Ch 4 Exam (Health Providers)

What is Medicare?

A hospital and medical expense insurance program

Which of these is considered a true statement regarding Medicaid?

Funded by both the state and federal governments

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

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

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

Closed Panel

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

Commercial insurers

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

HMO

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

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 and routine physical examinations?

Health Maintenance Organizations (HMO)

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?

Her group health plan

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

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

PPO's are NOT a type of managed care systems

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

Primary Care Physician

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

They are nonprofit organizations

Medicare is intended for all of the following groups EXCEPT

Those enrolled as a full time student