Chapter 4 - Health Insurance Providers

Which of the following does Social Security provide benefits for?

- Survivorship - Disability - Retirement (Social Security does not provide for dismemberment)

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

Closed panel

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

Commercial Insurers (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.)

A characteristic of Preferred Provider Organizations (PPOs) would be:

Discounted fees for the patient

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 preset price. What type of plan does J belong to?

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

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

Health Maintenance Organization (HMOs) (the medical care providers work directly for the HMO)

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

Health Maintenance Organizations (HMOs)

A 66 year-old is covered under 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.)

Which of the following are NOT managed care organizations?

Medical Information Bureau (MIB)

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

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 (PPO, or preferred provider organization is a org which uses a preferred group of doctors and hospitals in your area. Going outside the group may cost more.)

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

PPO's are NOT a type of managed care system.

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

PPO's are considered to be a managed health care system.

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...

Primary Care Physician