Chapter 8: Health Insurance Classes, Providers, and Programs

Question 1

Health insurance provided by the goverment is also called _____ ______

Answer 1

Social Insurance

Question 2

The federal goverment administers disability benefits through ________ _______

Answer 2

Social Security

Question 3

______ insurance provides specialized coverage such as AD&D, which only provides coverage for accidental death and dismemberment. These insurance policies are also referred to as conditional contracts because they do not pay benefits unless specific conditions are met.

Answer 3

Limited

Question 4

If the insured only loses one extremity or vision in one eye, the policy will pay ______ of the principal sum.

Answer 4

50%

Question 5

______________- policies provide broad coverage for accident and sickness.

Answer 5

Comprehensive

Question 6

_______ insurers include stock and mutual insurers. These insurers provide a wide range of health insurance plans such as:

Medical expense policies,
Disability income, and
Limited policies.

Answer 6

Commercial

Question 7

Commercial insurers typically pay benefits on a ___________ basis, meaning that the insured pays the medical providers for services and the insurer reimburses the insured.

Answer 7

reimbursement

Question 8

________ __________ include BlueCross BlueShield. They differ from commercial insurers in that they pay benefits on a service basis, which means that the insurer pays benefits directly to the medical providers instead of the insured.

Answer 8

Service Providers

Question 9

TF: Service Providers such as BlueCross BlueShield have contacts with subscribers, but not with medical providers

Answer 9

False - service providers have contracts with both subscribers AND medical providers

Question 10

TF: Service providers differ from stock and mutual insurers in that they provide the medical services; whereas, stock and mutual insurers provide reimbursement of medical services.

Answer 10

True

Question 11

BlueCross BlueShield plans are ______ because subscribers pay a fixed monthly fee for all services.

Answer 11

prepaid

Question 12

BlueCross BlueShield organizations are also referred to as ______ _______ because the doctors and hospitals that sponsor BlueCross BlueShield also supply the insurance coverage. BlueCross provides hospital service and BlueShield provides doctors’ service.

Answer 12

Producer Cooperatives

Question 13

____ ____ ____ plans allow plan participants to receive care from participating OR nonparticipating providers

Answer 13

Point of Service (POS)

Question 14

_______ also provides benefits to people who qualify for Social Security or Railroad Retirement Board disability benefits, those with ESRD (end stage renal disease – permanent kidney failure), or those who have Lou Gehrig’s disease.

Answer 14

medicare

Question 15

_______, or Title XIX, is a welfare program funded by state and federal dollars for people who have limited incomes and resources to cover the cost of health care. This is not insurance. It is a welfare program.

Answer 15

Medicaid

Question 16

People that qualify for both Medicaid and Medicare are referred to as ____-_____

Answer 16

Dual-eligible

Question 17

TF: Medicaid provides coverage for medical care and services that Medicare only partially covers, including nursing home and home health care.

Answer 17

True

Question 18

_______ provides health insurance coverage to active duty and retired members of the uniformed services and their dependents.

Answer 18

TRICARE

Question 19

TRICARE: _____ is managed care that provides comprehensive coverage, with fewer out-of-pocket costs

Answer 19

Prime

Question 20

TRICARE: _____ is “fee for service” coverage that allows enrollees to receive medical care from any medical provider, but has higher out-of-pocket costs.

Answer 20

Standard

Question 21

TRICARE: _____ allows enrollees to receive medical care through a PPO arrangement, which is TRICARE in-network with discounted cost sharing.

Answer 21

Extra

Question 22

_____ ______ disability benefits are only available to covered workers who are fully insured at the time of disability

Answer 22

Social Security

Question 23

TF: Disability income benefits are paid to the covered worker in the amount of the primary insurance amount (PIA) after a 6 month waiting period. Social Security disability benefits are only available prior to the age of 65.

Answer 23

False - 5 month waiting period

Question 24

TF: Social Security does not pay partial disability or short-term disability benefits. The disability must be total and the following conditions must be met:

The covered worker cannot do the work they did prior to the disability;
The covered worker cannot do other work because of physical or mental conditions; and
The disability has already lasted or will last for at least 12 full months, or the disability is expected to result in death.

