Question 1

Match each health insurance term with its definition.
-Method of controlling health care costs by reviewing services to be provided to members of a plan to determine the appropriateness and medical necessity of the care prior to the delivery of the care

Accepted Answer

Utilization management (review) is the method of controlling health care costs by reviewing services to determine their appropriateness and medical necessity before they are provided.

Question 2

Match each health insurance term with its definition.
-Predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness

Accepted Answer

A deductible is the amount that the insured must pay out of pocket before the insurance company starts to pay their share for covered services.

Question 3

Match each health insurance term with its definition.
-Insurance offered to all employees by the employer

Accepted Answer

Group insurance is a type of insurance plan that is offered to all employees by an employer, providing coverage under a single policy.

Question 4

Match each health insurance term with its definition.
-Commercial plan in which the insurance company or group reimburses providers or beneficiaries for services

Accepted Answer

Indemnity plans are a type of health insurance plan that reimburses the insured, or provider, for services rendered. Unlike managed care plans, indemnity plans allow policyholders to visit the healthcare provider of their choice and receive a set portion of the total charge for the service provided.

Question 5

Match each health insurance term with its definition.
-Condition that existed before the insured's policy was issued

Accepted Answer

A preexisting condition is a health issue that existed before the start date of an individual's health insurance policy.

Question 6

Match each health insurance term with its definition.
-A form of insurance providing wage replacement and medical benefits to employees who are injured on the job or who have developed work-related disorders,disabilities,or illnesses

Accepted Answer

Workers' compensation is specifically designed to provide wage replacement and medical benefits to employees who suffer work-related injuries or illnesses.

Question 7

Match each health insurance term with its definition.
-Group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Accepted Answer

Health Maintenance Organization (HMO) is a type of group insurance that provides members with access to a range of healthcare services through a network of participating hospitals, clinics, and providers. Members typically pay a monthly premium and co-payments for services, but the focus is on preventive care and keeping costs low by using providers within the HMO network.

Question 8

Match each health insurance term with its definition.
-Authorization,by signature of the patient,for payment to be paid directly by the patient's insurance to the provider for services

Accepted Answer

Assignment of benefits is the process where the patient authorizes their health insurance benefits to be sent directly to the healthcare provider for payment of services rendered, rather than the payment being sent to the patient who then pays the provider.

Question 9

Match each health insurance term with its definition.
-Established to aid dependents of active service personnel,retired service personnel and their dependents,and dependents of service personnel who died on active duty,with a supplement for medical care in military or Public Health Service facilities

Accepted Answer

TRICARE is the health care program for uniformed service members, retirees, and their families around the world. It provides comprehensive coverage to all eligible beneficiaries, including health plans, prescriptions, dental plans, and programs for special needs.

Question 10

Match each health insurance term with its definition.
-Numeric values assigned to payment components of the resource-based relative value scale (RBRVS)

Accepted Answer

Relative Value Units (RVUs) are numerical values assigned to payment components of the Resource-Based Relative Value Scale (RBRVS), which is used to determine how much healthcare providers are paid based on the relative resources used to perform various services.

Question 11

Match each health insurance term with its definition.
-Geographic area served by an insurance carrier

Accepted Answer

The term "service area" refers to the geographic area served by an insurance carrier, indicating where the insurance coverage is applicable and services can be accessed.

Question 12

Match each health insurance term with its definition.
-Health care delivery system that combines the delivery of health care and payment of the services

Accepted Answer

Managed care is a health care delivery system that integrates the delivery and payment of health care services by employing mechanisms to control costs and manage the quality of care.

Question 13

Match each health insurance term with its definition.
-Joint funding program by federal and state governments for the medical care of low-income patients on public assistance

Accepted Answer

Medicaid is the joint funding program by federal and state governments designed to provide medical care for low-income individuals and families who cannot afford necessary medical care.

