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?
Signup and view all the answers
Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?
Signup and view all the answers
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?
Signup and view all the answers
Which of these statements is FALSE regarding a Preferred Provider Organization (PPO)?
Signup and view all the answers
A characteristic of Preferred Provider Organizations (PPOs) would be:
Signup and view all the answers
The individual who provides general medical care for a patient as well as the referral for specialized care is known as...
Signup and view all the answers
What does Medicare Parts A and B cover?
Signup and view all the answers
Which of the following reimburses its insureds for covered medical expenses?
Signup and view all the answers
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?
Signup and view all the answers
Which of these is considered a true statement regarding Medicaid?
Signup and view all the answers
Which of these statements is TRUE regarding a Preferred Provider Organization (PPO)?
Signup and view all the answers
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?
Signup and view all the answers
Which of the following does Social Security provide benefits for?
Signup and view all the answers
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
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.
