Deck 5: Employer-Sponsored Health Insurance Programs

Question 1

Exclusive provider organizations are similar to PPOs in that they offer reimbursement for services provided outside the established network. (Preferred Provider Organizations)

Answer 1

False

Question 2

In 2011,half of the private sector workers in opposite sex partnerships had access to health care benefits. (Health Insurance Coverage)

Answer 2

False

Question 3

Staff model HMOs own the medical facilities and employ the medical and support staffs that work on the premises. (Prepaid Group Practice Model)

Answer 3

True

Question 4

Single employees pay a larger percentage of their health care premium than employees with family coverage pay. (Health Insurance Coverage and Costs)

Question 5

Preadmission testing is offered under the in-patient hospitalization benefit of a fee-for-service. (Hospitalization Benefits)

Question 6

Fee-for-service plans pay expenses according to a schedule of usual,customary and reasonable charges. (Surgical Benefits)

Question 7

Individual health insurance coverage can also cover the employee's dependents. (Individual Versus Group Insurance Coverage)

Question 8

Morbidity tables express annual probabilities of the occurrence of health problems. (Individual versus Group Insurance Coverage)

Question 9

Comprehensive major medical plans usually apply a single deductible for all covered services. (Major Medical Insurance Plans: Supplemental and Comprehensive)

Question 10

Network model HMOs primarily use contracts with established practices of physicians that cover multiple specialties,but do not directly employ physicians. (Prepaid Group Practice Model)

Question 11

The assets of health savings accounts must be held in trust and cannot be subject to forfeiture. (Consumer-Driven Health Care)

Question 12

The National Association of Insurance Commissioners deals with state level issues relating to supervision of insurance. (State Regulations)

Question 13

Coinsurance rates are generally higher in HMOs than in fee-for-service plans. (Features of Health Maintenance Organizations)

Question 14

Companies must offer HMOs if they are subject to the minimum wage provisions of FSLA. (The Health Maintenance Organization Act of 1973)

Question 15

Some of the major impacts of the PPACA provisions include changes to health plan provisions such as the elimination of lifetime dollar limits on insurance coverage and designating a set of essential benefits. (Patient Protection and Affordable Care Act of 2010)

Question 16

Physicians that work in individual practice associations work out of their own facilities and work on HMO patients as well as the ones in their private practice. (Individual Practice Associations)

Question 17

Title XVIII of the Social Security Act established the Medicaid program. (Origins of Health Insurance Benefits)

Question 18

Fee-for-service plans generally offer hospital expense,surgical expense and physician expense benefits. (Types of Medical Expense Benefits)

Question 19

Formularies are lists of drugs proven to be clinically appropriate and cost effective. (Prescription Drug Benefits)

Question 20

Preexisting condition clauses usually span between one and two years. (Preexisting Condition Clauses)

Question 21

In consumer-driven health care plans,the first tier is a pretax account that allows employees to pay for services using pretax dollars (Consumer-Driven Health Care)

Question 22

Company-sponsored insurance benefits appeared in the late 1800s for mining and railroad workers when companies hired doctors to provide medical services to employees. (Origins of Health Insurance Benefits)

Question 23

FASB 106 does not affect the amount of net profit companies list on balance sheets. (Retiree Health Care Benefits)

Question 24

What are the three common forms of managed care plans? (Managed Care Plans)

A)Individual practice organizations, point-of-service plans, health maintenance organizations
B)Health maintenance organizations, preferred provider organizations, point-of-service plans
C)Preferred provider organizations, point-of-service plans, individual practice organizations
D)Preferred provider organizations, health maintenance organizations, individual practice organizations

Question 25

Union presence does not affect access to health insurance. (Origins of Health Insurance Benefits)

Question 26

President Bush has advanced a plan to place the burden of health insurance costs with the government. (Consumer-Driven Health Care)

Question 27

The Mental Health Parity Act,which plays a prominent role in establishing parity requirements for mental health plans,was enacted in 2003. (Regulation of Mental Health and Substance Abuse Plans)

