Deck 19: Health Insurance

Question 1

Indemnity insurance provides monetary benefits rather than service

Answer 1

True

Question 2

Medical reimbursement is based on codes that reflect the complexity of the service provided.

Answer 2

True

Question 3

State insurance commissioners can provide information regarding the types of policies approved for sale within their state.

Answer 3

True

Question 4

Major medical insurance policies generally include a deductible clause and coinsurance provisions.

Question 5

Open-enrollment is a period during which an insurance plan must accept eligible people regardless of their health status.

Question 6

"Stop loss"features of some insurance plans can protect consumers from exorbitant out-of-pocket expenses.

Question 7

Major medical insurance supplements basic health insurance to offset heavy expenses from prolonged illness.

Question 8

If a physician "accepts assignment,"the patient will not be billed for the difference between the physician's usual fee and the amount paid by the health insurance company (except for coinsurance and deductibles).

Question 9

Medicare is a federally funded health insurance program primarily for people over 65 years of age.

Question 10

Health insurance premium costs are lower for policies with higher deductible provisions.

Question 11

Preferred Provider Organizations involve "closed panels"of doctors and hospitals who accept insurer-fixed fees for services.

Question 12

When Medicare patients are hospitalized, payment is made according to a schedule that is based mainly on the patient's diagnosis.

Question 13

Medicaid is a federal grant-in-aid program to help finance health care services for public assistance recipients.

Question 14

Many major medical insurance policies have a stop-loss feature that limits the amount of out-of-pocket expenses to be paid by those insured.

Question 15

COBRA is a federal law stating that employees who quit or are laid off from their employment can have health insurance coverage for 18 months after job severance by paying the premiums.

Question 16

The Newborns' and Mothers' Health Protection Act of 1996 prohibits the restriction of hospital length of stays below specified durations.

Question 17

Physicians may not charge Medicare patients over 65 more than 15% above the fees approved by Medicare.

Question 18

It has been estimated that 46% of Americans who are 65 will enter a nursing home sometime before they die.

Question 19

PPO subscribers generally must select services from a designated panel of providers.

Question 20

The Medicare DRG system has pressured hospitals to become more cost efficient.

Question 21

Comprehensive medical insurance plans are usually more expensive than purchasing separate basic and major medical policies.

Question 22

Medicare and Medicaid are the only federal programs that pay for health related services.

Question 23

Health care flexible spending accounts provide tax exempt reimbursement for medical expenses from special trust accounts.

Question 24

Disability insurance and worker's compensation are the same thing.

Question 25

An Explanation of Benefit (EOB) is submitted to the insurance company to explain the services provided.

Question 26

Long-term care refers to a broad range of services provided in an acute care hospital for the elderly.

Question 27

Medicare permits beneficiaries to enroll in an HMO after paying a small extra premium for Part B of their coverage.

Question 28

Medigap insurance pays all expenses beyond those covered by Medicare.

Question 29

Dental health insurance plans usually include coverage of orthodontics, endodontics, and oral surgery.

Question 30

Poor people generally have the most health insurance.

Question 31

The DRG system of payment for Medicare services provides an incentive for hospitals to keep patients longer than needed.

Question 32

Basic health insurance generally includes benefits only for hospital and surgical expenses.

Question 33

Dread-disease and hospital indemnity policies are among the best buys in health insurance.

Question 34

Individual fee-for-service health insurance plans are no longer available from insurance companies.

Question 35

Compared with group policies, individual health insurance policies provide greater benefits at reduced costs.

Question 36

The premiums for health insurance are lower when the deductibles are lower.

Question 37

Medicare covers all the following except

A) dental care.
B) inpatient hospital care.
C) medical care.
D) surgical care.

Question 38

When evaluating major medical insurance, consideration should be given to

A) double indemnity.
B) reversibility.
C) renewability.
D) convertibility.

Question 39

The number of Americans without health insurance at any given moment in 2004 was

A) unknown.
B) about 15%.
C) about 25%.
D) about 35%.
E) none of these choices.

Question 40

Basic health insurance covers all the following except

A) lost income from disability.
B) hospital costs.
C) surgical costs.
D) nonsurgical physician's fees.

Question 41

Approximately what proportion of Americans over age two have dental insurance?

A) about 75%
B) about 50%
C) about 25%
D) less than 10%
E) none of these choices

Question 42

When considering health insurance, which of these is important?

A) Purchase a group policy if possible.
B) Avoid policies that have a deductible clause.
C) Check the company's Medicare licensure status.
D) Check the company's standing with your local Better Business Bureau.