Chapter 12 Health Insurance Essentials
The amount of money the policy holder pays per claim on per accident torward the totally amount of an insured loss before the company will pay on the claim is known as the
Deductible
Medigap policies cover which of the following?
Difference between major medical reimbursement and patient financial responsibilities
The tricare option that is similar to a preferred provider network is tricare
Extra
Which of the following is not an advantage of managed care
Access to specialized care and referrals is limited
Health insurance benefits are determined by?
All the above
The medical assistant should verify which of the following prior to the patients appointment?
All the above
The maximum amount of money third-party layers will pay for a specific procedure or service is called the
Allowable amount
Which of the following is not a disadvantage of managed care ?
Authorized services usually are covered
The amount payable by an insurance company for a monetary loss to an individual insured by that company under each coverage is called the
Benefits
Most of today's health insurance policies cover which of the following?
Both A and B
Which of the following plans require healthcare providers to become participating providers?
Both A and B
A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether he person sees the provider that month, is called a. plan.
Capitation
Veterans of the US armed forces may be covered by
ChampVA
The amount of money paid to keep an insurance policy in force is the?
Co-pay
Which type of HMO model consist of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?
Independent practice association
The federal and state sponsored health insurance program for the medically indigent is called
Medicaid
Which part of Medicare covers prescription services?
Part D
The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a Providers
Participating
Which of the following expenses would be paid by Medicare Part B?
Physicians office visits
Which type of referral is usually processed immediately?
STAT
Employee sponsored group policies usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However there employee sponsored group health insurance plans offer limit benefits and healthcare access is limited to health care providers that are contracted with them
The first statement is false, the second is true
Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called
Third party payers
Health insurance designed for military dependents and military personnel is called?
Tricare
A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called
Utilization review
A type of insurance that protects workers from loss of wages after an industrial accident that happened on he job is called?
Workers compensation
Which of the following individuals would not normally be eligible for Medicare?
A 23 year old recipient of AFDC
A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called?
Group policy
Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?
HMOs
Which of the following pays the hospital surgical room fee?
Hospital
Organizations that fund their own insurance programs offer their employees
Self-funded plans
Which of the following HMO modes hires physicians and pays them a salary rather than contracting the physicians to create a network?
Staff model
