PF Chapter 9

Which of the following is part of the Patient Protection and Affordable Care Act?

*Prohibits denying coverage to children with preexisting medical conditions *Bans insurance companies from dropping people when they get sick *Tax credits for small business

Physician expense insurance provides benefits for which of the following?

*X rays *Lab tests *Doctors' fees for nonsurgical care

Basic health insurance coverage is a combination of

*hospital expense insurance *physician expense insurance *surgical expense insurance

Supplemental health services for an HMO include

*prescription services *vision care

Health insurance coverage is available from:

*private insurance *hospital service plans *government programs *health maintenance organizations

Basic health services for an HMO include inpatient and outpatient services such as:

*surgery *emergency care *hospitalization

What are some of the factors that have led to increasing health care costs?

*An aging population *The cost of prescription drugs *An increased number of uninsured individuals

What are the sources of disability income coverage?

*Employer plans *Social Security *Worker's compensation

Which two groups pay the majority of the nation's health care bill, leading to a lack of incentives to cut down on costs?

*Government *Private health insurers

Managed care is offered by which of the following?

*Health maintenance organizations *Point-of-service plans *Preferred provider organizations

A "good" health insurance policy provides which of the following?

*Pay at least 80 percent of out-of-hospital expenses after a yearly deductible of $1,000 per person or $2,000 per family *Offer basic coverage for hospital and doctor bills

____________ income insurance provides regular cash income when an insured person is unable to work because of pregnancy, a non-work-related accident, or an illness.

Blank 1: Disability

______________ insurance makes up the difference between Medicare payments and medical costs not covered by Medicare by providing supplemental insurance.

Blank 1: Medigap or Medsup

______________health services for an HMO include vision and prescription services.

Blank 1: Supplemental or Extra

In order to contain health care costs, physicians are encouraging consumers to pay with ____________ for routine medical care and lab services.

Blank 1: cash or debit

HMO basic health services include inpatient, outpatient, maternity, mental health, substance abuse rehabilitation, and , ___________ care.

Blank 1: emergency

Most private insurance companies are providers of __________ health insurance policies through employers.

Blank 1: group

Medicare __________ insurance is financed from a portion of Social Security taxes.

Blank 1: hospital or hospitalization

Blue Cross is an independent, nonprofit membership corporation that provides protection against the cost of ___________ care

Blank 1: hospital, medical, or health

Preventive care for an HMO includes checkups, screening, testing, and routine _____________

Blank 1: immunizations, shots, vaccinations, or vaccines

The deductible is an amount the policyholder must pay before benefits become payable by the _______________ company.

Blank 1: insurance or insuring

Comprehensive major medical insurance policies are complete insurance policies offering a very ____________ deductible.

Blank 1: low, small, cheap, or affordable

Surgical expense insurance pays part or all of surgeons' fees for a(n)

Blank 1: operation, procedure, or surgery

A network of selected contracted participating providers, also called an HMO-PPO hybrid, is a ___________-of-service plan.

Blank 1: point

A preferred provider organization (PPO) is a group of doctors and hospitals that agree to provide health care to members at _____________fees.

Blank 1: prearranged, predetermined, set, fixed, given, approved, or specified

Blue Shield is an independent, nonprofit membership corporation that provides benefits for ____________ and medical services performed by physicians.

Blank 1: surgical or surgery

Name an independent, nonprofit membership corporation that provides protection against the cost of hospital care.

Blue Cross

Which type of insurance is complete major medical insurance that has a very low deductible?

Comprehensive

Which type of insurance pays part or all of hospital bills for room, board, and other charges?

Hospital expense insurance

_________is the process of paying a premium in exchange for financial protection.

Insurance

____________medical expense insurance pays the large costs involved in long hospital stays and multiple surgeries, and it covers every type of care and treatment prescribed by a physician, in and out of a hospital.

Major

Which insurance supplements Medicare by filling the difference between Medicare payments and medical costs not covered by Medicare?

Medigap insurance

Which type of insurance covers only doctors' fees for nonsurgical care, X rays, and lab tests?

Physician expense insurance

Which of the following is a provision of the Patient Protection and Affordable Care Act?

Requires health insurance companies to submit justification for all requested premium increases

Which type of insurance pays part or all of the surgeon's fees for an operation?

Surgical expense insurance

When selecting disability income insurance, you will want to select a policy that will replace ______ your income.

all of

A combination of hospital expense insurance, physician expense insurance, and surgical expense insurance is called:

basic health insurance

A provision under which the insurer and insured share the covered losses (for example, you pay 25 percent) is called:

coinsurance.

A health maintenance organization (HMO) is a health insurance plan that provides a wide range of health care services for a(n) ________ monthly premium.

fixed prepaid

A health insurance plan that provides a wide range of health care services for a fixed prepaid monthly premium is called a:

health maintenance organization (HMO)

____________expense coverage pays for some or all of the daily costs of room and board during a hospital stay.

hospital

Because third parties, private health insurers, and the government pay such a large part of the nations health insurance bill, there is a lack of ______ to make the most economical use of the health care system.

incentive

Coinsurance is a provision under which the ______ share the covered losses.

insurer and the insured

A group of doctors and hospitals that agree to provide health care to members at prearranged fees is called a:

preferred provider organization.

Flexible spending accounts allow you to contribute ______ dollars to an account managed by your employer.

pretax

A provision under which an insured pays all costs up to a certain amount, after which the insurance company pays 100% of the remaining covered expenses, is called a:

stop loss

What might a person who is uninsured experience during times of illness and injury?

A financial burden