Health Insurance Providers

Health Maintenance Organization (HMO)

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

Her group health plan

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?

Medicaid

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

Primary Care Physician (PCP)

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a:

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

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

Health Maintenance Organizations (HMO)

Which type of provider is known for stressing preventative medical care and routine physical examinations?

Part A covers hospitalization; Part B covers doctor's services

What does Medicare Parts A and B cover?

A hospital and medical expense insurance program

What is Medicare?

100% of the insured's Primary Insurance Amount (PIA)

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

More physicians to choose from

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

Obtain prior approval from the insurer for the medical service

Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?

dismemberment

Which of the following does Social Security NOT provide benefits for?

Commercial insurer

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

Commercial Insurers

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

They are nonprofit organizations

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

HMO (Health Maintenance Organization)

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?

Funded by both state and federal governments

Which of these is considered a true statement regarding Medicaid?

Health Maintenance Organization (HMO)

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?

below a specific income limit

Medicaid was designed to assist individuals who are:

Dental work

Medicare Part A and Part B do NOT pay for:

Those enrolled as a full-time student

Medicare is intended for all of the following groups EXCEPT:

Social Security Disability Income

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

closed panel

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

PPO (Preferred Provider Organization)

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?