Health Insurance Providers

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

Health Maintenance Organization (HMO)

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

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

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

PPO's are NOT a type of managed care systems

Medicaid was designed to assist individuals who are:

below a specific income limit

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 insureds for covered medical expenses?

Commercial insurers

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 heath plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?

HMO

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

More physicians to choose from

What does Medicare Parts A and B cover?

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

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?

Social Security Disability Income

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

They are nonprofit organizations

Medicare is intended for all of following groups EXCEPT:

Those enrolled as a full-time student