Health Insurance Providers

Question 1

commercial insurers

Answer 1

function on the reimbursement approach

Question 2

health maintenance organizations

Answer 2

finance health care services for their subscribers on a pre paid basis, also organize and deliver health services using its own facilities

Question 3

how are HMOs funded

Answer 3

subscribers pay a fee as opposed to paying when services are rendered

Question 4

what is a closed panel?

Answer 4

salaried employees working within HMO facility

Question 5

how many employees must there be in order to have HMO?

Answer 5

at least 25

Question 6

preferred provider organizations

Answer 6

offer services to certain groups at prearranged DISCOUNT prices; this is a fee-for-service basis

Question 7

Medicare eligibility

Answer 7

• 65 or older
• chronic kidney disease
• receives ss disability benefits for at least 24 months

Question 8

participating providers

Answer 8

doctors who agree to cover ALL medicare claims

Question 9

Medicare Part A

Answer 9

hospitalization

Question 10

Medicare Part B

Answer 10

required doctors services and other services not covered by Part A

Question 11

Medicare Part D

Answer 11

drugs

Question 12

social security disability income requirements

Answer 12

40 credits and fully insured; max benefit is equal to 100% of insured’s PIA; those who qualify under social security ; must not be able to perform substantial work; impairment is expected to last 12 months; must wait 5 month waiting period before receiving benefits; spouse and children covered up to insured’s insurance amount

Question 13

medicaid

Answer 13

people under 21, blind, or disabled

Question 14

state workers comp

Answer 14

lost wages and medical expenses due to occupational accidents