Answer 24

True

Question 25

Disability benefits include:

_______ benefits: Monthly payments to the disabled covered worker in the amount of the worker’s PIA. At the earliest, the disabled covered worker may be eligible to receive Social Security disability benefits upon the sixth month of disability.
_________ Benefits: Monthly payments to the disabled worker’s spouse if the spouse is caring for a child under the age of 16, or a disabled child under the age of 22 in the amount of 50% of the worker’s PIA.

Answer 25

Disabled Worker
Spousal

Question 26

TF: Disabled Worker Benefits: Monthly payments to the disabled covered worker in the amount of the worker’s PIA. At the earliest, the disabled covered worker may be eligible to receive Social Security disability benefits upon the sixth month of disability.

Answer 26

True

Question 27

TF: Spousal Benefits: Monthly payments to the disabled worker’s spouse if the spouse is caring for a child under the age of 16, or a disabled child under the age of 22 in the amount of 50% of the worker’s PIA.

Answer 27

true

Question 28

TF: SS Spousal benefits are also payable if the spouse is age 65 in the amount of 50% of the worker’s PIA. For a spouse age 62, the benefits are reduced.

Answer 28

True

Question 29

TF: SS Child’s Benefits: Monthly payments to an unmarried child under age 18 (19 if the child is a full-time high school student), or a child who became disabled before the age of 22 in the amount of 50% of the worker’s PIA.

Answer 29

True

Question 30

TF: A disabled covered worker, regardless of age, is eligible to receive full Medicare benefits after the waiting period and two years of receiving Social Security disability benefits – after 29 months.

Answer 30

True

Question 31

Most employers are required to have _____ ______ insurance to cover accidental injury and sickness employees incur as a result of employment.

Answer 31

Workers Compensation

Question 32

______ ______ benefits include medical, disability income, death, and rehabilitation benefits.

Answer 32

Workers Compensation

Question 33

TF: Workers Comp medical benefits are provided to an employee until the condition is completely treated or cured

Answer 33

True

Question 34

SS Disability income benefits are relatively small, but are paid after the employee undergoes a waiting period called an ______ _______

Answer 34

Elimination Period

Question 35

If the disability extends beyond the elimination period, then SS disability income benefits will be paid in an amount of _______ of weekly wages for a permanent total or temporary total disability.

Answer 35

66 2/3%

Question 36

TF: For partially disabled employees, the SS weekly benefit is equivalent to the percentage of wages lost due to inability to work.

Answer 36

True

Question 37

SS Death benefits include a one-time burial payment and weekly income in an amount of _____ of the deceased employee’s weekly wage for a dependent spouse and children.

Answer 37

66 2/3%

Question 38

TF: Each state has a maximum time and amount limit for weekly income benefits.

Answer 38

True

Question 39

Which of the following is not true about Medicare?

Select one:
a. It is federally funded.
b. It provides coverage for people over 65.
c. It provides benefits for disabled people who qualify for Social Security.
d. It provides coverage for people with limited incomes.

Answer 39

D

Question 40

TF: Medicare is not the program that provides benefits for low income people _ that is Medicaid.

Answer 40

True

Question 41

Which plan is nonprofit, provides medical services to subscribers on a service basis and is called a producer cooperative”?
Select one:
a. Medigap
b. Long-term care
c. Medicare
d. BlueCross BlueShield

Answer 41

D

Question 42

Commercial insurers:

Select one:
a. Pay health insurance benefits on a service basis
b. Pay health insurance benefits on a reimbursement basis
c. Include BlueCross BlueShield
d. Pay benefits directly to medical providers instead of the insured

Answer 42

B

Question 43

What type of health plan is offered by BlueCross BlueShield?
Select one:
a. POS plans
b. HMO
c. PPO
d. All of the above

Answer 43

D

Question 44

Coverage for groups not large enough to apply for group coverage can be provided by:
Select one:
a. Franchise insurance
b. Government insurance
c. Social Security
d. All of the above

Answer 44

A