Deck 20: Basics of Health Insurance

Question 1

Health insurance designed for military dependents and retired military personnel is:

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

Answer 1

TRICARE

Question 2

Approximately _____% of people in the United States have no health insurance coverage.

A)10
B)20
C)40
D)50

Answer 2

20

Question 3

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called:

A)group coverage
B)individual coverage
C)a government plan
D)a self-insured plan

Answer 3

group coverage

Question 4

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called:

A)riders
B)service benefit plans
C)third-party payers
D)capitation

Question 5

Veterans of the U.S.armed forces may be covered by:

A)CHAMPVA
B)TRICARE
C)workers' compensation
D)Blue Cross/Blue Shield

Question 6

The amount of money paid to keep an insurance policy in force is the:

A)premium
B)deductible
C)co-pay
D)co-insurance

Question 7

The purpose of health insurance is to help individuals and families offset the costs of medical care.

Question 8

Which of the following is not a disadvantage of managed care?

A)Authorized services usually are covered.
B)Physicians' choices in the treatment of patients can be limited.
C)More paperwork may be necessary.
D)Reimbursement is historically less than with traditional health insurance.

Question 9

Which of the following individuals would not normally be eligible for Medicare?

A)A 66-year-old retired woman
B)A blind teenager
C)A 23-year-old recipient of AFDC
D)A person on dialysis

Question 10

Which type of protection, formerly called catastrophic insurance, provides coverage for especially large medical bills resulting from a prolonged illness?

A)Disability protection
B)Basic medical
C)Hospitalization
D)Major medical

Question 11

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n):

A)credentialing committee review
B)peer review committee evaluation
C)utilization review
D)audit committee review

Question 12

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

A)Staff model
B)Independent practice association
C)Group model
D)None of the above

Question 13

Which of the following is not an advantage of managed care?

A)Healthcare costs are usually contained.
B)Access to specialized care and referrals is limited.
C)Most preventive medical treatment is covered.
D)Out-of-pocket expenses tend to be less than traditional insurance.

Question 14

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

A)participating
B)paying
C)physician
D)none of the above

Question 15

Organizations that fund their own insurance programs offer their employees:

A)group coverage
B)individual coverage
C)government plans
D)self-insured plans

Question 16

The federal- and state-sponsored health insurance program for the medically indigent is called:

A)Medicare
B)Medicaid
C)Medigap
D)MediCal

Question 17

A physician can choose whether to accept Medicaid patients.

Question 18

Health insurance typically covers services and procedures considered medically necessary.Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Question 19

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the:

A)exclusion
B)premium
C)deductible
D)remittance

Question 20

The maximum amount of money third-party payers will pay for a specific procedure or service is called the:

A)benefit
B)allowed charge
C)allowed service
D)incurred amount

Question 21

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called:

A)an individual policy
B)workers' compensation
C)unemployment insurance
D)disability insurance

Question 22

Which of the following is a type of insurance verification method?

A)Asking about the patient's insurance during the initial appointment telephone call
B)Copying the insurance card when the patient arrives for an appointment
C)Calling the carrier to verify benefits and eligibility
D)All of the above

Question 23

The TRICARE option that is similar to a preferred provider network is TRICARE:

A)Prime
B)Extra
C)Standard
D)Basic

Question 24

Insurance that protects a person in the event of a certain type of accident, such as an automobile or plane crash, is called:

A)liability insurance
B)life insurance
C)special risk insurance
D)long-term insurance

Question 25

If Mr.Jones's insurance has a $500 deductible and a $50 surgery co-pay, how much will his insurance pay on his bill of $4,359?

A)$3,809
B)$2,809
C)$3,980
D)$3,900

Question 26

Health insurance benefits are determined by:

A)indemnity schedules
B)service benefit plans
C)relative value studies
D)all of the above

Question 27

If Mr.Jones's insurance has a $500 deductible, a $50 surgery co-pay, and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

A)$3027.20
B)$3047.20
C)$3047.00
D)$3067.50

Question 28

Which part of Medicare covers prescription drug services?

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

Question 29

The individual entitled to receive benefits from an insurance policy or program is called the:

A)beneficiary
B)insured
C)payer
D)carrier

Question 30

Which of the following expenses would be paid by Medicare Part B?

A)Inpatient hospital charges
B)Hospice services
C)Physician's office visits
D)Home healthcare charges

Question 31

A document that explains what expenses were paid after submission to Medicaid and sent to the physician's office is called a(n):

A)remittance advice
B)estimate of benefits
C)explanation of benefits
D)utilization review

Question 32

Which type of referral is usually processed immediately?

A)Regular
B)Urgent
C)STAT
D)All of the above

Question 33

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether the person sees the provider that month, is called a ______ plan.

A)capitation
B)self-insured
C)managed care
D)fee-for-service