Health Insurance – Lesson 12

Question 0

HMOs come under the regulation of:

Answer 0

Department of managed health care

Question 1

In California, the word disability encompasses medical expenses, disability income, and accidental death and dismemberment. True or false?

Answer 1

True

Question 2

Organizers of HMOs include commercial insurers, hospitals, employers, unions, and local communities. True or false?

Answer 2

True

Question 3

If primary care physicians receive a flat monthly payment from the HMO for every member without regard to actual services provided by the physician, this agreement is known as:

Answer 3

Capitation

Question 4

If an HMO owns its own hospitals and clinics and doctors are considered employees, it is referred to as what type of organization?

Answer 4

Staff model

Question 5

When an HMO chooses a limited number of health care providers to provide services to its subscribers, it is called:

Answer 5

A closed panel

Question 6

HMO physicians who practice individually in their own offices are known as:

Answer 6

Independent practice Association model.

Question 7

What are some examples of service contractors?

Answer 7

1. PPOs
2. HMOs
3. Blue Cross/Blue Shield

Question 8

Persons insured by service contractors are referred to as:

Answer 8

Subscribers

Question 9

The gatekeeper system is a common feature of HMOs. True or false?

Answer 9

True

Question 10

The basic services provided by an HMO include:

Answer 10

1. Physician services
2. Hospital care
3. Emergency services
4. Preventative care

Question 11

What is true about PPO?

Answer 11

1. Provides healthcare to subscribers.
2. Either open or closed panels.
3. Doctors are paid on a fee-for-service basis.
4. More flexible of choices of physicians.

Question 12

The California state program which provides medical services to those who are financially unable to pay the costs of needed care is:

Answer 12

Media-cal