Chapter 9 Smartbook

What are the sources of disability income coverage?

- Employer plans - Social Security - Worker's compensation

Which of the following factors has not been attributed to increasing health care costs?

A focus on healthy living options

A provision under which the insured pays a flat dollar amount each time a covered medical service is received is called:

copayment

An amount the insured must pay before benefits become payable by the insurance company is called a:

deductible

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

emergency

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

vaccines

What qualifications must you have to be eligible for Medicare?

- Be 65 or older - Be under age 65 with certain disabilities

Which of the following activities have been undertaken by health care professionals and consumers to keep the overall cost of health care down?

- Getting involved in community health planning - Offering incentives to encourage preventive care - Initiating community health education programs

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

Managed care is offered by which of the following?

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

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

- Private health insurers - Government

Identify ways in which you can personally reduce your health care costs.

- Take sufficient rest. - Exercise regularly. - Avoid smoking. - Eat a balanced diet to keep weight under control.

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

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

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

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

Health insurance coverage is available from:

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

Health insurance is one way people protect themselves against economic losses due to:

- injury - illness

Physician expense insurance provides benefits for which of the following?

- lab tests - X rays - doctors' fees for nonsurgical care

Basic health insurance coverage is a combination of:

- surgical expense insurance - physician expense insurance - hospital expense insurance

Supplemental health services for an HMO include

- vision care - prescription services

Stop-loss is a provision under which an insured pays a certain amount, after which the insurance company pays _____ percent of the remaining covered expenses.

100

The majority of people who draw on Medicare are __ years of age or older.

65

A "good" health insurance plan pays what percentage of out-of-hospital expenses once a yearly deductible for the individual and family have been met?

80%

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

Blue Cross

Name an independent, nonprofit membership corporation that provides protection against the cost of surgical and medical care (not hospital care).

Blue Shield

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

Comprehensive

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.

Disability

Which insurance provides payments to replace income when an insured person is unable to work for a long period of time?

Disability income 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 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

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

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

cash

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

coinsurance

___ health services for an HMO include vision and prescription services.

extra

Health insurance coverage is only available from private insurance companies.

false

Most private insurance companies do not provide group policies.

false

Your work-related expenses and taxes will likely not decrease during a period of disability.

false

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

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

group

By exercising, not smoking, getting rest, and driving carefully, individuals can greatly reduce their:

health care costs

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)

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

hospital

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

hospital

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

hospital expense insurance

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

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

insurance

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

insurance

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

insurer and the insured

Match the waiting periods and premiums for disability plans.

long waiting periods -> lower premiums short waiting periods -> higher premiums

Comprehensive major medical insurance policies are complete insurance policies offering a very___ deductible.

low

With disability plans, the longer the waiting period, the ___ the premiums.

lower

Which type of insurance pays the larger expenses of a serious injury or long illness, including those covered by the hospital, surgical, and physician expense policies, beyond those paid by basic health insurance?

major medical expense insurance

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

medigap

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

medigap insurance

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

operation

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

point

A network of selected contracted participating providers, also called an HMO-PPO hybrid, is a:

point-of-service plan

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

prearranged

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

preferred provider organization

Managed care refers to ___ health plans that provide comprehensive health care to members.

prepaid

The sources of disability income coverage include worker's compensation, employer group insurance plans, and ___ Security

social

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

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

surgical

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

surgical expense insurance

Copayment is the provision under which the insured pays a flat dollar amount each time a covered medical service is received.

true