FIN 300- Ch.9
Administrative costs represent what percentage of health care costs in the United States? A. 11% B. 5% C. 26% D. 16%
26%
_____ health insurance coverage includes hospital expense coverage, surgical expense coverage, and physician expense coverage
Basic
_____ major medical insurance is a type of complete insurance that helps pay hospital, surgical, medical, and other bills; it has a low deductible, usually $500 to $1000
Comprehensive
_____ income insurance provides regular cash income when you're unable to work because of a pregnancy, a non-work related accident, or an illness
Disability
The ____ of 1996 set federal standards to ensure that workers would not lose their health insurance if they changed jobs
HIPAA
____ are tied to high-deductible polices and funded *solely* by your employer and give you a pot of money to spend on health care
HRA (health reimbursement account)
The ____ website includes links to more than 1000 website operated by government and nonprofit organizations
Healthfinder
_____ expense coverage pays for some or all of the daily costs of room and board during a hospital stay as well as routine nursing care, minor medical supplies, and the use of other hospital facilities
Hospital
_____ care insurance provides coverage for the expense of daily help that you may need if you become seriously ill or disabled and are unable to care for yourself
Long-term
____ medical expense insurance pays the large costs involved in long hospital stays and multiple surgeries; it takes up where basic health insurance coverage leaves off
Major
The majority of people who draw on ____ are 65 years of age or older
Medicare
____ insurance makes up the difference between Medicare payments and medical costs not covered by Medicare by providing supplemental insurance
Medigap
IN order to contain health care costs, physicians are encouraging consumers to pay with ____ for routine medical care and lab services
cash
Age, marital status, and dependency requirements are usually specified in the ____ provision of an insurance policy
eligibility
An insurance policy with ____ and limitations may deny coverage for preexisting conditions, cosmetic surgery, or routine checkups
exclusions
PPOs are more popular than HMO because they allow patients greater _____
flexibility
Employers typically provide health insurance called _____ health insurance
group
Most private insurance companies are providers of ____ health insurance policies through employers
group
With a ____ renewable policy provision, the insurance company cannot cancel unless you fail to pay premiums when due
guaranteed
Disability income insurance protects your most valuable asset, which is your ability to earn _____, or earning power
income
A health _____ organization (HMO) is a health insurance plan that directly employs or contracts with selected physicians and other medical professionals to provide health care services in exchange for a fixed, prepaid monthly premium
maintenance
Medicare Part B is ____ insurance and it helps pay for doctors services and a variety of other medical services and supplies not covered or not fully covered by Part A
medical
Health insurance includes ____ expense insurance and ____ income insurance
medical; disability
Group policies do not always cover the ____ of every employe
needs
A good disability plan will also pay ____ benefits even if you are able to work only part-time
partial
A policy that covers "reasonable and customary" medical expenses limits ____ to the usual charges of medical providers in an area
payments
A ____ of service (POS) plan combines features of both HMOs and PPOs; they use a network of participating physicians and medical professionals who have contracted to provide services for certain fees
point
Out-of-pocket limit is a provision in an insurance policy that limits the amount one must pay, but this causes the ____ you must pay to increase
premium
HMOs are based on the idea that ____ services will minimize future medical problems
preventative
Unlike Part A and B of Medicare, Part C (Medicare Advantage) is run by ____ health care providers
private
Medline Plus, the worlds most extensive collection of published medical information, was originally designed for health ____ and researchers
professionals
A ____ policy pays you back for actual expenses
reimbursement
The typical out-of-pocket payment for a stop-loss provision ranges from: A. $0-$2000 B. $2000 to $4000 C. $10,000 to $20,000 D. $3000 to $5000
$3000 to $5000
You have ___ days from the date coverage ends to elect COBRA
60
A "good" health insurance plan pays what percentage of out-of-hospital expenses once a yearly deductible for the individual and family have been met? A. 20% B. 40% C. 80% D. 100%
80%
Medicare Part __ is hospital insurance and helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care
A
Benefits for disability plans have a wide variety of payout ranges. The most desirable benefits are those that are paid for: A. 10 year B. 20 years C. life D. 5 years
life
____ is the percentage of the medical expenses the policy holder must pay in addition to the deductible amount
Coinsurance
____ care refers to prepaid health plans that provide comprehensive healthcare to their members and is designed to control the cost of healthcare services by controlling how they are used
Managed
The Health Insurance ____ allows individuals to enroll in health plan that meets their needs
Marketplace
_____ was designed to provide medical assistance normally to low-income families and individuals who are eligible to receive payments under one of the cash assistance programs
Medicaid
Which of the following factors has NOT been attributed to increasing healthcare costs? A. an increased amount of uninsured individuals B. a focus on healthy living options C. an aging population D. the cost of prescription drugs
a focus on healthy living options
____ work like HMOs, except the networks are managed by groups of doctors and hospitals
PPOs (preferred provider organizations)
Which part of Medicare is voluntary and covers prescription drugs? A. Part A B. Part D C. Part B D. Part C
Part D
_____ expense insurance meets some or all the costs of physician care that do not involve surgery; this form of health insurance covers treatment in a hospital, a doctors office, or even a patients home
Physician
