Chapter Exam - Health Providers

What is Medicare Part B also known as?

Supplementary medical insurance

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

A gatekeeper must authorize treatment from a specialist.

How is Medicare Part B funded?

General tax revenue and user premiums

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 -A Multiple Employer Welfare Association consists of small employers who have joined to provide health benefits for their employees.

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

Multiple Employer Welfare Arrangement (MEWA) A MEWA is an arrangement where a group of employers pool their contributions together to purchase group health and other insurance benefits for their employees. By pooling their contributions together, these smaller employers are better positioned to offer the best benefit packages from insurance companies due to economies of scale. MEWA's are also formed to allow a group of employers to self-insure their healthcare needs.

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-

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

poverty stricken people

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-Medicare Part A (Hospital Insurance) will cover a maximum of 100 days per benefit period in a skilled nursing facility.

How much does Medicare Part B pay for physician fees? 40% 60% 80% 100%

80% - Medicare Part B pays 80% of most doctor's services, outpatient treatments, and durable medical equipment (like oxygen or wheelchairs).

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

insured An accident and health policy that provides reimbursement benefits makes them payable to the insured. However, the right of assignment is built into most commercial insurance policies that allows policyowners to assign benefit payments from the insurer directly to the health care provider.

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