CH 12- Health insurance providers
What is Medicare?
A hospital and medical expense insurance program
Which of these is considered a true statement regarding Medicaid?
Funded by both state and federal governments
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
commercial insurer
What is the maximum social security disability benefit amount an insured can receive?
100% of the insured's Primary Insurance Amount (PIA)
Which of the following reimburses its insured for covered medical expenses?
Commercial insurers
Which of the following does Social Security NOT provide benefits for?
Dismemberment
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?
HMO
A medical care provider which typically delivers health services at its own local medical facility is known as a:
Health Maintenance Organization
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)
Which type of provider is known for stressing preventative medical care?
Health Maintenance Organizations (HMO)
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
Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?
Obtain prior approval from the insurer for the medical service
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
What does Medicare Pasts A and B cover?
Part A covers hospitalizations and Part B covers doctor's services
The percentage of an individuals Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs?
Social Security Disability Income
Which of the following statements is true about most Blue/Blue Shield organizations?
They are nonprofit organizations
Medicare is inteded for all of the following groups, EXCEPT
Those enrolled as a full-time student
Medicaid was designed to assist individuals who are
below a specific income limit
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n):
closed panel
Medicare Part A and Part B do NOT pay for
dental work
A 66 year old is covered under a group health plan while employed with a business that has 40 employees. If seh injures herself while walking in the park, what coverage would be considered primary?
her group health plan