Xcel 2 EXAM (Health Insurance Providers)

5. What is Medicare?

A hospital and medical expense insurance program

3. 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

9. 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

7. 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

2. What does Medicare Parts A and B cover?

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

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

They are nonprofit organizations

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

closed panel

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

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

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

Health Maintenance Organization

8. 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