chapter 12 healther insurance providers quiz Flashcards
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 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
her group health plan
which type of provider is known for stressing preventative medical care and routine physical examinations
HMO
Medicare part A and Part B do not pay for
dental care
what is medicare
a hospital and medical expense insurance program
which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care
obtain prior approval from the insurer for the medical service
a medical care provider which typically delivers health services at its own local medical facility is known as a
HMO
which of these statements is INCORRECT regarding a preferred provider organization
PPO are not a type of managed care systems
medicare is intended for all of the follow groups except
full time students
which of the following best describes how a PPO is less restrictive than a HMO
more physicisans to chose from –wider choise of physicians and hospitals
which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures
commercial insurer
allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement
which of the following does social security NOT provide benefits for
dismemberment
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
pop
what does medicare part A and B cover
A-hospitalizaiton B doctors services
a hospital benefits b physicians services
medicaid was designed to assist individuals who are
below a specific income limit
which of these is considered a true statement regarding medicaid
funded by both state and federal governments
the percentage of an individuals primary insurance amount determines the benefits paid in which of the following programs
social security disability income
which of the following statements is true about most blue cross/blue shield organizations
they are nonprofit organizations
what is the maximum SS disability benefit amount an insured can receive
100% of the insured Primary insurance account (PIA)
the situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called an
closed panel
represented by a group of physicians who are salaried employees and work out of the HMO facility
