Question 1

The BlueCross BlueShield Federal Employee Program (FEP) is a(n) __________ health benefits program established by an Act of Congress in 1959.

Accepted Answer

A

Question 2

The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments.

Accepted Answer

The correct answer is A because the passage states that "Surgical care is subject to any established contract basic plan deductibles and copayments."

Question 3

BCBS indemnity coverage offers choice and flexibility to subscribers who want to receive a full range of benefits along with the __________.

Accepted Answer

BCBS indemnity coverage allows subscribers the freedom to use any licensed health care provider, offering maximum flexibility and choice.

Question 4

Participating providers contract to participate in a BCBS plan's preferred provider network (PPN), which is a program that requires providers to adhere to __________ care provisions.

Accepted Answer

Participating providers in a BCBS plan's preferred provider network (PPN) are required to adhere to managed care provisions, which focus on cost-effective and quality care management.

Question 5

The BCBS outpatient pretreatment authorization plan (OPAP) requires preauthorization of outpatient physical, occupational, and speech therapy services. Other terms for OPAP include precertification and __________ authorization.

Accepted Answer

Prospective authorization is another term for preauthorization, as it involves obtaining approval from the insurance provider before the services are rendered.

Question 6

For-profit corporations pay taxes on profits generated by the corporation's enterprises and pay dividends to __________ on after-tax profits.

Accepted Answer

For-profit corporations pay dividends to shareholders from their after-tax profits. Shareholders are the owners of the corporation and receive a portion of the profits in the form of dividends.

Question 7

BCBS corporations offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by the word __________ on the patient's plan ID card.

Accepted Answer

Medicare supplemental plans are commonly referred to as "Medigap" plans, and this term is often used on the patient's plan ID card to identify them.

Question 8

BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.

Accepted Answer

Major medical coverage typically includes additional benefits beyond basic coverage, such as office visits, therapy, and mental health services.

Question 9

The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or __________ for policyholder.

Accepted Answer

The BCBS PPO plan uses the term "member" as a substitute for "policyholder," indicating the individual who holds the insurance policy.

Question 10

BlueCross plans originally covered only hospital bills, and BlueShield plans covered fees for physician services, and there was close cooperation between the plans that resulted in joint ventures where the two corporations were housed in one building. In these joint ventures, BlueCross BlueShield (BCBS) __________.

Accepted Answer

BlueCross and BlueShield plans shared facilities and resources like computer services but maintained separate corporate identities.

Question 11

By 1932 some plans modified the prepaid plan concept and organized community-wide programs that allowed the subscriber to be hospitalized in one of several member hospitals in accordance with signed contracts to provide services __________.

Accepted Answer

These plans were designed to offer services at negotiated special rates, making healthcare more affordable and accessible to subscribers.

Question 12

BCBS has a mandatory second surgical opinion (SSO) requirement necessary when a patient is considering elective, nonemergency surgical care. The initial surgical recommendation must be made by a physician qualified to perform the anticipated surgery. If a second surgical opinion is not obtained prior to surgery, the patient's out-of-pocket expenses may be __________.

Accepted Answer

If a second surgical opinion is not obtained, the patient's out-of-pocket expenses may be increased because the insurance may not cover as much of the cost without the required second opinion.

Question 13

The BCBS coordinated home health and hospice care program allows patients with this option to elect an alternative to __________ or long-term care settings.

Accepted Answer

The BCBS coordinated home health and hospice care program provides an alternative to acute care settings, allowing patients to receive care at home instead of in a hospital.

Question 14

Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract.

Accepted Answer

Riders in insurance contracts typically provide additional coverage beyond what is included in the standard contract, hence "over and above" is the correct choice.

Question 15

Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.

Accepted Answer

Nonprofit corporations reinvest any profits back into the organization to further their mission, rather than distributing them to shareholders or officers.

Question 16

BlueShield plans were created as the result of a resolution passed by the House of Delegates at an American Medical Association meeting in 1938. This resolution supported the concept of __________ health insurance that would encourage physicians to cooperate with prepaid health care plans.

Accepted Answer

The resolution supported the concept of voluntary health insurance, encouraging physicians to cooperate with prepaid health care plans without mandating participation.

Question 17

BCBS fee-for-service __________ coverage includes minimum benefits, such as inpatient hospitalizations and diagnostic laboratory services.

Accepted Answer

Basic coverage typically includes minimum benefits like inpatient hospitalizations and diagnostic laboratory services.

Question 18

The medical emergency care rider covers __________ treatment sought and received for sudden, severe, and unexpected conditions that if not treated would place the patient's health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or body part.

Accepted Answer

The medical emergency care rider covers immediate treatment, as it is necessary for sudden, severe, and unexpected conditions that could lead to permanent harm if not promptly addressed.

Question 19

FEP cards contain the phrase __________ under the BCBS trademark.

Accepted Answer

The phrase "Government-Wide Service Benefit Plan" is associated with the Federal Employee Program (FEP) under the Blue Cross Blue Shield (BCBS) trademark.

Question 20

The forerunner of what is known today as the BlueCross plan began in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents, in exchange for a $6 annual premium. This was considered a __________ plan.

Accepted Answer

The plan was considered a prepaid plan because subscribers paid a fixed annual premium in advance for a specified amount of hospital services.

Quiz 13: Bluecross Blueshield