Question 28

The network model compensates physicians using a fee schedule. (Prepaid Group Practice Model)

Question 29

These indicate yearly probabilities of death based on such factors as age and sex. (Individual Versus Group Insurance Coverage)

A)Experience ratings
B)Formulary ratings
C)Mortality tables
D)Morbidity tables

Question 30

Employee costs for health care services tend to be least with managed care plans,higher costs are associated with the consumer driven health plans and even higher costs are associated with fee-for-service plans (State Regulations)

Question 31

Health insurance became part of the Social Security Act of 1935 during the Great depression of the 1930s. (Origins of Health Insurance Benefits)

Question 32

Flexible spending accounts permit employees to pay for health costs covered by an employer's insurance plan. (Consumer-Driven Health Care)

Question 33

IRC does not allow deductions for providing national health coverage. (Tax Regulations)

Question 34

This federal law requires group health plans to provide medical and surgical benefits for mastectomies. (The Employee Retirement Income Security Act of 1974 (ERISA))

A)Women's Health and Cancer Rights Act
B)Health Insurance Portability and Accountability Act
C)Pregnancy Discrimination Act
D)Women with Disabilities Act

Question 35

This consumer-driven health care option allows employees to contribute pre-tax wages annually to pay for qualified medical expenses,but they will lose the balance not used at year's end. (Consumer-Driven Health Care)

A)Flexible spending accounts
B)Health reimbursement arrangements
C)Health savings accounts
D)Flexible savings accounts

Question 36

In consumer-driven health care plans,the third tier is the difference between the amount of money in the individual's pretax account and the insurance plan's deductible amount. (Consumer-Driven Health Care)

Question 37

A premium is the amount an employer pays to establish and maintain a health insurance policy. (Defining and Exploring Health Insurance Programs)

Question 38

Oftentimes,consumer-driven health care plans are referred to as two-tier payment systems. (Consumer-Driven Health Care)

Question 39

Most dental insurance covers cosmetic improvements. (Dental Insurance)

Question 40

Canada,as opposed to the US,has a single-payer health care system. (Defining and Exploring Health Insurance Programs)

Question 41

This law sets minimum standards for the length of hospital stays for mothers and newborns. (Maternity Care)

A)Family and Medical Leave Act
B)Newborns' and Mothers' Health Protection Act
C)Pregnancy Discrimination Act
D)Newborns' and Mothers' Discrimination Act

Question 42

Which of the following is not one of the ways PPACA is expected to extend coverage to more people? (Patient Protection and Affordable Care Act of 2010)

A)By providing incentives to businesses to offer health insurance
B)By imposing penalties on businesses that do not provide coverage
C)By requiring individuals without health insurance to reasonably priced policies
D)By giving tax incentives to insurance companies

Question 43

Discuss and compare multiple-payer versus single-payer systems the US. (Defining and Exploring Health Insurance Programs)

Question 44

Companies can choose from which four classes of health insurance programs? (Defining and Exploring Health Insurance Programs)

A)Fee-for-service, managed care, point-of-service, consumer-driven health care
B)Indemnity, health savings accounts, managed care, fee-for-service
C)Point-of-service, fee-for-service, indemnity, managed care
D)Self-funded, managed care, fee-for-service, point-of-service

Question 45

What are the two types of fee-for-service plans? (Fee-For-Service Plans)

A)Health savings accounts, indemnity plans
B)Health savings accounts, health reimbursement plans
C)Health reimbursement plans, indemnity plans
D)Indemnity plans, self-funded plans

Question 46

This type of medical plan acts as a backup to basic insurance by covering expenses that exceed maximum benefit limits. (Major Medical Insurance Plans: Supplemental and Comprehensive)

A)Supplemental major medical plan
B)Comprehensive major medical plan
C)Network major medical plan
D)Uniform major medical plan

Question 47

Which of the following does not fall within the scope of the role of a primary care physician? (Exhibit 5.6,Role of Primary Care Physicians)

A)Making initial diagnosis and evaluation of patient's condition
B)Identifying applicable treatment protocols and practice guidelines
C)Providing specialist diagnosis
D)Deciding what treatment is warranted