Question 14

Match each health insurance term with its definition.
-Date when an insurance policy goes into effect

Accepted Answer

The effective date of an insurance policy is the date when the policy goes into effect, meaning the coverage starts from this date.

Question 15

Match each health insurance term with its definition.
-When a health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization,whether or not services were provided

Accepted Answer

Capitation is a payment arrangement for health care service providers such as physicians, clinics, and hospitals. They receive a set amount per patient per month from an insurer or a health maintenance organization (HMO), regardless of whether the patient seeks care.

Question 16

Match each health insurance term with its definition.
-Approval obtained before the patient is admitted to the hospital or receives specified outpatient or in-office procedures

Accepted Answer

Precertification is the process where approval is obtained before a patient is admitted to the hospital or receives specified outpatient or in-office procedures to ensure the service is covered by the health insurance plan.

Question 17

Match each health insurance term with its definition.
-Procedures used by insurers to avoid duplication of payment on claims when a patient has more than one policy

Accepted Answer

Coordination of Benefits (COB) is the process used by insurance companies to ensure that when a patient has more than one insurance policy, the payment for claims is not duplicated. This process determines which insurance is primary and how much the secondary insurance will pay towards the balance.

Question 18

Match each health insurance term with its definition.
-Insurance purchased by an individual or family who does not have access to group health insurance

Accepted Answer

Individual insurance is specifically designed for individuals or families who do not have access to group health insurance, allowing them to purchase insurance directly.

Question 19

Match each health insurance term with its definition.
-Person who is insured;an insurance policyholder

Accepted Answer

The term "subscriber" refers to the person who is insured or holds the insurance policy. This is the individual who has the insurance coverage under their name, often through their employer or a direct purchase from an insurance company.

Question 20

Match each health insurance term with its definition.
-Established for the spouses and dependent children of veterans who have total,permanent,service-connected disabilities

Accepted Answer

CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) is the health care program established for the spouses and dependent children of veterans who have total, permanent, service-connected disabilities.

Quiz 27: Health Insurance

Match each health insurance term with its definition. -Method of controlling health care costs by reviewing services to be provided to members of a plan to determine the appropriateness and medical necessity of the care prior to the delivery of the care

Match each health insurance term with its definition. -Predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness

Match each health insurance term with its definition. -Insurance offered to all employees by the employer

Match each health insurance term with its definition. -Commercial plan in which the insurance company or group reimburses providers or beneficiaries for services

Match each health insurance term with its definition. -Condition that existed before the insured's policy was issued

Match each health insurance term with its definition. -A form of insurance providing wage replacement and medical benefits to employees who are injured on the job or who have developed work-related disorders,disabilities,or illnesses

Match each health insurance term with its definition. -Group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Match each health insurance term with its definition. -Authorization,by signature of the patient,for payment to be paid directly by the patient's insurance to the provider for services

Match each health insurance term with its definition. -Numeric values assigned to payment components of the resource-based relative value scale (RBRVS)

Match each health insurance term with its definition. -Geographic area served by an insurance carrier

Match each health insurance term with its definition. -Health care delivery system that combines the delivery of health care and payment of the services

Match each health insurance term with its definition. -Joint funding program by federal and state governments for the medical care of low-income patients on public assistance

Match each health insurance term with its definition. -Date when an insurance policy goes into effect

Match each health insurance term with its definition. -When a health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization,whether or not services were provided

Match each health insurance term with its definition. -Approval obtained before the patient is admitted to the hospital or receives specified outpatient or in-office procedures

Match each health insurance term with its definition. -Procedures used by insurers to avoid duplication of payment on claims when a patient has more than one policy

Match each health insurance term with its definition. -Insurance purchased by an individual or family who does not have access to group health insurance

Match each health insurance term with its definition. -Person who is insured;an insurance policyholder

Match each health insurance term with its definition. -Established for the spouses and dependent children of veterans who have total,permanent,service-connected disabilities