PPO's are NOT a type of managed care systems

Medicaid was designed to assist individuals who are:

below a specific income limit

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

closed panel A closed panel is when an HMO is represented by a group of physicians who are salaried employees and work out of the HMO's facility.

Medicare Part A and Part B do NOT pay for:

dental work

Which of the following does Social Security NOT provide benefits for?

dismemberment

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a:

primary care physician

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

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

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

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

Commercial insurer

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

Commercial insurers Commercial insurance companies function on the reimbursement approach. Policyowners obtain medical treatment from whatever source they feel is most appropriate and submit their charges to their insurer for reimbursement.

Which of these is considered a true statement regarding Medicaid?

Funded by both state and federal governments

Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?

HMO

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 If the employer has more than 20 employees, the group health plan generally pays first.

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 PPO's normally provide a wider choice of physicians and hospitals.

What does Medicare Parts A and B cover?

Part A covers hospitalization; Part B covers doctor's services

The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs?

Social Security Disability Income Social Security Disability Income pays benefits that are based on a percentage of an individual's Primary Insurance Amount (PIA).

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