Question 1

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

Accepted Answer

The Newborns' and Mothers' Health Protection Act sets minimum standards for the length of hospital stays for mothers and newborns. The act requires insurance coverage for at least 48 hours following a vaginal delivery and 96 hours following a cesarean section.

Question 2

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

Accepted Answer

The three common forms of managed care plans are health maintenance organizations, preferred provider organizations, and point-of-service plans. Option B correctly lists these three forms of managed care plans. Option A is incorrect as it includes individual practice organizations instead of preferred provider organizations. Option C is also incorrect as it lists individual practice organizations first instead of preferred provider organizations. Option D is incorrect as it lists individual practice organizations first instead of preferred provider organizations.

Question 3

This type of group insurance plan is an arrangement made for employers with relatively small workforces.A single master trust holds each employer's contributions,and premiums are paid from the trust.(Exhibit 5.1,Types of Group Plans)

Accepted Answer

The type of group insurance plan described is a Multiple Employer Trust, as it is an arrangement for employers with small workforces where each employer's contributions are held in a single master trust and premiums are paid from the trust. Voluntary employee beneficiary associations, multiemployer plans, and pooled coverage are not accurate descriptions of this type of group plan.

Question 4

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

Accepted Answer

The Women's Health and Cancer Rights Act requires group health plans to provide medical and surgical benefits for mastectomies, including breast reconstruction and prostheses, after a breast cancer diagnosis. This law requires coverage for both the affected breast and the opposite breast to achieve symmetry. It amends ERISA to provide these protections to women with group health plans. The other options are not applicable to this specific requirement.

Question 5

What is coinsurance? (Coinsurance)

Accepted Answer

Coinsurance refers to the percentage of covered expenses that the insured person is responsible for paying, after any deductibles have been met.

Question 6

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)

Accepted Answer

Medical reimbursement plans are typically associated with indemnity plans, where the plan pays benefits after the deductible is met, and often have higher costs for filling prescriptions compared to other types of prescription drug plans.

Question 7

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

Accepted Answer

The three main types of dental plans are Dental Fee-for-Service, Dental Service Corporations, and Dental Maintenance Organizations. Dental Fee-for-Service plans allow patients to choose their dentist and pay for services individually. Dental Service Corporations are companies that provide dental care through a network of providers for a subscription fee. Dental Maintenance Organizations (DMOs) offer a network of dentists that patients must use to receive coverage.

Question 8

These types of insurance plans are set up to cover things like dental care,vision care and prescription drugs (Other Health-Care-Related Benefits)

Accepted Answer

Carve-out plans are specifically designed to cover services that are not included in the primary health insurance plan, such as dental, vision, and prescription drugs. These plans "carve out" a specific range of services or benefits from a broader health insurance coverage to provide targeted coverage for specific healthcare needs.

Question 9

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

Accepted Answer

According to data from the Bureau of Labor Statistics, medical care costs have risen by about 450% since 1984.

Question 10

_____ pay medical service providers a fixed amount based on the number of people enrolled,regardless of services received.(Health Plan Design Alternatives)

Accepted Answer

Prepaid plans pay medical service providers a fixed amount based on the number of people enrolled, regardless of services received. Indemnity plans and fee-for-service plans pay based on the services received, while self-funded plans are typically a mix of different payment models.

Question 11

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)

Accepted Answer

Fee-for-service plans provide cash benefits to the insured or the provider after the services are rendered, unlike managed care plans or point-of-service plans, which typically involve pre-negotiated rates and restrictions on certain types of care. Health savings accounts are a type of savings account specifically for healthcare expenses, rather than a type of insurance plan.

Question 12

Which of the following statements is true of health care costs? (Health-Care Coverage and Costs)

Accepted Answer

Many private-sector companies have employees contribute to health-care premiums due to the high costs involved. This helps companies manage the financial burden of providing health benefits.

Question 13

Which of the following does not fall within the scope of the role of a primary care physician? (Exhibit 5.4,Role of Primary Care Physicians)

Accepted Answer

Providing specialist diagnosis is not within the scope of the role of a primary care physician. Primary care physicians are responsible for initial diagnosis, identifying treatment protocols, and deciding what treatment is warranted. Specialist diagnosis is usually performed by specialists in a specific field of medicine.

Question 14

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)

Accepted Answer

Health Reimbursement Arrangements (HRAs) are funded by employers and allow unused balances to be carried over to the next year.

Question 15

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

Accepted Answer

State health instructor laws typically do not address employer's self-funded plans, as these are regulated by federal law under the Employee Retirement Income Security Act (ERISA). The other options listed are common areas of regulation for state health instructor laws.

Question 16

Health care premiums are quite high,often amounting to as much as ______ of annual benefits costs.(Health-Care Coverage and Costs)

Accepted Answer

According to the statement, health care premiums are quite high and often amount to as much as one-half of annual benefits costs. Therefore, the best choice is C (one-half).

Question 17

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

Accepted Answer

The statement "Coinsurance usually 70%" is not true. Coinsurance can vary from plan to plan and may not always be set at 70%.

Question 18

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

Accepted Answer

The three specific forms of prepaid group practices are staff model HMOs, group model HMOs, and network model HMOs, as listed in option C. Therefore, C is the best choice. Option A lists universal model HMOs, which is not a specific form of prepaid group practice. Option B lists the same three forms as option C, but in a different order. Option D lists network model and staff model HMOs, but does not include group model HMOs.

Question 19

Companies can choose from which of the following ways to provide health-care coverage? (Defining and Exploring Health-Care Plans)

Accepted Answer

Fee-for-service plans, alternative managed care plans, and consumer-driven health care plans are all ways that companies can provide health-care coverage.

Question 20

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)

Accepted Answer

The description matches that of a flexible spending account (FSA), which allows employees to contribute pre-tax wages to pay for qualified medical expenses but with the caveat that any remaining balance at the end of the year is forfeited. Health reimbursement arrangements (HRAs) and health savings accounts (HSAs) also allow for pre-tax contributions, but any remaining funds in those accounts can typically roll over to the next year. "Flexible savings accounts" is not a commonly used or recognized term in the context of health care benefits.

Quiz 5: Employer-Sponsored Health-Care Plans