Chapter 12 Healther Insurance Providers Quiz
This flashcard set explains prepaid health plans like HMOs, their focus on preventive care, and Medicare coverage basics. It includes key distinctions between primary and secondary coverage, what Medicare does not cover, and the need for prior approval when receiving care outside coverage areas.
which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements
HMO
Key Terms
which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements
HMO
a 66 year old is covered under a group health plan while employed with a business that has 40 employees. if she injures herself while walking in the park, what covereage would be considered primary
her group health plan
which type of provider is known for stressing preventative medical care and routine physical examinations
HMO
Medicare part A and Part B do not pay for
dental care
what is medicare
a hospital and medical expense insurance program
which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care
obtain prior approval from the insurer for the medical service
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| Term | Definition |
|---|---|
which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements | HMO |
a 66 year old is covered under a group health plan while employed with a business that has 40 employees. if she injures herself while walking in the park, what covereage would be considered primary | her group health plan |
which type of provider is known for stressing preventative medical care and routine physical examinations | HMO |
Medicare part A and Part B do not pay for | dental care |
what is medicare | a hospital and medical expense insurance program |
which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care | obtain prior approval from the insurer for the medical service |
a medical care provider which typically delivers health services at its own local medical facility is known as a | HMO |
which of these statements is INCORRECT regarding a preferred provider organization | PPO are not a type of managed care systems |
medicare is intended for all of the follow groups except | full time students |
which of the following best describes how a PPO is less restrictive than a HMO | more physicisans to chose from –wider choise of physicians and hospitals |
which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures | commercial insurer allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement |
which of the following does social security NOT provide benefits for | dismemberment |
under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured | pop |
what does medicare part A and B cover | A-hospitalizaiton B doctors services a hospital benefits b physicians services |
medicaid was designed to assist individuals who are | below a specific income limit |
which of these is considered a true statement regarding medicaid | funded by both state and federal governments |
the percentage of an individuals primary insurance amount determines the benefits paid in which of the following programs | social security disability income |
which of the following statements is true about most blue cross/blue shield organizations | they are nonprofit organizations |
what is the maximum SS disability benefit amount an insured can receive | 100% of the insured Primary insurance account (PIA) |
the situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called an | closed panel represented by a group of physicians who are salaried employees and work out of the HMO facility |