13. NVPRC - Health Insurance Providers
Which of the following does Social Security NOT provide benefits for? A) Dismemberment B) Survivorship C) Retirement D) Disability
A) Dismemberment Social Security provides for all of these types of benefits EXCEPT dismemberment.
A medical care provider which typically delivers health services at its own local medical facility is known as a: A) Health Maintenance Organization B) Preferred Provider Organization C) Regional Provider D) Multiple Employer Trust
A) Health Maintenance Organization Health Maintenance Organizations (HMO's) traditionally provide services to its members at its own local health care facilities.
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a : A) Primary Care Physician B) Secondary Care Physician C) Third Party Administrator D) Physician's assistant
A) Primary Care Physician 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.
The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs? A) Social Security Disability Income B) COBRA C) Medicaid D) Medicare Supplements
A) Social Security Disability Income Social Security Disability Income pays benefits that are based on a percentage of an individual's Primary Insurance Amount (PIA).
What is Medicare? A) is a hospital and medical expense insurance program B) offers assistance in making health insurance premiums C) Part D provides payment for surgeon expenses D) is a disability program
A) is a hospital and medical expense insurance program Medicare 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 government is called: A) Medicare B) Medicaid C) Long-term care D) Medicare Supplemental Program
B) Medicaid Medicaid is funded by both the federal and state governments and administered by individual states.
Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)? A) Prices are negotiated in advance for PPO providers B) PPO's are NOT a type of managed care systems C) PPO's normally have more providers to choose from as compared to an HMO D) In-network PPO providers offer members better coverage of incurred expenses
B) PPO's are NOT a type of managed care systems PPO's ARE considered to be a managed health care system.
Which of the following statements is true about most Blue Cross/Blue Sheild organizations? A) They are owned by hospitals and physicians B) They are nonprofit organizations C) They are the same as private insurance companies D) They are federally sponsored
B) They are nonprofit organizations Most Blue Cross/Blue Sheild organizations are considered to be nonprofit.
Medicaid was designed to assist individuals who are: A) disabled B) below a specific income limit C) in poor health D) Federal employees
B) below a specific income limit Medicaid was enacted to provide medical assistance to those whose income is below a specific limit.
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n): A) co-op panel B) closed panel C) open panel D) capitation panel
B) closed panel A closed panel is when an HMO is represented by a group of physicians who are salaried employees and work out of the HMO's facility.
Medicare Part A and Part B do NOT pay for: A) physical therapy B) dental work C) hospitalization D) skilled nursing care
B) dental work Dental services are not covered by Medicare Part A or B.
What is the maximum Social Security Disability benefit amount an insured can receive? A) 75% of the insured's Primary Insurance Amount (PIA) B) 100% of the insured's Primary Insurance Amount (PIA) minus any monies received from a retirement plan C) 100% of the insured's Primary Insurance Amount (PIA) D) 50% of the insured's Primary Insurance Amount (PIA)
C) 100% of the insured's Primary Insurance Amount (PIA) The MAXIMUM Social Security Disability benefit an insured may receive is equal to 100% of the insured's Primary Insurance Amount (PIA).
Which of the following reimburses its insureds for covered medical expenses? A) Preferred provider organizations B) Service providers C) Commercial insurers D) Health maintenance organizations
C) Commercial insurers Commercial insurance companies function on the reimbursement approach. Policyowners obtain medical treatment from whatever source they feel is most appropriate and submit their charges to their insurer for reimbursement.
Which of these is considered a true statement regarding Medicaid? A) Automatically covers those receiving Social Security disability benefits B) Intended to be used by individuals age 65 and older C) Funded by both state and federal governments D) Provides disability income benefits
C) Funded by both state and federal governments Medicaid is funded by both federal and state governments.
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? A) MEWA B) POS C) HMO D) PPO
C) HMO A Health Maintenance Organization (HMO) is a prepaid group health plan, where members pay in advance for the services of participating physicians and hospitals that have agreements.
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? A) Medicare B) Medicaid C) Her group health plan D) Long-term care
C) Her group health plan If the employer has more than 20 employees, the group health plan generally pays first.
What does Medicare Parts A and B cover? A) Part A covers doctor's services; Part B covers hospitalization B) Part A covers prescription drugs; Part B covers disability C) Part A covers hospitalization; Part B covers doctor's services D) Part A covers hospitalization; Part B covers long-term care
C) Part A covers hospitalization; Part B covers doctor's services Medicare Part A covers hospital benefits. Part B covers physician's services.
Medicare is intended for all of the following groups, EXCEPT: A) Those 65 and older B) Those receiving Social Security disability benefits for at least 24 months C) Those enrolled as a full-time student D) Those afflicted with chronic kidney failure
C) Those enrolled as a full-time student All of these groups of people are typically eligible for Medicare except full-time students.
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures? A) Health maintenance organization B) Preferred provider organization C) Administrative-services-only plan D) Commercial insurer
D) Commercial insurer Commercial health insurance companies use the reimbursement approach, which allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement.
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? A) Co-op Arrangement B) Multiple Employer Trust C) Multiple Employer Welfare Arrangement D) Health Maintenance Organization
D) Health Maintenance Organization A Health Maintenance Organization (HMO) contracts with doctors and hospitals to provide medical benefits to subscribers at a predetermined price.
Which type of provider is known for stressing preventative medical care? A) Multiple Employer Welfare Arrangements (MEWA) B) Preferred Provider Organizations (PPO's) C) Major medical provider D) Health Maintenance Organizations (HMO's)
D) Health Maintenance Organizations (HMO's) The health provider that stresses preventive medical care is known as a Health Maintenance Organization.
Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)? A) More benefits available B) Not regulated by the federal government C) Typically not subject to deductibles D) More physicians to choose from
D) More physicians to choose from PPO's normally provide a wider choice of physicians and hospitals.
Under what system do a group of doctors and hospitals in a designated are contract with an insurer to provide services at a prearranged cost to the insured? A) HMO B) EPO C) PLHSO D) PPO
D) PPO Under a Preferred Provider Organization (PPO), a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured.
