chapter 12 healther insurance providers quiz

Question 1

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

Answer 1

HMO

Question 2

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 covereage would be considered primary

Answer 2

her group health plan

Question 3

which type of provider is known for stressing preventative medical care and routine physical examinations

Answer 3

HMO

Question 4

Medicare part A and Part B do not pay for

Answer 4

dental care

Question 5

what is medicare

Answer 5

a hospital and medical expense insurance program

Question 6

which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care

Answer 6

obtain prior approval from the insurer for the medical service

Question 7

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

Answer 7

HMO

Question 8

which of these statements is INCORRECT regarding a preferred provider organization

Answer 8

PPO are not a type of managed care systems

Question 9

medicare is intended for all of the follow groups except

Answer 9

full time students

Question 10

which of the following best describes how a PPO is less restrictive than a HMO

Answer 10

more physicisans to chose from –wider choise of physicians and hospitals

Question 11

which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures

Answer 11

commercial insurer

allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement

Question 12

which of the following does social security NOT provide benefits for

Answer 12

dismemberment

Question 13

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

Answer 13

pop

Question 14

what does medicare part A and B cover

Answer 14

A-hospitalizaiton B doctors services

a hospital benefits b physicians services

Question 15

medicaid was designed to assist individuals who are

Answer 15

below a specific income limit

Question 16

which of these is considered a true statement regarding medicaid

Answer 16

funded by both state and federal governments

Question 17

the percentage of an individuals primary insurance amount determines the benefits paid in which of the following programs

Answer 17

social security disability income

Question 18

which of the following statements is true about most blue cross/blue shield organizations

Answer 18

they are nonprofit organizations

Question 19

what is the maximum SS disability benefit amount an insured can receive

Answer 19

100% of the insured Primary insurance account (PIA)

Question 20

the situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called an

Answer 20

closed panel

represented by a group of physicians who are salaried employees and work out of the HMO facility