Questions and Answers
Which of the following are NOT managed care organizations?
A medical care provider which typically delivers health services at its own local medical facility is known as a...
Health Maintenance Organization (HMO)
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called...
Closed panel
Which type of provider is known for stressing preventative medical care?
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Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?
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Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?
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Which of these statements is FALSE regarding a Preferred Provider Organization (PPO)?
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A characteristic of Preferred Provider Organizations (PPOs) would be:
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The individual who provides general medical care for a patient as well as the referral for specialized care is known as...
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What does Medicare Parts A and B cover?
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Which of the following reimburses its insureds for covered medical expenses?
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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?
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Which of these is considered a true statement regarding Medicaid?
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Which of these statements is TRUE regarding a Preferred Provider Organization (PPO)?
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J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a preset price. What type of plan does J belong to?
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Which of the following does Social Security provide benefits for?
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Study Notes
Health Insurance Providers Overview
- Managed Care Organizations: Medical Information Bureau (MIB) is NOT a managed care organization.
Health Maintenance Organizations (HMOs)
- Definition: Deliver health services at local facilities and employ providers directly.
- Characteristic: Focus on preventative medical care.
- Closed Panel: A group of salaried physicians working in HMO facilities.
Preferred Provider Organizations (PPOs)
- Comparison to HMOs: PPOs are less restrictive, offering more physician choices.
- Cost Structure: Uses contracts with a designated group of doctors and hospitals for prearranged costs; going outside this group incurs higher expenses.
- Characteristics: Provides discounted fees for patients; considered a managed healthcare system.
- False Statement: PPOs are NOT a type of managed care system (this statement is false).
Primary Care and Specialized Care
- Primary Care Physician: The individual who provides general medical care and referrals for specialized services.
Medicare
- Coverage: Medicare Part A covers hospitalization, while Part B covers doctor's services.
Reimbursement Policies
- Type of Insurers: Commercial insurers reimburse insured individuals for covered medical expenses, allowing choice of treatment providers.
Group Health Plans
- Primary Coverage: For employees over 65, their group health plan is primary if they work for a business with more than 20 employees.
Medicaid
- Funding: Medicaid is jointly funded by state and federal governments.
Social Security Benefits
- Coverage Areas: Provides benefits for survivorship, disability, and retirement; does not cover dismemberment.
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Description
Test your knowledge of health insurance providers with this Chapter 4 quiz. This includes managed care organizations and their various roles in the healthcare system. Dive into key terms and definitions to sharpen your understanding of health insurance concepts.