Health Insurance Providers Chapter 13

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

Social Security Disability Income

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

The are Nonprofit Organizations

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

Medicaid

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 organization 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

Which of the following BEST describes how a Preferred ProviderOrganization PPO is Less restrictive than a health Maintenance Organization HMO

(More Physicians to choose from) PPOs Normally provide a wider choice of physicians and hospitals

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

Closed Panel

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

Dismemberment

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

Health Maintenance Organization

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

Which Type of provide is known for stressing preventative medical care?

Health Maintenance Organizations (HMOs)

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

What is Medicare?

Is a hospital and medical expense insurance program

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

PPO

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

PPOs are NOT a type of managed care systems

What does Medicare Parts A and B cover?

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

Medicare is intended for all of the following groups EXCEPT

Those enrolled as a full-time student