Health Ins Plans

Question 1

Main principle of an HMO plan

Answer 1

Preventative care

Question 2

What is a fee for service health plan?

Answer 2

Providers receive payments for each service provided

Question 3

Tax implications for a Health Savings Acct for the individual insured?

Answer 3

Contributions are tax deductible

Question 4

Type of HI plan that covers all accidents and sicknesses that are not specifically excluded in the policy?

Answer 4

Comprehensive plans

Question 5

Type of care where insurers negotiate contracts with providers to allow subscribers access to health care services at a favorable cost?

Answer 5

Preferred Provider Organization PPO

Question 6

Type of injuries and services excluded from major medical coverage?

Answer 6

Caused by war, self inflicted, covered by workers comp, regular dental/vision/hearing care, custodial care, elective cosmetic surgery

Question 7

Who chooses the primary care doc in an HMO?

Answer 7

The individual member

Question 8

2 types of flex spending acts?

Answer 8

Health care acct and dependent care acct

Question 9

Purpose of managed care health ins plan

Answer 9

To control health ins claims expenses

Question 10

3 types of basic medical expense insurance?

Answer 10

Hospital, surgical, and medical

Question 11

Why do HMOs encourage members to get regular checkups?

Answer 11

To help catch health probs early when treatment has the greatest chance for success (preventative care)

Question 12

Can an insured who belongs to a POS plan use an out of network doc?

Answer 12

Yes but the copays and deductibles May be higher

Question 13

Main diff between coinsurance and copay?

Answer 13

Copay is a set dollar amount, coinsurance is a percentage of expenses

Question 14

Purpose of the coinsurance provision in HI policies?

Answer 14

Prevent over utilization of the policy benefits

Question 15

How are HMO territories typically divided?

Answer 15

Geographic areas

Question 16

Provision that provides for sharing of expenses between the insured and the ins co?

Answer 16

Coinsurance

Question 17

How can an HMO member see a specialist?

Answer 17

Referral by primary care doc

Question 18

When are newborns covered in individual HI policies?

Answer 18

From the moment of birth

Question 19

5 basic characteristics of managed care plans?

Answer 19

Controlled access to providers
Comprehensive case management 
Preventative care
Risk sharing
High quality care

Question 20

What are usual/reasonable and customary charges based on?

Answer 20

Avg charge for a given procedure in a specific geographic area

Question 21

What type of plan are providers paid for services in advance, regardless of service provided?

Answer 21

Prepaid plans

Question 22

Role of the gatekeeper in HMO?

Answer 22

To control costs for the services of specialists