Medical Plans

Question 1

What are the three types of basic medical expense insurance?

Answer 1

1 hospital

2 surgical

3 medical

Question 2

What are the two types of Flexible Spending Accounts?

Answer 2

1 health care accounts

2 dependent care accounts

Question 3

What are the five basic characteristics of managed care plans?

Answer 3

1 controlled access to providers
2 comprehensive case management
3'preventive care
4 risk sharing
5 high quality care

Question 4

Under what type of care do insurers negotiate contracts with healthcare providers to allow subscribers access to health care services at a favorable cost?

Answer 4

Preferred Provider Organization (PPO)

Question 5

What is the main principle of an HMO plan?

Answer 5

Preventive care

Question 6

What type of health insurance plans cover all accidents and sicknesses that are not specifically excluded in the policy?

Answer 6

Comprehensive plans

Question 7

What is a fee for service health plan?

Answer 7

Under a fee for service plan, providers receive payments for each service provided

Question 8

Why do HMOs encourage members to get regular checkups?

Answer 8

To help catch health problems early when treatment has the greatest chance for success (preventive care)

Question 9

In what type of health plans are providers paid for services in advance, regardless of the services provided?

Answer 9

Prepaid plans

Question 10

What are usual/reasonable and customary charges based on?

Answer 10

Average charge for a given procedure in e specific geographic area

Question 11

What is the purpose of managed care health insurance plans?

Answer 11

To control health insurance claims expenses

Question 12

How can an HMO member see a specialist?

Answer 12

Referral by the primary care physician

Question 13

What is the main difference between coinsurance and copay?

Answer 13

Copay is a set dollar amount

Coinsurance is a percentage of expenses

Question 14

What is the purpose of the coinsurance provision in health insurance policies?

Answer 14

To prevent over utilization of the policy benefits

Question 15

What is the role of the gatekeeper in an HMO plan?

Answer 15

To control costs for the services of specialists

Question 16

Who chooses a primary care physician in an HMO plan?

Answer 16

The individual member

Question 17

What provision provides for the sharing of expenses between the insured and the insurance company?

Answer 17

Coinsurance

Question 18

Can an insured who belongs to a POS plan use an out of network phsyician?

Answer 18

Yes but copay and deductibles may be higher

Question 19

What are the tax implications for contributions to Health Savings Accounts by the individual insured?

Answer 19

Contributions are tax deductible

Question 20

When are newborns covered in individual health insurance policies?

Answer 20

From the moment of birth

Question 21

What types of injuries and services will be excluded from major medical coverage?6

Answer 21

1 injuries caused by war
2 intentionally self inflicted injuries
3 injuries covered by workers compensation 
4 regular dental/vision/hearing care
5 custodial care
6 cosmetic surgery

Question 22

How are HMO territories typically divided?

Answer 22

Geographic areas