Consumer Economics Ch. 9

Stop-loss is a provision under which an insured pays a certain amount, after which the insurance company pays _____ percent of the remaining covered expenses.

100

A "good" health insurance plan pays what percentage of out-of-hospital expenses once a yearly deductible for the individual and family have been met?

80%

Which of the following factors has not been attributed to increasing health care costs?

A focus on healthy living options

What qualifications must you have to be eligible for Medicare?

Be 65 or older Be under age 65 with certain disabilities

Which type of insurance provides reimbursement for the expense of services and supplies and encourages preventive care for teeth?

Dental expense insurance

What are the sources of disability income coverage?

Employer plans Social Security Worker's compensation

_____ is the process of paying a premium in exchange for financial protection.

Insurance

Which of the following is a government health care program?

Medicare

Blue Cross and Blue Shield are:

Statewide organizations.

A provision under which the insurer and insured share the covered losses (for example, you pay 25 percent) is called:

coinsurance.

A provision under which the insured pays a flat dollar amount each time a covered medical service is received is called:

copayment

Long-term care insurance provides coverage for:

daily help

An amount the insured must pay before benefits become payable by the insurance company is called a:

deductible

Health reimbursements accounts (HRAs) are tied to high _____ insurance policies.

deductible

Age, marital status, and dependency requirements are usually specified in the ______ provision of an insurance policy.

eligibility

Medicare _____ insurance is financed from a portion of Social Security taxes.

hospital

Similar to car and life insurance, the individual pays a(n) _____ for health insurance in exchange for some degree of financial

premium

Preventive care for an HMO includes checkups, screening, testing, and routine _____.

vaccines

Supplemental health services for an HMO include

vision care prescription services

The money in a flexible spending account must be used for health care and used by the end of the _____

year

What is a typical copayment amount for individuals?

$20-40

The majority of people who draw on Medicare are _____ years of age or older.

65

______ cuts down on paperwork and time by allowing your insurance company to pay the hospital or doctor before you receive the bill from them.

Assigning benefits

Name an independent, nonprofit membership corporation that provides protection against the cost of hospital care.

Blue Cross

Name an independent, nonprofit membership corporation that provides protection against the cost of surgical and medical care (not hospital care).

Blue Shield

Which type of insurance is complete major medical insurance that has a very low deductible?

Comprehensive

_____ income insurance provides regular cash income when an insured person is unable to work because of pregnancy, a non-work-related accident, or an illness.

Disability

Which insurance provides payments to replace income when an insured person is unable to work for a long period of time?

Disability income insurance

Under the Patient Protection and Affordable Care Act of 2010, which of the following is NOT correct?

Employers must offer continuing coverage through COBRA for up to 24 months after you leave your job.

Health insurance coverage is only available from private insurance companies.

False

Most private insurance companies do not provide group policies.

False

The hospital indemnity policy is a major medical protection.

False

Your work-related expenses and taxes will likely not decrease during a period of disability.

False

The duration of benefits for a disability income insurance plan can be:

For only a few years. Until age 65. For life.

Which of the following activities have been undertaken by health care professionals and consumers to keep the overall cost of health care down?

Getting involved in community health planning Offering incentives to encourage preventive care Initiating community health education programs

Which of the following is a plan that is funded solely by employers and gives you a pool of money to spend on health care?

Health reimbursement account

______ allow you to contribute money to a tax-free account that can be used for out-of-pocket health care expenses if you buy high-deductible health insurance policies to cover catastrophic expenses.

Health savings accounts (HSAs)

_____ expense coverage pays for some or all of the daily costs of room and board during a hospital stay.

Hospital

Which type of insurance pays part or all of hospital bills for room, board, and other charges?

Hospital expense insurance

Which type of policy pays benefits when you are hospitalized that are in cash that you can spend as you choose?

Hospital indemnity policy

_____-term care insurance provides day-in day-out care for extended illness or disability. (Enter one word per blank.)

Long

_____ medical expense insurance pays the large costs involved in long hospital stays and multiple surgeries, and it covers every type of care and treatment prescribed by a physician, in and out of a hospital.

Major

Which type of insurance pays the larger expenses of a serious injury or long illness, including those covered by the hospital, surgical, and physician expense policies, beyond those paid by basic health insurance?

Major medical expense insurance

Which part of Medicare helps pay for doctors' services and a variety of other health services and supplies?

Medical (Part B)

Which insurance supplements Medicare by filling the difference between Medicare payments and medical costs not covered by Medicare?

Medigap insurance

Which part of Medicare is voluntary and covers prescription drugs?

Part D

A "good" health insurance policy provides which of the following?

Pay at least 80 percent of out-of-hospital expenses after a yearly deductible of $1,000 per person or $2,000 per family Offer basic coverage for hospital and doctor bills

Which type of insurance covers only doctors' fees for nonsurgical care, X rays, and lab tests?

Physician expense insurance

Which two groups pay the majority of the nation's health care bill, leading to a lack of incentives to cut down on costs?

