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Ins > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

Period of time during which benefits are paid under policy

Enrollee
Premium
Waiting period
Benefit period

A

Benefit period

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2
Q

Person enrolled in health ins plan, an insured doesn’t include dependents of insured

Enrollee
Benefit period
Waitin period
Per existing conditions

A

Enrollee

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3
Q

Conditions insured has recd diagnosis for diagnosis advice care or treatment during specific time period prior to Capp for health coverage

Benefit period
Premium
Social security disability insured status
Pre existing conditions

A

Pre existing conditions

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4
Q

Money paid to ins company for ins coverage

Waiting period
Medicare
Premium

A

Premium

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5
Q

Fully insured or currently insured depending on number of coverage credits earned

Social security disability insured status
Medicare
Premium

A

Social security disability insured status

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6
Q

Period of time that must pass after a loss occurs before insurer start paying policy benefits

Waiting period
Trial period
Executive period

A

Waiting period

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7
Q

Federal medical expense ins program for ppl age 65 and older even if individual continues to work

Actual charge insurance
Supplemental ins
Disability ins
Medicare

A

Medicare

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8
Q

Available to anyone regardless of age entitled to social security disability income benefits for two years or has permanent kidney failure

Rehab services
Medicare
Group care

A

Medicare

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9
Q

If already receives social security disability benefits what would need to be done to qualify for Medicare part a once 65

Nothing
Apply for coverage through state
Apply for coverage through social security administration

A

Nothing

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10
Q

Financed through portion of payroll tax FICA

Part a
Part b
Part c
Part d

A

Part a hospital ins

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11
Q

Financed from monthly premiums paid by insureds and from general revenues of federal govt

Part a
Part b
Part c
Part d

A

Part b

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12
Q

Allows ppl to rec all of their health care services through available provider organizations

Part a
Part b
Part c
Part d

A

Part c

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13
Q

Is for prescription drug coverage

Part a
Part b
Part c
Part d

A

Part d

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14
Q

Does not require patient to choose primary care doc nor does it require referral to see specialist as long as specialist is enrolled in Medicare

Ambulatory surgical services
Medicare part d
Original Medicare

A

Original medicare

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15
Q

Amount physician actually bills for particular service or supply

A

Actual charge

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16
Q

Provided at ambulatory center/performed at center that doesnt require hospital stay unlike inpatient hospital surgery

A

Ambulatory surgical services

17
Q

Amount Medicare determines to be reasonable for service that is covered under part b of Medicare

Assignment
Carriers
Actual charge
Approved amount

A

Approved amount

18
Q

Physician or medical supplier agrees to accept Medicare approved amount as full payment for covered services

Assignment
Carriers
Excess charge

A

Assignment

19
Q

Organizations that process claims that are submitted by doctors and suppliers under Medicare

Carriers
Xo insurance
Limiting charge

A

Carriers

20
Q

Portion of Medicare’s approved amount that beneficiary is responsible for paying

Coinsurance
Deductible
Excess charge

A

Coinsurance

21
Q

Outpatient services recd from Medicare participating comprehensive outpatient rehab facility

Peer review organization
Pap smear screening
Comprehensive outpatient rehabilitation facility services

A

Comprehensive outpatient rehabilitation facility services

22
Q

Organizations that process inpatient and outpatient claims on individuals by hospitals skilled nursing facilities home health agencies hospices or other providers of health services

Limiting charge
Intermediaries
Excess charge

A

Intermediaries

23
Q

Maximum physician may charge Medicare beneficiary

Limiting charge
Peer review organization
Participating doctor or supplier

A

Limiting charge

24
Q

Program of outpatient mental health care

Peer review organization
Nonparticipating
Limiting charge
Partial hospitalization for mental health care

A

Partial hospitalization fo mental health care

25
Q

Groups of practicing doctors and other health care professionals who are paid by govt to review care given to Medicare patients

Pap smear screening
Participating doctor or suppliers
Peer review organizations

A

Peer review organizations

26
Q

Bill confined in skilled nursing facility. Medicare will pay full benefits in facility for how many days

100
80
3
20

A

20

27
Q

Days 21 through 100 require a daily

Threshold
Advice
Physician’s note
Copayment

A

Copayment

28
Q

Citizen or legal resident of US age 65 or over and qualified for social security or railroad retirement benefits
Entitled to monthly social security benefits based upon the spouse’s work record and the spouse is at least 62; younger than 65 but has been entitled to social security disability benefits for 24 months/disabled; has end stage renal disease/permanent kidney failure that requires dialysis or transplant/has als

Aleatory eligible
Dependent care eligible
Hsa eligible
Medicare part a eligible

A

Medicare part a eligible

29
Q

Pays for inpatient care inpatient care in skilled nursing facility home health care and hospice care is known as

Part a
Part b
Part c
Part d

A

Part a

30
Q

Not an enrollment period for Medicare part a applicants

Initial enrollment
Special enrollment
General enrollment
Automatic enrollment

A

Automatic enrollment

31
Q

Three enrollment periods for Medicare part a

Initial general special
Beginning end middle
Moon sun ground

A

Initial general special

32
Q

All of following qualify for Medicare part a except

Someone in renal failure
Someone with social security
Someone over 65 willing to pay premium
Anyone willing to pay premium

A

Anyone willing to pay premium

33
Q

All following are covered by part a of Medicare except

Physician and surgeon services
Home health services
Post hospital nursing care

A

Physician and surgeon services

34
Q

To rec benefits under Medicare part a for care in skilled nursing facility which must be met

Insured must cover daily copayments
Insured must have first been hospitalized for 3 consecutive days
Insured must have a Medicare suppplement ins policy

A

Insured must have first been hospitalized for 3 consecutive days

35
Q

Fully insured under social security means they have earned

A

40 quarters of coverage equivalent of 10 years of work

Ins (77 decks)

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