Deck 12: Health and Disability Insurance

Question 1

Health care providers who are part of an HMO are paid a predetermined amount of compensation per month for each patient who participates in the plan.

Answer 1

True

Question 2

Compared to indemnity plans,managed health care plans impose more restrictions on the specific health care providers.

Answer 2

True

Question 3

Private health insurance plans contain hospital insurance,physician insurance,and surgical insurance.

Answer 3

True

Question 4

The cost of health care has risen dramatically in recent years due to all of the following,except

A) people living longer and requiring attention for longer periods of time.
B) the high cost of technology in health care.
C) reduced litigation costs.
D) the bureaucratic processes of reimbursement and claim handling.

Question 5

Technological advances are one of the things helping to keep the cost of health care from escalating further.

Question 6

A PPO health insurance plan allows individuals a better selection of health care providers,but is more expensive than an HMO.

Question 7

Which of the following statements regarding health insurance is not true?

A) It limits your potential liabilities and helps you receive the necessary medical care.
B) Health insurance is offered by private insurance companies and the government.
C) There are many more options available for homeowner's insurance than for health insurance.
D) Blue Cross and Blue Shield is the nation's largest health care insurer.

Question 8

Buying health insurance through employer-sponsored plans is somewhat more expensive than buying your own policy individually.

Question 9

Although indemnity plans are less flexible than managed care plans,they charge lower rates.

Question 10

Which of the following is not a difference between health insurance and other types of insurance like home and auto?

A) Health insurance covers specific medical bills beyond a deductible.
B) Health insurance helps protect your net worth.
C) Health insurance often includes and out-of-pocket maximum amount you will be required to pay in any year.
D) Health insurance does not include any liability coverage.

Question 11

Private health insurance plans contain all of the following coverage,except

A) hospital insurance.
B) nursing home insurance.
C) physician insurance.
D) surgical insurance.

Question 12

Hospitals,doctors,and patients have enough incentive to make the most economical use of health care services.

Question 13

Most people obtain health insurance through group plans offered by employers.

Question 14

Which one of the following benefits is most often available through an employer?

A) Disability insurance
B) Health insurance
C) Dental insurance
D) Vision insurance

Question 15

Health insurance protects net worth by minimizing the chance that you will have to reduce savings or incur debt when you require medical attention.

Question 16

When comparing auto insurance and health insurance,

A) you have fewer options with health insurance than with auto insurance.
B) both types of policies have deductibles.
C) the government has very little involvement in either of these areas.
D) All of the above are true.

Question 17

In most HMOs,if a person sees a specialist without being referred by the primary care physician,the HMO will not pay for the treatment.

Question 18

Which of the following is not true as it relates to the cost of health care?

A) Fraudulent claims by patients and health care providers add to the cost.
B) People are living longer and their health care costs are higher.
C) Better claim handling and processing has helped reduce the cost of health care.
D) Technology used in medicine is very expensive and has added to the cost.

Question 19

Use the following two columns of items to answer the matching questions below:
Blue Cross

A)covers health care expenses incurred by policyholders to limit their potential liabilities and ensure that they will receive the necessary medical care
B)the nation's largest health care insurer

Question 20

Use the following two columns of items to answer the matching questions below:
health insurance

A)covers health care expenses incurred by policyholders to limit their potential liabilities and ensure that they will receive the necessary medical care
B)the nation's largest health care insurer

Question 21

An arrangement in which the preferred provider organization (PPO)pays the provider a specific sum for each day a patient is hospitalized is called a

A) discount on charge arrangement.
B) per diem rate arrangement.
C) co-payment.
D) flat-fee arrangement.

Question 22

Which of the following is usually not offered as part of a benefits package to employees?

A) Auto insurance
B) Health insurance
C) Retirement benefits
D) Disability insurance

Question 23

Indemnity health care plans have

A) more flexibility and choices than managed care plans.
B) lower costs than managed care plans.
C) fewer health care professionals to choose from compared to HMOs.
D) less bill-related paperwork than other plans.

