Ch2 Health Insurance Providers

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

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

Social Security Disability Income

Which type of provider is known for stressing preventative medical care?

Health Maintenance Organizations (HMO's)

What does Medicare Parts A and B cover?

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

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

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

Commercial insurer

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

Commercial insurers

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

Dismemberment

Which of these is considered a true statement regarding Medicaid?

Funded by both state and federal governments

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 predetermined price. What type of plan does J belong to?

Health Maintenance Organization

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

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

Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)? PPO's normally have more providers to chose from as compared to an HMO Prices are negotiated in advance for PPO providers In-network PPO providers offer members better coverage of incurred expenses PPO's are NOT a type of managed care systems

PPO's are NOT a type of managed care systems

Medicare is intended 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

What is Medicare?

is a hospital and medical expense insurance program