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Questions and Answers
What type of organization is Blue Cross/Blue Shield?
Which of the following is a benefit of TRICARE?
Which of the following statements about Blue Cross plans is incorrect?
Who is eligible for TRICARE benefits?
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What is a primary feature of the TRICARE Prime plan?
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What must a military service member obtain if they need non-military care?
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What is a distinguishing feature of BCBS member ID numbers?
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Which of the following groups does NOT qualify for TRICARE?
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In the event of an emergency, what can a soldier do regarding medical treatment?
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What is one of the main differences between TRICARE Select and TRICARE Prime?
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What is a key benefit of the TRICARE Select plan?
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Who primarily assumes payer responsibility in TRICARE for Life?
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What does CHAMPVA provide coverage for?
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What is the primary function of workers' compensation insurance?
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How is temporary disability (TD) defined?
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What defines permanent disability (PD) in the context of workers' compensation?
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What is a similarity between private health insurance and workers’ compensation?
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What must happen when CHAMPVA is used in conjunction with other insurance?
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Which of the following is NOT a characteristic of workers’ compensation?
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Which company is NOT a noted private insurance company mentioned?
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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.