Question 24

Under a discount on charge arrangement,the provider receives

A) a flat fee.
B) more than what it would normally charge for a particular service.
C) less than what it would normally charge for a particular service.
D) an amount equal to the charge for the service.

Question 25

Use the following two columns of items to answer the matching questions below:
PPO

A)a health care plan where individuals pay the provider and then seek reimbursement for expenses
B)a prepaid health care plan using a limited number of health care providers
C)a managed plan that allows a greater choice of health care providers

Question 26

How much of a $2,000 medical bill would you pay if your policy contains a $400 deductible and a 10% coinsurance clause?

A) $200
B) $400
C) $160
D) $560

Question 27

Which of the following is an advantage of a PPO compared to an HMO?

A) The premiums are lower.
B) There are more choices of specialized health care providers.
C) There are no out-of-pocket expenses.
D) No approval is needed to see a specialist.

Question 28

A(n)________ plan requires that individuals pay health care providers and then put in a claim for reimbursement.

Question 29

Which of the following statements about an HMO is not true?

A) You will pay the same monthly premium whether you use the plan or not.
B) You need to be referred to see a specialist or the HMO may not pay.
C) Individuals usually pay a small fee for a visit to a physician or for a prescription.
D) The health care providers are compensated on the basis of each visit by a patient.

Question 30

Use the following two columns of items to answer the matching questions below:
indemnity plan

A)a health care plan where individuals pay the provider and then seek reimbursement for expenses
B)a prepaid health care plan using a limited number of health care providers
C)a managed plan that allows a greater choice of health care providers

Question 31

________ insurance serves as a backup for expenses not covered by basic health insurance.

A) Excess hospitalization insurance
B) Surgical expense insurance
C) Major medical insurance
D) Physician expense insurance

Question 32

Patients receive a(n)________ from the PPO that lists the total charges,the total amount owed to the provider,and the total amount billed to the patient.

A) remittance advice
B) statement of charges
C) invoice
D) explanation of benefits

Question 33

Compared to indemnity plans,what is an advantage of managed health care plans?

A) You will have lower insurance premiums.
B) There are no out-of-pocket expenses required.
C) You have greater choices of health care providers.
D) They are very efficient in their handling of paperwork.

Question 34

When considering an HMO or PPO,which of the following would you not consider regarding the cost of the plan?

A) Monthly premiums
B) Coinsurance
C) Number of doctors accepting new patients
D) Maximum out-of-pocket expenses per year

Question 35

Use the following two columns of items to answer the matching questions below:
HMO

A)a health care plan where individuals pay the provider and then seek reimbursement for expenses
B)a prepaid health care plan using a limited number of health care providers
C)a managed plan that allows a greater choice of health care providers

Question 36

How much would be owed by the patient on a $3,000 bill if a PPO uses a discount on charge arrangement wherein the percentage paid to the provider is 70% and the patient's co-pay,as specified by the PPO,is 20 percent?

A) $600
B) $700
C) $420
D) $200

Question 37

The managed health care plan with higher costs,but a greater choice of health care providers is the ________.

Question 38

Since health insurance is expensive,

A) most employers pay for the entire cost as an employee benefit.
B) employees are usually required to pay the entire cost of the insurance.
C) the employer and employee typically share the cost of the health insurance.
D) the government along with the employer helps to subsidize employee health insurance costs.

Question 39

The managed health care plan with the lowest premiums and also the least choice of health care providers is the ________.

Question 40

Indemnity health plans

A) greatly restrict the choice of health care providers.
B) may require you to pay the doctor and then get reimbursed.
C) require you to get approval to see a specialist.
D) are the least expensive of all health care plans.

Question 41

You are trying to help your aunt figure out how much she owes on a recent flurry of medical bills that resulted from her recent bypass surgery.Her company provided PPO plan includes the following provisions,$2,400 deductible,10% co-pay and a $6,000 maximum out-of-pocket limit.You have summarized her bills as follow: doctor visits $1,500,surgeon and other docs $16,000,operating room $15,000,hospital stay $21,000,rehabilitative service $10,000.How much does she owe in total on these enormous bills?

