Chapter 2 Health Flashcards
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)
Closed Panel. A closed panel is when an HMO is represented by a group of physicians who are salaried employees and work out of the HMO’s facility.
Medicare is intended for all of the following groups EXCEPT
Those enrolled as a full-time student
Those receiving Social Security disability benefits for at least 24 months
Those afflicted with chronic kidney failure
Those 65 and older
Those enrolled as a full-time student
A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?
Her group health plan. If the employer has more than 20 employees, the group health plan generally pays first.
Medicare Part A and Part B do NOT pay for
dental work
The health insurance program which is administered by each state and funded by both the federal and state governments is called
Medicaid
J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to?
Health Maintenance Organization. A Health Maintenance Organization (HMO) contracts with doctors and hospitals to provide medical benefits to subscribers at a predetermined price.
Under what system does a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?
PPO. Under a Preferred Provider Organization (PPO), a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured.
An HMO which is characterized by a network of physicians who work out of their own facilities and participate in the HMO on a part-time basis is known as which of the following?
An Open panel. An HMO which is characterized by a network of physicians who work out of their own facilities and participate in the HMO on a part-time basis is known as an open panel.
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
Commercial insurer. Commercial health insurance companies use the reimbursement approach, which allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement.
What does Medicare Parts A and B cover?
Part A covers hospitalization; Part B covers doctor’s services
A medical care provider which typically delivers health services at its own local medical facility is known as a
Health Maintenance Organizations (HMO’s) traditionally provide services to its members at its own local health care facilities.
Which type of provider is known for stressing preventative medical care?
Health Maintenance Organizations (HMO’s)
Which of these is considered a true statement regarding Medicaid?
Funded by both state and federal governments
Intended to be used by individuals age 65 and older
Provides disability income benefits
Automatically covers those receiving Social Security disability benefits
Funded by both state and federal governments
Which of the following statements is true about most Blue Cross/Blue Shield organizations?
They are the same as private insurance companies
They are federally sponsored
They are nonprofit organizations
They are owned by hospitals and physicians
They are nonprofit organizations
