CH 12- Health insurance providers

What is Medicare?

A hospital and medical expense insurance program

Which of these is considered a true statement regarding Medicaid?

Funded by both state and federal 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?

HMO

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 (HMO)

Which type of provider is known for stressing preventative medical care?

Health Maintenance Organizations (HMO)

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?

PPO

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

Social Security Disability Income

Medicare Part A and Part B do NOT pay for

dental work

A 66 year old is covered under a group health plan while employed with a business that has 40 employees. If seh injures herself while walking in the park, what coverage would be considered primary?

her group health plan

What is the maximum social security disability benefit amount an insured can receive?

100% of the insured's Primary Insurance Amount (PIA)

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

Dismemberment

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

Health Maintenance Organization

Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?

Obtain prior approval from the insurer for the medical service

Medicaid was designed to assist individuals who are

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

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?

commercial insurer

Which of the following reimburses its insured for covered medical expenses?

Commercial insurers

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

Medicaid

Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)

More physicians to choose from

What does Medicare Pasts A and B cover?

Part A covers hospitalizations and Part B covers doctor's services

Which of the following statements is true about most Blue/Blue Shield organizations?

They are nonprofit organizations

Medicare is inteded for all of the following groups, EXCEPT

Those enrolled as a full-time student