fin 125 ch.9

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%

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

: Medigap or Medsup

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

A focus on healthy living options

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

An increased number of uninsured individuals An aging population The cost of prescription drug

Most private insurance companies do not provide group policies.

False

All of the following services and treatments are not covered by Medicare, except:

Hospital Care

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

Social

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

deductible

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

insurance

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

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

A "good" health insurance policy provides which of the following?

-Offer basic coverage for hospital and doctor bills -Pay at least 80 percent of out-of-hospital expenses after a yearly deductible of $1,000 per person or $2,000 per family

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

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

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

The coinsurance clause, when related to health insurance, is a provision in which:

Both the insured and the insurer share the covered costs of medical treatment.

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

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

False

The Carter family has health insurance coverage that covers 90% of out-of-hospital expenses once a deductible of $300 (per person) is paid. Chris Carter has medical bills of $2,500. How much will the insurance company pay?

First, subtract the $300 annual deductible from the $2,500 medical bill, which equals $2,200. Then multiply $2,200 by 90%, which equals $1,980. Ninety percent represents the percentage of the bill the insurance company will pay after the policyholder has paid the annual deductible.

Blake is an employee for a corporate company and has $500 left in his account at the end of the year. Blake is staying with this company until retirement. Which type of account will let him carry over the $500 in his account to the next calendar year?

For flexible spending accounts (FSAs), current regulations allow a carry over of $500 into the next calendar year and FSAs do not carryover to other employers.

Jenna currently has a job with a corporate company and will not use all of the money in her account before the end of the year. Jenna is staying with this company until she retires. Which type of account will let her carry over $1,000 in the account at the end of the current year to the next year?

For health reimbursement accounts (HRAs), money in the account at the end of the year can carry over to the next year, but you lose the money if you change jobs since your employer funded the account.

Sam currently has a job with a corporate company, but he is switching jobs to work for a local company in Raleigh. Which type of account will let him take his account with him when switching jobs?

For health savings accounts (HSAs), money remaining in the account at the end of the year can carry over to the next year and because you fund the account, you can also take your HSA with you if you change jobs or retire.

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 Initiating community health education programs Offering incentives to encourage preventive care

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

Government Private health insurers

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 your hospital bills for room, board, and other charges?

Hospital Expense Insurance

Which Medicare part provides the Medicare Advantage program?

In Medicare Part C, coverage is provided by the Medicare Advantage program. Part A provides hospital coverage, Part B provides medical insurance, and Part D provides coverage for prescription drugs.

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 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

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

Medigap insurance

______ work like HMOs, except the networks are managed by groups of doctors and hospitals.

PPOs

Which type of insurance covers only doctors' fees for nonsurgical care, X rays, and lab tests?

Physician expense insurance

Which of the following is usually combined with hospital and surgical insurance and referred to as Basic Health Insurance Coverage?

Physician's Expense Insurance

Managed care is offered by which of the following?

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

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

The Carter family has health insurance coverage that covers 90% of out-of-hospital expenses once a deductible of $300 (per person) is paid. Chris Carter had a serious illness that required hospitalization, with total medical bills amounting to $55,000. Assume there was a stop-loss provision of $5,000. How much will the Carter family pay?

Step 1: Subtract the $300 annual deductible from $55,000, which equals $54,700. Step 2: Multiply $54,700 by 10%, which equals $5,470. Step 3: Add the $300 deductible and the $5,470 amount obtained in Step 2, which equals $5,770. Since this amount exceeds the stop-loss provision of $5,000, the Carter family would be responsible for $5,000 (the amount of the stop-loss provision) and the insurance company would pay the remainder.

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

Which type of coverage has a low deductible, is all-inclusive, helps to pay hospital and surgical medical bills, and is offered without a separate basic plan?

Which type of coverage has a low deductible, is all-inclusive, helps to pay hospital and surgical medical bills, and is offered without a separate basic plan?

What are the sources of disability income coverage?

Worker's compensation Social Security Employer plans

Physician expense insurance provides benefits for which of the following?

X rays Lab tests Doctors' fees for nonsurgical care

When selecting disability income insurance, you will want to select a policy that will replace Blank______ 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 or debit

Health insurance coverage is only available from private insurance companies.

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)

Health insurance coverage is available from

health maintenance organizations hospital service plans private insurance government programs

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

hospital, medical, or health

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 or insuring

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

lower, smaller, or less

Prepaid health plans that provide comprehensive health care to members are called

managed care.

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

operation, procedure, or surgery

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 fe

prearranged, predetermined, set, fixed, given, approved, or specified

Similar to car and life insurance, the individual pays a(n) for health insurance in exchange for some degree of financial assurance.

premium or fee

Basic health insurance coverage is a combination of:

surgical expense insurance hospital expense insurance physician expense insurance

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

surgical, surgery, or surgeries