____ health services for an HMO include vision and prescription services
Supplemental
_____ expense insurance pays all or part of the surgeons fees for an operation, whether it is done in a hospital or in the doctors office
Surgical
Which country has the highest per capita medical expenditures? A. Mexico B. Canada C. Indonesia D. United States
United States
Which of the following statements is NOT true? A. COBRA covers group health plans of employers with 20 or more employees B. COBRA allows employees who are laid off to continue coverage under the employer's plan at group rates C. You have 30 days from the date coverage ends to elect COBRA
You have 30 days from the date coverage ends to elect COBRA
When you ____ benefits, you sign a paper allowing your insurance company to make payments directly to your doctor or hospital
assign
According to recent projection, Medicare will be ____ by 2035 if no changes are made
bankrupt
Choosing a health insurance plan required ____ shopping and studying
comparison
What provision allows you to collect benefits from two or more group policies that could not exceed the actual charges? A. coordination of benefits B. assigned benefits C. benefit sharing D. exclusion and limitations
coordination of benefits
Economic losses due to ____ are offset by life insurance
death
A _____ is a set amount that the policy holder must pay toward medical expenses before the insurance company pays benefits
deductible
The two factors that greatly affect the cost of health insurance are the size of ____ and the amount of ____
deductible; coinsurance
Which type of insurance provides reimbursement for the expense of services and supplies and encourages preventative care for teeth? A. coinsurance B. stop-loss insurance C. dental expense insurance D. deductible E. dental annual plan
dental expense insurance
Good disability insurance will pay for ____ caused by both accident and sickness
disabilities
The benefit limits provision defines the maximum benefits possible in terms of either a ____ amount or a number of ____ spent in the hospital
dollar; days
Which of the following insurance policies is considered to have a poor value? A. long term care insurance B. dread disease insurance C. major medical insurance D. vision care insurance
dread disease insurance
POS plans are different from HMOs in that they reimburse expenses for out-of-plan providers, but outside the network there are _____ overall costs
higher
Rising hospital costs, new medical technology, and the increasing number of elderly people have helped make ____ health care one of the fastest-growing areas of the health care industry
home
Blue Cross is an independent, nonprofit membership corporation that provides protection against the cost of ____ care
hospital
Medicare ____ insurance is financed from a portion of Social Security taxes
hospital
Dread disease, trip accident, death insurance, and cancer policies play upon unrealistic fears and are _____ in many states
illegal
Because third parties, private health insurers, and the government pay such a large part of the nations health insurance bill, there is a lack of ____ to make the most economical use of the health care system
incentive
The added use of technology, use of prescription drugs, life expectancy of the elderly, and accidents and crimes all lead to _____ health care costs
increased
A hospital _____ policy pays benefits when you're hospitalized, however it doesn't directly cover medical costs; you are paid in cash which you can spend on medical or nonmusical expenses as you choose
indemnity
An ____ policy provides you with specific amounts, regardless of how much the actual expenses may be
indemnity
A health insurance plan should be coordinated to the needs of the ____
individual
Health insurance is one way people protect themselves against economic losses due to ___ and ___
injury; illness
Coinsurance is a provision under which the ______ share covered losses A. policy and the insurer B. insured and the underwriter C. policyholder and the underwriter D. insurer and the insured
insurer and the insured
A policy with ____ limits will cover only a fixed amount for an expense, such as the daily cost of room and board during a hospital stay
internal
A policy with ____ limits will only pay a fixed amount for your hospital room no matter what the actual rate is For example, if your policy has a $500 limit and you are in a $600 room, you will pay $100
internal
Disability benefits may also be available through your employer or through Social Security in case of a ____ disability, or through workers _____ if the injury occurs on the job
long-term; compensation
Flexible spending accounts allow you to contribute ___-tax dollars to an account managed by your employer A. pre B. unlimited C. limited D. after
pre
One difference between point-of-service plans (POS) and preferred provider organizations (PPO) is that POS plans: A. require higher copays for in-network visits to primary care providers B. allow you to visit out-of network providers for much lower costs C. require a referral to a specialist D. have free choice for primary care services
require a referral to a specialist
Health ____ accounts (HSA) allow you to contribute money to a tax-free account that can be used for out-of pocket health care expenses if you buy high-deductible health insurance policies to cover catastrophic expenses
savings
The main risk involved with a _____ funded health plan is the financial burden if the medical bills are greater than the amount covered by premium income
self
Policies with the ____ benefits provision list coverage in terms of services, NOT dollar amount
service
Medicaid is funded by ____ and federal funds
state
A provision under which an insured pays all costs up to a certain amount, after which the insurance company pays 100% of the remaining covered expenses is called a ____
stop-loss
Blue Shield is an independent, nonprofit membership corporation that provides benefits for ____ and medical services performed by physicians
surgical
Disability benefits when added to other sources of income should equal 70-80% of: A. take-home pay B. average take-home pay of five years C. gross income D. total discretionary income
take-home pay
Aggregate limits are limits on the _____ amount of coverage
total