Health Insurance Providers

How does one become eligible for Part D: Prescription Drug coverage? Must meet certain underwriting guidelines Must have a valid prescription Must have Medicare coverage Must have Medicaid coverage

Must have Medicare coverage

Which payment method for a health claim settlement is typically made directly to the provider of the services? Settlement Fee-for-service Premium payment Prepaid

Prepaid

When comparing an HMO to a PPO, the PPO always requires service in a network provides a greater choice of providers always requires a referral to specialists is a prepaid medical service plan

Provides a greater choice of providers

What is Medicare Part B also known as? Medicare supplement Supplementary medical insurance Comprehensive insurance Medicaid

Supplementary medical insurance

An individual can enroll in a Part C Medicare Advantage Plan at what time? When becoming eligible for Medicaid At age of retirement Age 59 1/2 When becoming eligible for Medicare

When becoming eligible for Medicare

Medicare provides coverage for each of the following EXCEPT hospital room and board doctor and surgeon services prescription drugs custodial care

custodial care

Medicare Part B covers long-term care hospital room and board doctor's charges prescription drugs

doctor's charges

Medicare Part A does not pay for medical benefits provided for treatment in a skilled nursing facility beyond 30 days 60 days 100 days 120 days

100 days

A closed network plan offers a a primary physician copay of $25. If a subscriber chooses a primary care physician outside of the network, the subscriber will likely pay $0 $25 100% of the billed amount 100% of the allowed amount

100% of the billed amount.

At what age will a person normally enroll with an insurance carrier under a Part C Medicare Advantage Plan? Age 59 1/2 Age 60 Age 62 Age 65

65

Part A Hospital expense coverage provided under Medicare is automatically made available to each of the following EXCEPT A 50-year old individual who has qualified for SSDI in the last 24 months A 70-year old NOT eligible for Social Security A 55-year old suffering from kidney failure A 65-year old retiree

A 70-year old NOT eligible for social security

A medical provider that accepts Medicare Assignment must accept payment based upon a defined Medicare schedule and bill the insured for any difference accept payment based upon a defined Medicare schedule and negotiate any excess fees accept payment based upon a defined Medicare schedule and bill no more than 15% of the excess charges accept payment based upon a defined Medicare schedule as payment in full

Accept payment based upon a defined Medicare schedule as payment in full

Maria is a Preferred Provider Organization (PPO) subscriber and received care from an out-of-network provider. Which of the following is the likely result? Care is covered Care is not covered Care is only covered in a government facility Care is only covered if primary care physician gives a referral

Care is covered

Which of these is NOT a qualifying event for Medicare? On Social Security disability for over 2 years Kidney failure Age 65 or older Falling below the federal poverty level

Falling below the federal poverty level

A health care provider claim may be settled using which of the following payment methods? Litigation Unfair claim settlement Fee-for-service Prepaid expense

Fee-for-service

Which of these will typically authorize treatment from a specialist? Administrator Policyowner Insurance company Gatekeeper

Gatekeeper

How is Medicare Part B funded? Employer taxes Payroll taxes User premiums General tax revenue and user premiums

General tax revenue and user premiums

Which of the following is NOT taken into consideration when determining eligibility for Medicare benefits? Chronic kidney disease Income Age Social Security disability

Income

An HMO that involves a partnership of physicians and other providers who practice out of a central facility is called a(n) group HMO federal HMO central HMO managed HMO

Group HMO

The open enrollment period for Medicare Part B is January 1 through March 31 January 1 through April 30 January 1 through May 31 January 1 through June 30

Jan 1- March 31

Donna and Mary were racing bicycles in a store parking lot while being cheered on by fellow employees. Mary ran into John, another employee, who happened to be taking out the garbage. Both Mary and John are injured. Who would most likely be covered under Workers' Compensation? John Mary John and Mary Neither of them

John

Small employers who are sponsored by an insurer to provide group benefits to its employees are called Fraternal Benefit Society Surplus lines brokers Lloyd of London MEWA

MEWA

Which of the following is a legal entity created for the sole purpose of providing affordable group health coverage to its participants? Multiple Employer Welfare Arrangement (MEWA) Multiple Trust Arrangement (MTA) Multiple Purchasing Groups (MPG) Fraternal Benefit Society

MEWA

Which of the following is Medicare Part B also known as? Hospital insurance Medical insurance Long-term care insurance Medigap

Medical insurance

The role of the federal government was expanded when Medicaid was established by allowing the state to form a large PPO on a statewide level purchase health insurance from the federal government receive matching funds to expand public assistance programs defer all costs to the federal government for public assistance programs

Receive matching funds to expand public assistance programs

When a preferred provider organization (PPO) insured goes out-of-network, which of the following actions occur? The insured will pay a reduced amount The benefits are taxable The insured has lower out-of-pocket expenses The insurer will pay a reduced amount

The insurer will pay a reduced amount.

A 70-year old insured individual has suffered from kidney failure for the past 24 months. She is covered by her spouse's large-group employer plan. How will Medicare be utilized in this situation? Will be the primary insurer and pay for 100% of covered expenses Will be the secondary insurer and pay for claims not fully covered by the group plan Will not pay for any of the covered expenses Will be the primary insurer and the group plan will be secondary

Will be secondary insurer, and pay for claims not fully covered by the group plan

Medicare Part A covers outpatient services doctor's fees inpatient hospital stay prescription drugs

inpatient hospital stay

An accident and health policy that provides reimbursement benefits makes them payable to the provider facility providing service insured insured's spouse

insured

Paul is an employee who caught a disease unique to the trade in which he was exposed to. Paul has a(n) genetic predisposition worksite malady contagious disease occupational disease

occupational disease

Medicaid is a government-funded program designed to provide health care to all individuals over the age of 65 all individuals who carry Medicare supplemental insurance anyone who does not have a proper caregiver poor people

poor people

Medicaid is intended for people with kidney failure people aged 65 and older unemployed people poverty stricken people

poverty-stricken people

The Federal Employees Benefit Program consists of two types of health plans for federal civilian employees. The two plans are fee-for-service and prepaid ambulatory facility blanket

prepaid

An individual covered under a Blue Cross Blue Shield plan is called a(n) participant subscriber policyowner insured

subscriber

Funding for Medicare Part B is partially provided by Municipal bonds State bonds private insurers user premiums

user premiums

What type of injury would NOT be covered under a health insurance policy? Accidental Work-related Sports-related Recreational

work-related