Question 1

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:
A)a limited provider network.
B)gatekeepers.
C)payment by capitation.
D)flexible benefit design.

Accepted Answer

The answer of An exclusive provider organization (EPO) is similar...

Question 2

Which of the following is true of self-insured plans?

Accepted Answer

They are regulated by the Employee Retirement Income Security Act (ERISA)., They use third-party administrators., They assume the financial risk of providing benefits for employees or members., They do not abide by state insurance regulations.

Question 3

In comparing group and individual insurance, group insurance provides:
A)fewer benefits and lower costs.
B)fewer benefits and higher costs.
C)better benefits and higher costs.
D)better benefits and lower costs.

Accepted Answer

The answer of In comparing group and individual insurance, group...

Question 4

A point-of-service (POS) plan allows members to:
A)choose a health maintenance organization (HMO) or preferred provider organization (PPO) option each time they seek care.
B)receive medical care from any in-network or non-network provider.
C)do both a and b.
D)do neither a nor b.

Accepted Answer

The answer of A point-of-service (POS) plan allows members to:
A)choose...

Question 5

Features of a preferred provider organization (PPO) includes which of the following?
A)It contracts with healthcare providers to form a network.
B)It offers members financial incentives to use network providers.
C)A PCP arranges, provides, coordinates, and authorizes all aspects of a member's healthcare.
D)It employs salaried physicians who treat members in facilities it owns and operates.

Accepted Answer

The answer of Features of a preferred provider organization (PPO)...

Question 6

Which of the following is a characteristic of a preferred provider organization (PPO)?
A)It includes a contracted network of providers.
B)Members select a primary care physician (PCP) as a gatekeeper.
C)The plan is more restrictive than a health maintenance organization (HMO).
D)Members must obtain referrals to see a specialist.

Accepted Answer

A preferred provider organization (PPO) includes a contracted network of providers.

Question 7

By accepting lower payments from MCOs, physicians are forced to see more patients each day in order to:
A)deliver MCO-required preventive care.
B)minimize malpractice suits.
C)enroll more members in the health plan.
D)maintain their income due to lower payments.

Accepted Answer

The answer of By accepting lower payments from MCOs, physicians...

Question 8

Health maintenance organization (HMO) plans add a point-of-service (POS) option to:
A)lower the cost of the plan.
B)lower the benefits of the plan.
C)provide physicians with more choice.
D)provide members with more choice.

Accepted Answer

The answer of Health maintenance organization (HMO) plans add a...

Question 9

Incentives for preferred provider organization (PPO) members to use network providers include:
A)lower out-of-pocket costs.
B)reduced benefits.
C)higher out-of-pocket costs.
D)ability to obtain care more quickly.

Accepted Answer

The answer of Incentives for preferred provider organization (PPO) members...

Question 10

Disadvantages of managed care include all of the following EXCEPT:
A)it includes disease management programs based on recent research.
B)it creates an increased administrative burden.
C)it may require physicians to carry additional malpractice insurance.
D)it restricts physicians' latitude in caring for patients.

Accepted Answer

The answer of Disadvantages of managed care include all of...

Question 11

Group insurance is issued to an employer to provide coverage for:
A)employees only.
B)employees and spouses only.
C)employees and children only.
D)employees and all their dependents.

Accepted Answer

Group insurance is typically offered to employees and all their dependents, which can include spouses and children. Providing coverage for all dependents can help attract and retain employees, who may be more likely to stay with an employer that offers comprehensive benefits for their families.

Question 12

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n):
A)group model.
B)individual practice association (IPA) model.
C)network model.
D)staff model.

Accepted Answer

The individual practice association (IPA) model involves contracting with individual physicians to create a healthcare delivery system. This model allows patients to choose their own physician and provides flexibility in terms of choosing a specialist.

Question 13

All of the following are types of health maintenance organizations (HMOs) EXCEPT the:
A)group model.
B)preferred provider model.
C)individual practice association.
D)open access model.

Accepted Answer

All the other options (group model, individual practice association, and open access model) are types of HMOs, while the preferred provider model is a type of managed care organization, but not an HMO.

Question 14

The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n):
A)group model.
B)individual practice association (IPA) model.
C)network model.
D)staff model.

Accepted Answer

The answer is C because a network model HMO contracts with multiple community-based multispecialty groups to provide wider geographical coverage. The other choices do not involve contracting with multiple groups for wider coverage. The group model HMO employs its own healthcare providers, the IPA model contracts with individual healthcare providers, and the staff model HMO employs healthcare providers directly.

