Medical Plans Quiz

Question 1

What is an important feature of a dental expense insurance plan that is NOT typically found in a medical expense insurance plan?

1. A broad coverage area
2. A low monthly premium
3. Diagnostic and preventive care
4. Low cost deductibles

Answer 1

Diagnostic and preventive care

Question 2

If an insured is not required to pay a deductible, what kind of coverage does the insured have?

Answer 2

First dollar

Question 3

Most policies will pay the accidental death benefits as long as the death is caused by the accident and occurs within

Answer 3

90 days

Question 4

All of the following are ways in which a Major Medical policy premium is determined EXCEPT

1. the amount of the deductible
2. the coinsurance percentage
3. the stop-loss amount
4. the average age of the group

Answer 4

average age of the group

Question 5

Which of the following is NOT the purpose of HIPAA?

1. to limit exclusions for pre-existing conditions
2. to provide immediate coverage to new employees who had been previously covered for 18 months
3. to prohibit discrimination against employees based on their health status
4. to guarantee the right to buy individual policies to eligible individuals

Answer 5

to provide immediate coverage to new employees who had been previously covered for 18 months

Question 6

HIPAA applies to groups of

1. at least 1oo
2. more than 2, fewer than 50
3. At least 10
4. 2 or more

Answer 6

2 or more

Question 7

Most vision expense plans restrict benefits to one exam and one pair of glasses in what time period?

Answer 7

12 months

Question 8

How can a new physician be added to the PPOs approved list?

Answer 8

Agree to follow the PPO standards and charge the appropriate fees

Question 9

A health insurance plan which involves financing, managing, and delivery of health care services and involves a group of providers who share in the financial risk of the plan or who have an incentive to deliver cost effective service, is called

Answer 9

Managed care plan

Question 10

what are the three basic coverages for medical expense insurance?

Answer 10

Hospital, Surgical, Medical

Question 11

Under which provision can a physician submit claim information prior to providing treatment?

Answer 11

Prospective Review

Question 12

Which of the following terms describes a specific dollar amount of the cost of care that must be paid by the member?

1. cost share
2. prepayment
3. contractual cost
4. copayment

Answer 12

copayment

Question 13

Which of the following is NOT provided by an HMO?

1. reimbursement
2. financing
3. patient care
4. services

Answer 13

Reimbursement for

Question 14

What happens if a non-member physician is utilized under the Point-of-Service plan?

Answer 14

the attending physician will be paid a fee for service, but the member patient will have to pay a higher coinsurance amount

Question 15

How is emergency care covered for a member of an HMO?

Answer 15

A member of an HMO may receive care in or out of the HMO service area, but care is preferred in the service area