Question 48

What is coinsurance? (Features of Fee-For-Service Plans)

A)When both parents have employer-sponsored insurance coverage for their children
B)Two insurance companies combine to offer a group policy to an employer
C)The amount an employee has to pay out-of-pocket before the insurance kicks in
D)The percentage of covered expenses paid by the insured

Question 49

These are the most popular approaches used by employers to offer consumer-driven health care. (Consumer-Driven Health Care)

A)Flexible savings accounts, health reimbursement arrangements
B)Health spending accounts, health reimbursement arrangements
C)Flexible spending accounts, health reimbursement arrangements
D)Health savings accounts, flexible spending accounts

Question 50

These types of insurance plans are set up to cover things like dental care,vision care and prescription drugs (Specialized Insurance Benefits)

A)Flexible savings plans
B)Flexible services accounts
C)Carve-out plans
D)Health services accounts

Question 51

Which of the following is not true for medical reimbursement plans? (Prescription Drug Benefits)

A)Reimburses employees totally or partially
B)Usually associated with self-funded or independent indemnity plans
C)Deductibles must be met
D)Coinsurance usually 70%

Question 52

These are the three main types of dental plans. (Types of Dental Plans)

A)Dental fee-for-service, dental savings accounts, dental maintenance organizations
B)Dental savings accounts, dental maintenance organizations, dental service plans
C)Dental preferred provider organizations, dental maintenance organizations, dental service corporations
D)Dental fee-for-service, dental service corporations, dental maintenance organizations

Question 53

This type of group insurance plan offers health insurance and other benefits to the employees of two or more unaffiliated employers,except for any arrangements established by a collective bargaining agreement. (Exhibit 5.2,Types of Group Plans)

A)Voluntary employee beneficiary associations
B)Multiple employer trusts
C)Pooled coverage
D)Multiple employer welfare arrangement

Question 54

This prescription drug plan is usually associated with indemnity plans,pays benefits after the employee has met the deductible and tends to charge the most for filling the prescriptions. (Prescription Drug Benefits)

A)Drug prescription plan
B)Mail order prescription drug program
C)Medical reimbursement plan
D)Prescription card program

Question 55

These types of insurance plans provide protection against health care expenses in the form of cash benefits paid to the insured or directly to the provider after the services are rendered. (Fee-For-Service Plans)

A)Point-of-service plans
B)Managed care plans
C)Fee-for-service plans
D)Health savings accounts

Question 56

State health instructor laws address all BUT which of the following (State Regulations)

A)Extending coverage to particular services, treatments or health conditions
B)Reimbursing recognized health care providers for health care services
C)Employer's self-funded plans
D)Length of time coverage

Question 57

FASB 106 does not do which of the following? (Retiree Health Care Benefits)

A)Held firm the method for how companies recognize the costs of non pension retirement benefits, including health insurance, on financial balance sheets
B)Reduces the amount of net profit companies list on balance sheets
C)Benefits such as health care coverage establish an exchange between the employer and employee
D)Post-retirement benefits are part of employee's compensation package

Question 58

This consumer-driven health care option contains contributions made by employers and the balance can be carried-over to the next year. (Consumer-Driven Health Care)

A)Flexible spending accounts
B)Health reimbursement arrangements
C)Health savings accounts
D)Flexible savings accounts

Question 59

What are the three specific forms of prepaid group practices? (Prepaid Group Practice Model)

A)Universal model HMOs, group model HMOs, staff model HMOs
B)Group model HMOs, network model HMOs, universal model HMOs
C)Staff model HMOs, group model HMOs, network model HMOs
D)Network model HMOs universal model HMOs, staff model HMOs

Question 60

Medical care has risen about how much since 1984? (Health Insurance Coverage and Costs)

A)1224%
B)433%
C)220%
D)860%

Question 61

Discuss the various FASB rulings associated with retiree health insurance. (Retiree Health Care Benefits)

Question 62

Discuss consumer driven health care plans briefly. (Consumer-Driven Health Care)