Private health insurers Government

Which of the following is a provision of the Patient Protection and Affordable Care Act?

Requires health insurance companies to submit justification for all requested premium increases

Which type of insurance pays part or all of the surgeon's fees for an operation?

Surgical expense insurance

The type of health insurance coverage that may specify the maximum payment amount for each type of operation is:

Surgical expense.

Identify ways in which you can personally reduce your health care costs.

Take sufficient rest. Exercise regularly. Avoid smoking. Eat a balanced diet to keep weight under control.

Which of the following is part of the Patient Protection and Affordable Care Act?

Tax credits for small business Bans insurance companies from dropping people when they get sick Prohibits denying coverage to children with preexisting medical conditions

What are some of the factors that have led to increasing health care costs?

The cost of prescription drugs An aging population An increased number of uninsured individuals

Copayment is the provision under which the insured pays a flat dollar amount each time a covered medical service is received.

True

Health insurance is one way people protect themselves against economic losses due to illness, accident, or disability.

True

Physician expense insurance provides benefits for which of the following?

X rays, Lab tests, Doctors' fees for nonsurgical care

Part _____ of Medicare covers all services for inpatient hospital care after you pay a single deductible.

a

When selecting disability income insurance, you will want to select a policy that will replace Blank______ your income.

all of

When you _____ benefits, you sign a paper allowing your insurance company to make payments directly to your doctor or hospital.

assign

Medicare Part _____ covers many doctors' services and other health services not covered by Part A.

b

A combination of hospital expense insurance, physician expense insurance, and surgical expense insurance is called:

basic health insurance

Group health insurance provided by employers is often part of an employee's:

benefit package

In order to contain health care costs, physicians are encouraging consumers to pay with _____ for routine medical care and lab services.

cash

In most group health insurance plans, the employees pay part of the premium and the _____ pays the remainder.

employer

In a group health insurance plan arrangement, ______ and ______ are most likely to pay for the cost of health care.

employers, employees

_____ health services for an HMO include vision and prescription services.

extra

A health maintenance organization (HMO) is a health insurance plan that provides a wide range of health care services for a(n) ________ monthly premium.

fixed prepaid

Employers typically provide health insurance called _____ health insurance. (Enter one word per blank.)

group

Most private insurance companies are providers of _____ health insurance policies through employers.

group

Blue Cross is an independent, nonprofit membership corporation that provides protection against the cost of _____ care

health

Blue Cross is an independent, nonprofit membership corporation that provides protection against the cost of _____ care.

health

_____ savings accounts allow you to contribute money to a tax-free account that can be used for out-of-pocket health care expenses if you buy high-deductible health insurance policies to cover catastrophic expenses.

health

By exercising, not smoking, getting rest, and driving carefully, individuals can greatly reduce their:

health care costs

A health insurance plan that provides a wide range of health care services for a fixed prepaid monthly premium is called a:

health maintenance organization (HMO)

Health insurance coverage is available from:

hospital service plans government programs private insurance health maintenance organizations

Because third parties, private health insurers, and the government pay such a large part of the nations health insurance bill, there is a lack of ______ to make the most economical use of the health care system.

incentive

The deductible is an amount the policyholder must pay before benefits become payable by the _____ company.

insurance

Coinsurance is a provision under which the ______ share the covered losses.

insurer and the insured

The eligibility provision defines who:

is entitled to benefits under the policy

Comprehensive major medical insurance policies are complete insurance policies offering a very _____ deductible.

low

With disability plans, the longer the waiting period, the _____ the premiums.

lower

Prepaid health plans that provide comprehensive health care to members are called

managed care.

_____ insurance makes up the difference between Medicare payments and medical costs not covered by Medicare by providing supplemental insurance.

medigap

Surgical expense insurance pays part or all of surgeons' fees for a(n)

operation

Under _____ _____ coverage of Medicare, plans cover different drugs and medically necessary drugs must be covered.

part d

A network of selected contracted participating providers, also called an HMO-PPO hybrid, is a _____ -of-service plan.

point

A network of selected contracted participating providers, also called an HMO-PPO hybrid, is a:

point-of-service plan

A preferred provider organization (PPO) is a group of doctors and hospitals that agree to provide health care to members at _____ fees

prearranged

A group of doctors and hospitals that agree to provide health care to members at prearranged fees is called a

preferred provider organization.

Flexible spending accounts allow you to contribute ______ dollars to an account managed by your employer.

pretax

Dental expense insurance provides reimbursement for the expense of services and supplies and encourages _____ dental care.

preventative

The sources of disability income coverage include worker's compensation, employer group insurance plans, and _____ Security.

social

A provision under which an insured pays all costs up to a certain amount, after which the insurance company pays 100% of the remaining covered expenses, is called a:

stop-loss

Blue Shield is an independent, nonprofit membership corporation that provides benefits for _____ and medical services performed by physicians.

surgery

Basic health services for an HMO include inpatient and outpatient services such as:

surgery hospitalization emergency care

Basic health insurance coverage is a combination of:

surgical expense insurance hospital expense insurance physician expense insurance