Question 15

Which of the following is true of an exclusive provider organization (EPO)?

Accepted Answer

It is regulated under insurance statutes.

Question 16

The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n):
A)group model.
B)individual practice association (IPA) model.
C)network model.
D)staff model.

Accepted Answer

The staff model HMO employs salaried physicians who work in facilities that are owned and operated by the HMO. This is different from the group model, where physicians are in private practice but contract with the HMO, and the IPA model, where physicians are in private practice and contract with the HMO to treat its members. The network model is similar to the group model, but typically has a larger network of contracted physicians.

Question 17

Physicians in an individual practice association (IPA) health maintenance organization (HMO):
A)are typically capitated.
B)see both members and nonmembers of the HMO.
C)must act as primary care physicians (PCPs).
D)contract only with managed care organizations (MCOs).

Accepted Answer

The answer of Physicians in an individual practice association (IPA)...

Question 18

A characteristic of a staff model health maintenance organization (HMO) is that it:
A)contracts with a multispecialty physician group.
B)is a decentralized healthcare delivery system.
C)employs salaried physicians.
D)agrees to contractual discounts with physicians.

Accepted Answer

A staff model HMO employs salaried physicians who are directly employed by the HMO, rather than contracting with outside physicians. This model allows greater control over the quality and cost of healthcare services provided to members.

Question 19

Advantages of managed care include all of the following EXCEPT:
A)hospitals and physicians provide services more efficiently.
B)providers strive to improve the quality of their care.
C)physicians run the risk of adverse selection by enrollees.
D)data is collected and analyzed to measure health outcomes.

Accepted Answer

The answer of Advantages of managed care include all of...

Question 20

Physician-hospital organizations (PHOs) may include:
A)nursing homes.
B)laboratories.
C)surgery centers.
D)all of the above.

Accepted Answer

Physician-hospital organizations (PHOs) may include nursing homes, laboratories, and surgery centers, along with other healthcare facilities and services. The goal of a PHO is to facilitate collaboration between physicians and hospitals and improve the quality and efficiency of care for patients. Including a variety of healthcare services and facilities allows for a more comprehensive approach to patient care within the organization.

Quiz 2: Understanding Managed Care: Insurance Plans

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have: A)a limited provider network. B)gatekeepers. C)payment by capitation. D)flexible benefit design.

Which of the following is true of self-insured plans?

In comparing group and individual insurance, group insurance provides: A)fewer benefits and lower costs. B)fewer benefits and higher costs. C)better benefits and higher costs. D)better benefits and lower costs.

A point-of-service (POS) plan allows members to: A)choose a health maintenance organization (HMO) or preferred provider organization (PPO) option each time they seek care. B)receive medical care from any in-network or non-network provider. C)do both a and b. D)do neither a nor b.

By accepting lower payments from MCOs, physicians are forced to see more patients each day in order to: A)deliver MCO-required preventive care. B)minimize malpractice suits. C)enroll more members in the health plan. D)maintain their income due to lower payments.

Health maintenance organization (HMO) plans add a point-of-service (POS) option to: A)lower the cost of the plan. B)lower the benefits of the plan. C)provide physicians with more choice. D)provide members with more choice.

Incentives for preferred provider organization (PPO) members to use network providers include: A)lower out-of-pocket costs. B)reduced benefits. C)higher out-of-pocket costs. D)ability to obtain care more quickly.

Group insurance is issued to an employer to provide coverage for: A)employees only. B)employees and spouses only. C)employees and children only. D)employees and all their dependents.

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n): A)group model. B)individual practice association (IPA) model. C)network model. D)staff model.

All of the following are types of health maintenance organizations (HMOs) EXCEPT the: A)group model. B)preferred provider model. C)individual practice association. D)open access model.

The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n): A)group model. B)individual practice association (IPA) model. C)network model. D)staff model.

Which of the following is true of an exclusive provider organization (EPO) ?

The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n): A)group model. B)individual practice association (IPA) model. C)network model. D)staff model.

Physicians in an individual practice association (IPA) health maintenance organization (HMO): A)are typically capitated. B)see both members and nonmembers of the HMO. C)must act as primary care physicians (PCPs). D)contract only with managed care organizations (MCOs).

A characteristic of a staff model health maintenance organization (HMO) is that it: A)contracts with a multispecialty physician group. B)is a decentralized healthcare delivery system. C)employs salaried physicians. D)agrees to contractual discounts with physicians.

Physician-hospital organizations (PHOs) may include: A)nursing homes. B)laboratories. C)surgery centers. D)all of the above.