Deck 24: Health Insurance

Question 1

An insurance plan that covers a group of employees usually has

A) fewer benefits
B) lower premiums
C) separate policies for each member of the group
D) all of the above

Answer 1

lower premiums

Question 2

Most outpatient IV therapies require a

A) waiting period
B) premium
C) preauthorization
D) deductible

Answer 2

preauthorization

Question 3

TRICARE is a health care benefit program for all of the following, EXCEPT

A) Coast Guard
B) Navy
C) families of uniformed personnel
D) families of veterans with service-related disabilities

Answer 3

families of veterans with service-related disabilities

Question 4

For patients who have an HMO, what option will allow them to utilize an out-of-network provider?

A) preferred provider option
B) point-of-service option
C) out-of-network option
D) non-HMO physician option

Question 5

Medicaid is

A) always the primary carrier
B) secondary carrier when the patient has Medicare
C) type of Medigap insurance policy
D) governmental insurance plan with which all physicians must comply

Question 6

Which of the following is a third-party health plan that is funded by the federal government?

A) Blue Cross and Blue Shield
B) Starmark
C) Aetna
D) TRICARE

Question 7

If a patient has two insurance plans, and the primary insurance carrier pays 80% of the charges, what is the most that the secondary will pay?

A) 10%
B) 20%
C) 80%
D) 100%

Question 8

Which of the following Medicare programs covers hospital charges?

A) Part A
B) Part B
C) Part C
D) Part D

Question 9

The Blue Cross part of the Blue Cross and Blue Shield Association plans covers

A) physician services
B) hospital services
C) dental services
D) vision

Question 10

An individual contract for health insurance

A) has lower premiums
B) has more benefits
C) is also called personal insurance
D) all of the above

Question 11

Providers are required by law to file which of the following for all eligible Medicare patients?

A) CMS
B) HCPCS
C) RBRVS
D) CMS-1500

Question 12

Which of the following is an example of fraud?

A) miscoding a diagnosis unintentionally
B) leaving a field blank on the CMS-1500 by mistake
C) altering a patient's chart to increase the amount reimbursed
D) releasing a patient's medical records without the patient's permission

Question 13

TRICARE was formerly known as

A) CHAMPVA
B) CHAMPUS
C) BCBS
D) Medicaid

Question 14

The Kaiser Foundation Health Plans

A) offer no-deductible physician visits
B) contract with physicians for their services
C) are essentially a type of HMO
D) own the medical facilities and employ the physicians

Question 15

The most common insurance claim form is the

A) superbill
B) charge sheet
C) ICD-9
D) CMS-1500

Question 16

Which of the following plans covers spouses of veterans with permanent, service-related disabilities?

A) Medicare
B) Medicaid
C) CHAMPUS
D) CHAMPVA

Question 17

Which of the following is true about Blue Cross and Blue Shield?

A) It offers prepaid health services.
B) It helps Medicare to determine covered health services.
C) It helps Medicaid to determine covered health services.
D) It offers prepaid Medicare Part D.

Question 18

Medicare Part B covers

A) hospital care
B) outpatient services
C) hospice care
D) nursing facility care

Question 19

What is true about Health Maintenance Organizations (HMOs)?

A) Physicians are often paid only for patient visits.
B) Physicians are responsible for the administrative tasks.
C) Members of an HMO select a primary care physician (PCP) from a group.
D) Both b and c are true.

Question 20

Workers' Compensation benefits usually include

A) weekly income replacement
B) comprehensive health care for entire companies
C) survivor benefits when applicable
D) both a and c

Question 21

Which TRICARE program is a preferred provider organization plan?

A) TRICARE standard
B) TRICARE PPO
C) TRICARE Extra
D) TRICARE Prime

Question 22

The Medicaid health benefits program is not used for

A) low income people
B) blind and disabled persons
C) veterans
D) families with dependent children without financial support from at least one parent

Question 23

The largest single medical benefits program in the United States is

A) Medicaid
B) Medicare
C) TRICARE
D) CHAMPUS

Question 24

TRICARE replaced which government program?

A) Medicare Part C
B) CHAMPVA
C) CHAMPUS
D) Medicare Choice Plans

Question 25

Medicare Part B coverage

A) is for those who do not qualify for Part A coverage
B) is free for enrollees in Medicare Part A
C) covers hospitalization expenses not covered under Part A
D) is optional

Question 26

With workers' compensation, it is the injured worker's responsibility to

A) notify the employer promptly of an injury
B) pay all medical bills until reimbursed by the employer
C) pay a 20% deductible for all medical bills
D) pay for coinsurance

Question 27

____________________ is the largest single medical benefits program in the United States.

Question 28

All of the following insurance programs are sponsored by the federal government, EXCEPT

A) TRICARE
B) CHAMPVA
C) Medicaid
D) Workers' Compensation

Question 29

Pharmacy technicians may have more interaction with insurance companies in which of the following pharmacy settings?

