Health Providers Chapter Exam

What is Medicare?

A hospital and medical expense insurance program

Medicaid was designed to assist individuals who are:

Below a specific income limit

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

Health Maintenance Organization

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

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?

Health Maintenance Organization

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

PPO's are NOT a type of managed care systems

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

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

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 reimburses its insured for covered medical expenses?

Commercial Insurers

Which of these is considered a true statement regarding Medicaid?

Funded by both state and federal governments

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?

Her group health plan

Which of the following BEST describes how a Preferred Provider Organization is less restrictive than a Health Maintenance Organization?

More physicians to choose from

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

What does Medicare Parts A and B cover?

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

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?

Preferred Provider Organization

The individual who provides general medical care for a patient as well as the referral for specialised care is known as a

Primary Care Physician

Social Security provides benefits for

Survivorship Disability Retirement

Medicare is intended for all of the following groups EXCEPT

Those enrolled as a full-time student