A) $2,400
B) $61,100
C) $6,000
D) $8,510

Question 42

Assuming you were in the 25% federal and 5% state income tax brackets last year,and you allocated $200 per month to your flexible spending account,how much did you save if there was $1,000 remaining in the account at the end of the year?

A) You lost $1,000
B) You saved $720
C) You lost $280
D) Not enough information to accurately determine the answer

Question 43

One of the problems with changing jobs is that you will immediately lose your health insurance and may not be able to get new insurance right away.

Question 44

Unfortunately,you have had several medical procedures in the current year with the following bills,$2,000,$9,200,$18,000,$5,000,and $3,500.Your deductible is $2,400,after which your co-pay is 10%.Your policy also includes a $6,000 out-of-pocket maximum clause.How much of the total bills are you responsible to pay?

A) $2,400
B) $6,000
C) $5,400
D) $5,930

Question 45

If you are in the 20% federal and 5% state income tax brackets,how much do you save each year by allocating $200 per month to your flexible spending account assuming you have zero funds left over at the end of the year?

A) $600
B) $400
C) $20 per month
D) $2,400

Question 46

Regarding a flexible spending account,which of the following is not true?

A) You may put a predetermined amount of your pre-tax salary in the account monthly.
B) The money may be used throughout the year to pay medical or dental expenses tax-free.
C) If you don't use the funds during the year, you lose them.
D) Your employer will match your funds dollar-for-dollar.

Question 47

What would be the out-of-pocket cost to an individual whose health care policy includes a 20% co-pay for all long-term illnesses.The policy has a stop loss provision of $40,000.A current long-term illness has resulted in total expenses of $250,000.

A) $8,000
B) $40,000
C) $50,000
D) $210,000

Question 48

Medicaid is health insurance for people with low income and is administered by each state within certain broad federal requirements and guidelines.

Question 49

Usually plans such as dental insurance and vision insurance are good deals if they are offered through employers.

Question 50

Which of the following is not true regarding government regulations to allow individuals who change jobs to maintain health insurance coverage?

A) You may continue your health insurance provided through an employer's plan for 18 months after you stop working for that employer.
B) Even if you retire, you may continue coverage for 18 months unless you qualify for Medicare.
C) If you change jobs, a new insurance company cannot deny you coverage based on your health, medical condition, previous claims, or disability.
D) When changing jobs, you are allowed to stop and start health care plans whenever you need to and still be guaranteed insurance coverage by a new provider.

Question 51

Medicare is a government health insurance program for those over 65 years of age who can show need for financial assistance.

Question 52

One disadvantage of a flexible spending account is

A) the amount is not subject to federal, state or local taxes.
B) funds allocated to the account cannot be rolled over into the next year.
C) funds are available to pay for out-of-pocket expenses.
D) it allows you to budget for uncovered medical expenses.

Question 53

Health insurance policies may provide coverage for all of the following except

A) cosmetic surgery.
B) rehabilitation.
C) mental health.
D) pregnancy.

Question 54

Part D of Medicare represents a combination of Part A and Part B provided through private insurance companies.

Question 55

Having money deducted from your paycheck and put in a flexible spending account is one of the ways you can avoid paying taxes on the amount you spend for health care expenses.

Question 56

An account that allows employees to use pre-tax income to pay for medical expenses is a

A) HMO.
B) PPO.
C) flexible spending account.
D) medical savings account.

Question 57

Which of the following is not a disadvantage of an HMO plan versus a PPO plan?

A) The HMO plan may be less expensive.
B) The HMO plan is more restrictive on which doctors the patient is able to use.
C) The HMO plan often requires a referral in order to see a specialist.
D) The HMO plan is generally more expensive for the same level of coverage.

Question 58

You must have Parts A and B of Medicare in order to qualify for Part D.