A) hospital pharmacies
B) community pharmacies
C) both hospital and community pharmacies
D) neither hospital nor community pharmacies

Question 30

A plan in which the member may seek care outside the network is called

A) point-of-service
B) policy limitation
C) beneficiary
D) group plan

Question 31

Which is NOT true regarding an insurance policy?

A) It is a legally enforceable agreement.
B) It becomes effective as soon as it is offered.
C) It may include dependents of the insured.
D) There is no standard contract for all plans.

Question 32

The subscriber is known as a(n)

A) dependent
B) coinsurance
C) insured
D) beneficiary

Question 33

If a patient has both Medicare and Medicaid, charges must be filed with

A) Medicare first and then Medicaid
B) Medicaid first and then Medicare
C) both Medicaid and Medicare
D) only Medicaid

Question 34

Medicare plus Choice plan is also known as

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D

Question 35

Government-sponsored health plans include all the following, EXCEPT

A) TRICARE
B) Medicaid
C) CHAMPVA
D) Kaiser Foundation Health Plans

Question 36

Which of the following parts of Medicare covers drug prescriptions?

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D

Question 37

Patients who can receive medical benefits under Medicare include

A) any person without health insurance who is a U.S. citizen
B) citizens 65 years of age and older
C) children under the age of 18
D) all of the above

Question 38

All of the following conditions are "exclusions" on insurance policies, EXCEPT

A) cancer
B) heart attack
C) pregnancy
D) attempted suicide

Question 39

Medicare Part B covers

A) outpatient prescriptions
B) durable medical equipment
C) home health care
D) inpatient care

Question 40

What is true regarding a Preferred Provider Organization (PPO)?

A) enrollees can see any physician they wish
B) it is a type of Health Maintenance Organization (HMO)
C) enrollees can see a specialist without prior authorization from a primary care physician
D) enrollees can go to any hospital for care

Question 41

The Kaiser Foundation Health Plan is a type of prepaid group practice ____________________.

Question 43

Medicare Part D is offered to all Medicare recipients to cover the costs of their ____________________.

Question 44

The requirement of notification and permission to receive additional types of services prior to obtaining those services is called ____________________.

Question 45

If the patient chooses coverage and Medicare Part C, she will not need coverage under ____________________ and ____________________.

Question 46

Claims may be submitted either electronically or by using actual paper ____________________.

Question 47

TRICARE runs a military pharmacy as well as a(n) ____________________ pharmacy.

Question 48

A(n) ____________________ is a specific amount of money that must be paid each year before the policy benefits begin.

Question 49

Paper claims can only be used by offices that do not handle any other ____________________related transactions.

Question 50

In a preferred provider organization, patients may see specialists without ____________________ from their primary care physicians.

Question 51

Monthly automatic premium deductions for Medicare Part B are taken out of monthly ____________________ checks, railroad retirement checks, or civil service checks.

Question 52

If a patient has both Medicare and Medicaid, charges must be filed with ____________________ first, and ____________________ is the secondary payer.

Question 53

An exclusion of certain types of coverage in an insurance policy is called a(n) ____________________.

Question 54

The period of time that an individual must wait to become eligible for insurance coverage is referred to as the ____________________.

Question 55

A payment made by either an insurer or a patient that is greater than the actual amount due is called a(n) ____________________.

Question 56

The amount of time from the date of service to the deadline the claim can be filed with the insurance company is called a(n) ____________________.

Question 57

Medicare Part A covers hospitals, nursing facilities, home health care, ____________________, and inpatient care.

Question 58

Medicaid is a health benefits program designed for ____________________ people, the blind, and the disabled.

Question 59

The most common health insurance claim form is the ____________________ that was developed by the Centers for Medicare and Medicaid Services (CMS).

Question 60

All claims processing involving pharmacies is now done ____________________.

Question 61

What are the four parts of Medicare? What are the benefits of each?

Question 62

Explain legal and ethical issues related to medical insurance and pharmacy.

Question 63

List the items that a major medical contract is designed to cover.

Question 64

Explain eligibility criteria for Medicare.

Question 65

Identify and explain government plans.

Question 66

What are three ways a person can obtain health insurance other than through government programs?