XCEL Chapter 12

Medicare Part A does not pay for medical benefits provided for treatment in a skilled nursing facility beyond? A. 30 days B. 60 days C. 100 days D. 120 days

100 days

Part A Hospital expense coverage provided under Medicare is automatically made available to each of the following EXCEPT A. A 50-year old individual who has qualified for SSDI in the last 24 months B. A 70-year old NOT eligible for Social Security C. A 55-year old suffering from kidney failure D. A 65-year old retiree

A 70-year old NOT eligible for Social Security

Which of the following is a health insuring corporation (HIC) provider of specialty care? A. A neurologist B. The admissions nurse at a designated HIC provider hospital C. An HIC medical director D. A preferred provider organization (PPO) director

A neurologist

All of the following statements about HIC's are true EXCEPT A. Routine physical examinations usually are covered B. These plans may be established by health care providers C. Benefits include both physician and hospital care D. Benefits usually are provided on a reimbursement basis

Benefits usually are provided on a reimbursement basis

Maria is a Preferred Provider Organization (PPO) subscriber and received care from an out-of-network provider. Which of the following is the likely result? A. Care is covered B. Care is not covered C. Care is only covered in a government facility D. Care is only covered if primary care physician gives a referral

Care is covered

Which of these is NOT a qualifying event for Medicare? A. On Social Security disability for over 2 years B. Kidney failure C. Age 65 or older D. Falling below the federal poverty level

Falling below the federal poverty level

A health care provider claim may be settled using which of the following payment methods? A. Litigation B. Unfair claim settlement C. Fee-for-service D. Prepaid expense

Fee-for-service

All of the following preventative care services are provided by health insuring corporation (HIC) primary care physicians EXCEPT? A. Well-baby checkups B. Immunizations for children C. Hearing screenings for adults D. Physical examinations

Hearing screenings for adults

Which of the following is NOT taken into consideration when determining eligibility for Medicare benefits? A. Chronic kidney disease B. Income C. Age D. Social Security disability

Income

According to Ohio HIC laws, confidentiality of health information applies to? A. Information supplied by an employer ONLY B. Information supplied both by the covered individual and by providers C. Information supplied by the covered individual ONLY D. Certain kinds of medical information ONLY

Information supplied both by the covered individual and by providers

Donna and Mary were racing bicycles in a store parking lot while being cheered on by fellow employees. Mary ran into John, another employee, who happened to be taking out the garbage. Both Mary and John are injured. Who would most likely be covered under Workers' Compensation? A. John B. Mary C. John and Mary D. Neither of them

John

Small employers who are sponsored by an insurer to provide group benefits to its employees are called? A. Fraternal Benefit Society B. Surplus lines brokers C. Lloyd of London D. MEWA

MEWA

Which of the following is Medicare Part B also known as? A. Hospital insurance B. Medical insurance C. Long-term care insurance D. Medigap

Medical insurance

Which of the following is a legal entity created for the sole purpose of providing affordable group health coverage to its participants? A. Multiple Employer Welfare Arrangement (MEWA) B. Multiple Trust Arrangement (MTA) C. Multiple Purchasing Groups (MPG) D. Fraternal Benefit Society

Multiple Employer Welfare Arrangement (MEWA)

Which payment method for a health claim settlement is typically made directly to the provider of the services? A. Settlement B. Fee-for-service C. Premium payment D. Prepaid

Prepaid

A health insuring corporation (HIC) member receives all preventative and routine medical care from the? A. Primary care physician B. Medical director C. Routine care physician D. Provider association

Primary care physician

Hospital care under a typical health insuring corporation (HIC) plan includes all of the following EXCEPT A. Private duty nursing B. In-hospital laboratory work and x-rays C. Inpatient laboratory services D. Inpatient mental health care

Private duty nursing

Under Ohio law, an HIC may release a subscriber's confidential medical information for any of the following reasons EXCEPT? A. Consent of the subscriber B. A court order C. Public interest D. Litigation between the enrollee and the HIC

Public interest

All of the following doctors provide primary care to health insuring corporation (HIC) members EXCEPT? A. Internists B. Surgeons C. General practitioners D. Pediatricians

Surgeons

An individual can enroll in a Part C Medicare Advantage Plan at what time? A. When becoming eligible for Medicaid B. At age of retirement C. Age 59 1/2 D. When becoming eligible for Medicare

When becoming eligible for Medicare

A 70-year old insured individual has suffered from kidney failure for the past 24 months. She is covered by her spouse's large-group employer plan. How will Medicare be utilized in this situation? A. Will be the primary insurer and pay for 100% of covered expenses B. Will be the secondary insurer and pay for claims not fully covered by the group plan C. Will not pay for any of the covered expenses D. Will be the primary insurer and the group plan will be secondary

Will be the secondary insurer and pay for claims not fully covered by the group plan

What type of injury would NOT be covered under a health insurance policy? A. Accidental B. Work-related C. Sports-related D. Recreational

Work-related

Medicare Part B covers? A. long-term care B. hospital room and board C. doctor's charges D. prescription drugs

doctor's charges

An accident and health policy that provides reimbursement benefits makes them payable to the A. provider B. facility providing service C. insured D. insured's spouse

insured

Paul is an employee who caught a disease unique to the trade in which he was exposed to. Paul has a(n) A. genetic predisposition B. worksite malady C. contagious disease D. occupational disease

occupational disease

All of the following are defined as supplemental health insuring corporation (HIC) services EXCEPT A. outpatient medical services B. prescription drugs C. physical therapy D. dental care

outpatient medical services

Medicaid is intended for? A. people with kidney failure B. people aged 65 and older C. unemployed people D. poverty stricken people

poverty stricken people

The Federal Employees Benefit Program consists of two types of health plans for federal civilian employees. The two plans are fee-for-service and A. prepaid B. ambulatory C. facility D. blanket

prepaid

An individual covered under a Blue Cross Blue Shield plan is called a(n) A. participant B. subscriber C. policyowner D. insured

subscriber