Question 1

Triple option plans are intended to prevent the problem of covering members who are sicker than the general population, which is called __________ selection.

Accepted Answer

Triple option plans are designed to mitigate adverse selection, which occurs when individuals who anticipate needing more healthcare services are more likely to enroll, potentially leading to higher costs for the insurer.

Question 2

Which is a voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law?

Accepted Answer

Accreditation is a voluntary process where a health care facility or organization seeks to demonstrate that it meets certain standards that go beyond the minimum legal requirements.

Question 3

A managed care network of physicians and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee is called a(n) __________.

Accepted Answer

A preferred provider organization (PPO) is a managed care network where physicians and hospitals contract with insurers to provide care at reduced rates.

Question 4

Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings?

Accepted Answer

An independent practice association (IPA) contracts with physicians who maintain their own private practices and deliver services to HMO subscribers.

Question 5

Which consumer-directed health plan allows tax-exempt accounts to be offered by employers with 50 or more employees, which individuals then use to pay health care bills? Funds must be used for qualified health care expenses, and unspent money can be accumulated for future years. If an employee changes jobs, he or she can continue to use the funds to pay for qualified health care expenses.

Accepted Answer

The answer of Which consumer-directed health plan allows tax-exempt accounts...

Question 6

Which is a private, not-for-profit organization that assesses the quality of managed care plans in the United States and releases the data to the public for consideration when selecting a managed care plan?

Accepted Answer

The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that evaluates and reports on the quality of managed care plans in the United States.

Question 7

Which is usually offered either by a single insurance plan or as a joint venture among two or more insurance payers and provides subscribers or employees with a choice of HMO, PPO, or traditional health insurance plans?

Accepted Answer

A triple option plan is typically offered by a single insurance plan or as a joint venture among multiple insurance payers, providing subscribers or employees with a choice among HMO, PPO, or traditional health insurance plans.

Question 8

A triple option plan is also called a __________ or flexible benefit plan because of the different benefit plans and extra coverage options provided through the insurer or third-party administrator.

Accepted Answer

A triple option plan is also called a cafeteria plan because it offers employees a variety of benefit options to choose from, similar to how one might choose food items in a cafeteria.

Question 9

Which consumer-directed health plan allows participants to enroll in a relatively inexpensive high-deductible insurance plan and open a tax-deductible savings account to cover current and future medical expenses? Money deposited (and earnings) is tax-deferred, and money withdrawn to cover qualified medical expenses is tax-free. Money can be withdrawn for purposes other than health care expenses after payment of income tax plus a 15 percent penalty. Unused balances "roll over" from year to year, and if an employee changes jobs, he or she can continue to use the fund to pay for qualified health care expenses.

Accepted Answer

A Health Savings Account (HSA) allows participants to enroll in a high-deductible health plan and open a tax-deductible savings account for medical expenses. It offers tax-deferred growth and tax-free withdrawals for qualified expenses, with unused balances rolling over annually.

Question 10

Which consumer-directed health plan funds health care expenses with insurance coverage and the individual selects one of each type of provider to create a customized network and pays the resulting customized insurance premium?

Accepted Answer

A customized sub-capitation plan allows individuals to select providers to create a personalized network and pay a customized insurance premium based on their choices.

Question 11

Which consumer-directed health plan provides tax-exempt accounts offered by employers to any number of employees, which individuals use to pay health care bills? The employees contribute funds through a salary reduction agreement and withdraw funds to pay medical bills. Funds are exempt from both income tax and Social Security tax (and employers may also contribute). By law, employees forfeit unspent funds at the end of the year.

Accepted Answer

A flexible spending account (FSA) allows employees to contribute pre-tax dollars to pay for eligible medical expenses. Unspent funds are forfeited at the end of the year.

Question 12

Which is created when a number of people are grouped for insurance purposes and the cost of health care coverage is determined by employees' health status, age, sex, and occupation?

Accepted Answer

A risk pool is created when a group of people is combined for insurance purposes, and the cost of health care coverage is determined by factors such as health status, age, sex, and occupation.

Question 13

To create flexibility in managed care plans, some HMOs and preferred provider organizations have implemented a(n) __________, under which patients have freedom to use the managed care panel of providers or to self-refer to out-of-network providers.

Accepted Answer

A point-of-service plan allows patients the flexibility to choose between using the managed care panel of providers or self-referring to out-of-network providers, offering more freedom in their healthcare choices.

Question 14

Accreditation organizations develop standards that are reviewed during an evaluation process that is conducted both offsite and onsite. The evaluation process is called a(n) __________.

Accepted Answer

The evaluation process conducted by accreditation organizations is typically referred to as a "survey," which involves both offsite and onsite assessments to ensure compliance with established standards.

Quiz 3: Managed Health Care