Xcel #2-Health Insurance Providers

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? HMO PPO EPO PLHSO

PPO

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures? Administrative-services-only plan Commercial insurer Preferred provider organization Health maintenance organization

commercial insurer

Which of the following reimburses its insureds for covered medical expenses? Health maintenance organizations Preferred provider organizations Commercial insurers Service providers

commercial insurers

Medicare Part A and Part B do NOT pay for dental work hospitalization skilled nursing care physical therapy

dental work

Which of the following does Social Security NOT provide benefits for? Survivorship Dismemberment Disability Retirement

dismemberment

Which of these is considered a true statement regarding Medicaid? -Funded by both state and federal governments -Intended to be used by individuals age 65 and older -Provides disability income benefits -Automatically covers those receiving Social Security disability benefits

funded by both state and federal governments

A medical care provider which typically delivers health services at its own local medical facility is known as a Health Maintenance Organization Regional Provider Multiple Employer Trust Preferred Provider Organization

health maintenance organization

J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to? Multiple Employer Welfare Arrangement Multiple Employer Trust Health Maintenance Organization Co-op Arrangement

health maintenance organizations

Which type of provider is known for stressing preventative medical care? Multiple Employer Welfare Arrangements (MEWA) Major medical provider Health Maintenance Organizations (HMO's) Preferred Provider Organizations (PPO's)

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? Medicaid Long-term care Medicare Her group health plan

her group health plan

Medicare - is a disability program -is a hospital and medical expense insurance program -offers assistance in making health insurance premiums -Part D provides payment for surgeon expenses

is a hospital and medical expense insurance program

The health insurance program which is administered by each state and funded by both the federal and state governments is called Long-term care Medicaid Medicare Supplemental Program Medicare

medicaid

Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)? Typically not subject to deductibles Not regulated by the federal government More benefits available More physicians to choose from

more physicians to choose from

What does Medicare Parts A and B cover? - Part A covers hospitalization; Part B covers long-term care -Part A covers doctor's services; Part B covers hospitalization -Part A covers hospitalization; Part B covers doctor's services -Part A covers prescription drugs; Part B covers disability

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 Medicare Supplements Medicaid COBRA

social security disability income

What is the maximum Social Security Disability benefit amount an insured can receive? -50% of the insured's Primary Insurance Amount (PIA) -75% of the insured's Primary Insurance Amount (PIA) -100% of the insured's Primary Insurance Amount (PIA) -100% of the insured's Primary Insurance Amount (PIA) minus any monies received from a retirement plan

100% of the insured's primary insurance amount (PIA)

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? PPO HMO MEWA POS

HMO(health maintenance organization)

Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)? - PPO's normally have more providers to chose from as compared to an HMO -Prices are negotiated in advance for PPO providers -In-network PPO providers offer members better coverage of incurred expenses -PPO's are NOT a type of managed care systems

PPO's are NOT a type of managed care systems

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a Physician's assistant Primary Care Physician Secondary Care Physician Third Party Administrator

Primary Care Physician

Medicaid was designed to assist individuals who are Federal employees disabled in poor health below a specific income limit

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 open panel co-op panel capitation panel

closed panel

Which of the following statements is true about most Blue Cross/Blue Shield organizations? They are the same as private insurance companies They are federally sponsored They are nonprofit organizations They are owned by hospitals and physicians

they are nonprofit organizations

Medicare is intended for all of the following groups EXCEPT - Those enrolled as a full-time student -Those receiving Social Security disability benefits for at least 24 months -Those afflicted with chronic kidney failure -Those 65 and older

those enrolled as a full-time student