Question 59

Additional types of insurance commonly offered through employers include

A) dental insurance.
B) fitness insurance.
C) vision insurance.
D) Both A and C are correct

Question 60

Medigap insurance,intended to supplement Medicare,is sold and serviced by the federal government.

Question 61

In order to remain eligible for protection under HIPAA,a person must maintain continuous enrollment in a health care plan.

Question 62

Use the following two columns of items to answer the matching questions below:
Medicaid

A)federal program that provides health care to those over 65 who qualify for Social Security benefits
B)a government program providing health care for those with low incomes or in need of public assistance

Question 63

Medicare basic coverage (Part A) covers

A) hospital expenses, including surgeries.
B) outpatient hospital care.
C) physical therapy.
D) All of the above.

Question 64

The part of Medicare that provides coverage for prescription drugs is

A) Part A.
B) Part B.
C) Part C.
D) Part D.

Question 65

The Affordable Care Act allows young adults to continue on a parent's health insurance plan until age 19 at which time they must obtain their own coverage.

Question 66

Beginning in 2014,health insurers will not be able to deny applicants based on pre-existing conditions.

Question 67

Regarding Medicaid,which of the following is true?

A) It is a program totally funded and run by each state.
B) It provides free unlimited health care for low income individuals and families.
C) It is a federal program administered by each state.
D) It is a program funded and run by the federal government.

Question 68

________ is the government program that provides health insurance to individuals who are 65 years of age or older.

A) Medicaid
B) Medicare
C) HMO
D) Blue Cross and Blue Shield

Question 69

Which statement regarding COBRA is true?

A) The act applies to private firms and agencies of state government but not to federal government agencies.
B) COBRA allows you to continue your health coverage for two years after you stop working.
C) The act was passed in 2010.
D) If you retire and are not yet eligible to receive Medicare, you are not covered by COBRA.

Question 70

If you are no longer covered under your parents' or guardian's health insurance plan,the Affordable Care Act requires you to

A) visit the university's infirmary at least once per semester for a check-up.
B) purchase a prescription coverage plan.
C) purchase an individual health insurance plan or face a tax penalty.
D) purchase an individual health care plan from medicaid.

Question 71

Use the following two columns of items to answer the matching questions below:
Medicare

A)federal program that provides health care to those over 65 who qualify for Social Security benefits
B)a government program providing health care for those with low incomes or in need of public assistance

Question 72

Policy premiums for long-term care insurance are relatively low,even for those over 60 years old.

Question 73

Certain federal regulations ensure that individuals can maintain continuous health care coverage.

Question 74

In addition to social security tax withholding,wage earners also pay a 1.45% withholding tax on all gross salary and wages for

A) supplemental social security tax.
B) medicaid tax.
C) medicare tax.
D) the supplemental college loan fund.

Question 75

________ insurance is provided by private insurance companies to cover medical expenses that are not covered by Medicare.

Question 76

Because of COBRA,you can continue to remain covered by your employer's health insurance plan for no more than one year after you stop working for your employer.

Question 77

Which of the following is true regarding Medicare?

A) Eligibility for the plan is based on both need and age.
B) The entire plan is free to qualified participants.
C) Part of the program is optional and has a charge.
D) Virtually all medical expenses are paid for those covered.

Question 78

Basic health insurance policies and Medicare will not cover stays in nursing homes or assisted living centers for very long.

Question 79

Which act established provisions that require U.S.citizens to obtain health insurance?

A) Medicaid
B) Consolidated Omnibus Budget Reconciliation Act
C) Health Insurance Portability and Accounting Act
D) Affordable Care Act

Question 80

Which of the following statements about the Medicare Prescription Drug Improvement and Modernization Act of 2003 is not true?

A) Seniors may purchase various forms of coverage for prescription drugs.
B) The act provides coverage for seniors and people with disabilities.
C) Low-income seniors are subject to a $250 deductible.
D) Individuals can establish a health-savings account.