Chapter 4 - Health Insurance Providers

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n): closed panel open panel co-op panel capitation panel

closed panel

Medicare Part A and Part B do NOT pay for dental work hospitalization skilled nursing care physical therapy

dental work

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a... physician's assistant primary care physician secondary care physician third part administrator

primary care physician

What is the maximum social security disability benefit around an insured can receive? - 50% of the insured's primary insurance amount (PIA) - 75% of the insured's primary insurance amount (PIA) - 100% of the insured's primary insurance amount (PIA) - 100% of the insured's primary insurance amount (PIA) minus any monies received from retirement plan

- 100% of the insured's primary insurance amount (PIA)

What does Medicare Parts A and B cover? - A: hospitalization B: long term care - A: doctor's services B: hospitalizations - A: hospitalization B: doctor's services - A; prescription drugs B: disability

- A: hospitalization B: doctor's services

What type of provider is known for stressing preventative medical care? - Multiple Employer Welfare Arrangements (MEWA) - Major Medical provider - Health Maintenance Organizations (HMO's) - Preferred Provider Organizations (PPO's)

- Health Maintenance Organizations (HMO's)

Which of these statements is INCORRECT regarding a PPO? - PPOs normally have more providers to chose from as compared to a HMO - Prices are negotiated in advance for PPO providers - in network PPO providers offer members better coverage of incurred expenses - PPOs are NOT a type of managed care system

- PPOs are NOT a type of managed care system

Medicare is intended for all of the following groups EXCEPT... - Those enrolled as a full-time student - those receiving social security disability benefits for at least 24 months - those affected with chronic kidney failure - those 65+

- Those enrolled as a full-time student

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenses? - administrative services only plan - commercial insurer - preferred provider organization - health maintenance organization

- commercial insurer

Which of these is considered a true statement regarding Medicaid? - funded by both states and federal governments - intended to be used by individuals age 65 and older - provides disability income benefits - automatically covers those receiving Social Security disability benefits

- funded by both states and federal governments

What is Medicare? - a disability program - is a hospital and medical expense insurance program - offers assistance in making health insurance premiums - part D provides payment for surgeon expenses

- is a hospital and medical expense insurance program

Which of the following BEST describes how a Preferred Provider organization (PPO) Is less restrictive than a Health Maintenance organization (HMO)? - typically not subject to deductibles - not regulated by the federal government - more benefits available - more physicians to choose from

- more physicians to choose from

Which of the following statements is true about most Blue Cross/Blue Shield organizations? - they are the same as private insurance companies - they are federally sponsored - they are non profit organizations - they are owned by hospitals and physicians

- they are non profit organizations

Which of the following reimburses the insureds for covered medical expenses? HMO PPO Commercial Insurers Service Providers

Commercial Insurers

Which of the following does social security NOT provide benefits for? Survivorship Dismemberment Disability Retirement

Dismemberment

A medical care provider which typically delivers health services at its own local medical facility is known as a ... HMO Regional Provider Multiple Employer Trust PPO

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? - Multiple Employer Welfare Arrangement - multiple employer trust - HMO - Co-op arrangement

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? HMO PPO EPO PLHSO

HMO

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? PPO HMO MEWA POS

HMO

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? Medicaid Long-term care Medicare Her group health plan

Her group health plan