2 - Health Insurance Providers

What is the maximum Social Security Disability benefit amount an insured can receive?

100% of the insured's Primary Insurance Amount (PIA) The MAXIMUM Social Security Disability benefit an insured may receive is equal to 100% of the insured's Primary Insurance Amount (PIA).

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 Under a Preferred Provider Organization (PPO), a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured.

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

PPO's are NOT a type of managed care systems PPO's ARE considered to be a managed health care system.

Medicare Part A and Part B do NOT pay for

dental work

Medicare

is a hospital and medical expense insurance program

Which of these is considered a true statement regarding Medicaid?

Funded by both state and federal governments

J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to?

Health Maintenance Organization A Health Maintenance Organization (HMO) contracts with doctors and hospitals to provide medical benefits to subscribers at a predetermined price.

Which type of provider is known for stressing preventative medical care?

Health Maintenance Organizations (HMO's)

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

Health Maintenance Organizations (HMO's) traditionally provide services to its members at its own local health care facilities.

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 If the employer has more than 20 employees, the group health plan generally pays first.

The health insurance program which is administered by each state and funded by both the federal and state governments is called

Medicaid

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

More physicians to choose from PPO's normally provide a wider choice of physicians and hospitals.

What does Medicare Parts A and B cover?

Part A covers hospitalization; Part B covers doctor's services Medicare Part A covers hospital benefits. Part B covers physician'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 individual who provides general medical care for a patient as well as the referral for specialized care is known as a Primary Care Physician.

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?

A Health Maintenance Organization (HMO) is a prepaid group health plan, where members pay in advance for the services of participating physicians and hospitals that have agreements.

Which of the following reimburses its insureds for covered medical expenses?

Commercial insurers Commercial insurance companies function on the reimbursement approach. Policyowners obtain medical treatment from whatever source they feel is most appropriate and submit their charges to their insurer for reimbursement.

Which of the following does Social Security NOT provide benefits for? Survivorship Dismemberment Disability Retirement

Dismemberment Social Security provides for all of these types of benefits EXCEPT dismemberment.

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

They are nonprofit organizations

The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs?

Social Security Disability Income Social Security Disability Income pays benefits that are based on a percentage of an individual's Primary Insurance Amount (PIA).

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?

The correct answer is "Commercial insurer". Commercial health insurance companies use the reimbursement approach, which allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement.

Medicaid was designed to assist individuals who are

The correct answer is "below a specific income limit". Medicaid was enacted to provide medical assistance to those whose income is below a specific limit.

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 afflicted with chronic kidney failure Those 65 and older

Those enrolled as a full-time student All of these groups of people are typically eligible for Medicare except full-time students.

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)

closed panel A closed panel is when an HMO is represented by a group of physicians who are salaried employees and work out of the HMO's facility.