Types Of Insurance Plans

Question 1

Medicare

Answer 1

Generally covers patients age 65 and older by Part A (hospitalization) or Part B (routine medical office visits) benefits

Question 2

Tricare

Answer 2

Authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government.

Question 3

CHAMPVA

Answer 3

Covers surviving spouses and dependent children of veterans who dies as a result of service-related disabilities.

Question 4

Medicaid

Answer 4

Provides health insurance to the medically indigent population through a cost-sharing program between federal and state governments for those who meet specific eligibility criteria.

Question 5

Managed Care

Answer 5

Is an umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals.

Question 6

Workers’ compensation

Answer 6

Protects wage earners against the loss of wages and the cost of medical care resulting from an occupational accident or disease as long as the employee in not proven negligent.

Question 7

CMS - 1500 Form

Answer 7

Health insurance claim form for claims submitted by a provider or supplier. Information needed to complete the form, including the patient’s and guarantor’s demographic and insurance information; diagnostic test, treatment, or procedure information; and billing information. The CMS-1500 form has 33 blocks or items , which are divided into three sections.

Question 8

CMS-1500 Form Section 1

Answer 8

Carrier Block: contains the address of the insurance carrier and is located at the top of the form.

Question 9

CMS-1500 Form Section 2

Answer 9

Patient/Insured Section: contains information about the patient or insured (if other than the patient); includes boxes 1 through 13

Question 10

CMS-1500 Form Section 3

Answer 10

Physician/Supplier Section: contains information about the physician or supplier; includes boxes 14 to 33.