Blue Cross/ Blue Shield/ TRICARE/ CHAMPVA (Pg. 70-73)

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Questions and Answers

What type of organization is Blue Cross/Blue Shield?

Public health organization

For-profit health insurance organization

Not-for-profit, private health insurance organization (correct)

Government-sponsored health program

Which of the following is a benefit of TRICARE?

Costs for civilian health care services are paid by the federal government (correct)

Patients do not have to pay deductibles

It's exclusively managed by private insurers

Coverage is only for active-duty military personnel

Which of the following statements about Blue Cross plans is incorrect?

They offered only physician benefits. (correct)

Individuals can purchase BCBS plans.

They can be part of group health coverage plans.

They traditionally provided hospital benefits.

Who is eligible for TRICARE benefits?

All of the above Signup and view all the answers

What is a primary feature of the TRICARE Prime plan?

It consists of a network of assigned providers. Signup and view all the answers

What must a military service member obtain if they need non-military care?

Non-availability statement Signup and view all the answers

What is a distinguishing feature of BCBS member ID numbers?

They begin with three letters. Signup and view all the answers

Which of the following groups does NOT qualify for TRICARE?

Average civilian employees Signup and view all the answers

In the event of an emergency, what can a soldier do regarding medical treatment?

Seek immediate care and the military will reimburse the costs. Signup and view all the answers

What is one of the main differences between TRICARE Select and TRICARE Prime?

TRICARE Select does not require a primary care provider. Signup and view all the answers

What is a key benefit of the TRICARE Select plan?

No need for referrals to specialists Signup and view all the answers

Who primarily assumes payer responsibility in TRICARE for Life?

Medicare Signup and view all the answers

What does CHAMPVA provide coverage for?

Veterans and dependents with qualifying injuries or disabilities Signup and view all the answers

What is the primary function of workers' compensation insurance?

To cover medical bills and wage replacement for employees injured at work Signup and view all the answers

How is temporary disability (TD) defined?

Inability to perform job functions for a limited time Signup and view all the answers

What defines permanent disability (PD) in the context of workers' compensation?

A worker is permanently disabled with no further improvement expected Signup and view all the answers

What is a similarity between private health insurance and workers’ compensation?

Both are regulated on a state level Signup and view all the answers

What must happen when CHAMPVA is used in conjunction with other insurance?

The other insurance must be billed first Signup and view all the answers

Which of the following is NOT a characteristic of workers’ compensation?

Patient can be billed for services if not work-related Signup and view all the answers

Which company is NOT a noted private insurance company mentioned?

Coca-Cola Health Signup and view all the answers

Study Notes

Blue Cross/Blue Shield (BCBS)

BCBS operates as a not-for-profit private health insurance organization, offering plans for group coverage and individual purchases.
Historically, Blue Cross focused on hospital benefits while Blue Shield provided physician benefits.
Benefits vary geographically and include fee-for-service, managed care, and Medicare supplemental plans available nationwide.
BCBS membership ID numbers consist of three letters for easy identification by medical office staff.

TRICARE/CHAMPVA

TRICARE, a government program, provides healthcare benefits for active-duty servicemembers and their families.
Eligibility includes active duty servicemembers, spouses, unmarried children (up to ages 21 or 23 if full-time students), children with disabilities, uniformed service retirees, and dependents of deceased service members.
Benefits cover a portion of civilian healthcare costs with stipulations on deductibles and cost-sharing percentages; patients usually seek care from nearby military hospitals.
Active-duty personnel typically receive care from military facilities, except in cases of unavailability, which requires a non-availability statement.
TRICARE includes several plans:
- TRICARE Prime: Functions like an HMO with assigned primary care physicians and a network of military health facilities.
- TRICARE Select: Operates as a PPO offering more flexibility and control over specialist access without referrals, generally at a higher cost.
- TRICARE for Life: Works alongside Medicare to provide secondary coverage for eligible beneficiaries after Medicare pays its share.

CHAMPVA

The Civilian Health and Medical Program of the Department of Veterans Affairs provides care for veterans and dependents under specific conditions (total or permanent disability).
CHAMPVA is a service benefit program, not a traditional insurance program; there are no contracts or premiums involved.
Beneficiaries can receive care from civilian or military providers without requiring preauthorization.
When combined with other insurance, CHAMPVA acts as the secondary payer.

Commercial Plans

Approximately half of insured Americans obtain health insurance through private or commercial companies, primarily through employer-sponsored group policies.
Private insurance companies also offer individual and self-insured plans, with notable companies like Aetna, United Health, Cigna, WellCare, Humana, and BCBS.
Regulations about private health insurance typically vary by state.

Workers’ Compensation

Workers' compensation provides wage replacement and medical benefits for employees injured during employment, sacrificing the right to sue for negligence.
This system, known as “the compensation bargain,” is established as a contract between employee and employer.
Benefits include wage replacements, medical reimbursements, and support for dependents of workers who are killed on the job.
Administered at the state level with provisions for weekly compensation and vocational rehabilitation programs for those with job-related disabilities.
Key aspects of workers’ compensation include:
- Coverage for work-related injuries or illnesses without a deductible or copayment; employers cover all premiums.
- All medical providers treating work-related injuries must accept payment in full and avoid billing patients.
Temporary Disability (TD) benefits support those unable to perform job functions temporarily based on earnings.
Permanent Disability (PD) benefits are for workers with lasting disabilities, structured for rehabilitation or monetary settlements once a case is evaluated for finality.

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Description

Explore the Blue Cross/Blue Shield (BCBS) health insurance organization, which offers various plans for individuals and groups. This quiz covers the different types of benefits provided by BCBS, including hospital and physician coverage. Learn about the distinctions between fee-for-service and managed care plans, as well as Medicare options.