Healthcare Business Models Quiz

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What is the term for the maximum amount an insured person must pay per calendar year?

Out-of-pocket maximum (correct)

Lifetime limit

Preadmission certification

Coinsurance

What refers to the maximum amount a health plan would cover each year?

Second surgical opinion

Preexisting condition

Yearly limit (correct)

Dental care

What does a high-deductible health plan (HDHP) combine with a pretax payment account?

Dental care

Consumer-driven health-care plan (CDHP) (correct)

Out-of-pocket maximum

Coinsurance

What is the term for the contract agreement to provide special health-care services such as dental care and mental health and substance abuse care?

Carve-out plan Signup and view all the answers

What reduces unnecessary surgical procedures and costs for health plans?

Second surgical opinion Signup and view all the answers

What does dental fee-for-service plans have in common with medical fee-for-service plans?

Both cover routine and necessary procedures Signup and view all the answers

How are dental maintenance organizations (dental HMOs) similar to HMOs?

Both focus on managing health-care plans Signup and view all the answers

What do prescription card programs offer?

Prepaid benefits with nominal copayments Signup and view all the answers

Which federal law requires employers to treat pregnancy as other disabilities?

Pregnancy Discrimination Act of 1978 Signup and view all the answers

What does the Newborns’ and Mothers’ Health Protection Act of 1996 set minimum standards for?

The length of hospital stays for mothers and newborns Signup and view all the answers

What has contributed to the more than 450% increase in healthcare costs since 1984?

All of the above Signup and view all the answers

Which federal regulation includes amendments such as COBRA, HIPAA, and the Women’s Health and Cancer Rights Act of 1998?

ERISA Signup and view all the answers

What does the Health Maintenance Organization Act of 1973 regulate?

Federal and state level regulations for HMOs Signup and view all the answers

What does the term 'pay or play' refer to in the context of health-care plans?

Failing to offer coverage Signup and view all the answers

Which type of benefits cover hospital expenses not requiring overnight stays?

Outpatient benefits Signup and view all the answers

What is the key difference between fully insured plans and self-funded plans?

Fully insured plans have a contractual relationship with insurance companies, while self-funded plans involve the employer choosing benefits to offer. Signup and view all the answers

What does individual coverage refer to in the context of health insurance?

Health insurance purchased by a person outside the employment setting for themselves and their dependents. Signup and view all the answers

What do plan providers use to determine terms and premium amounts for health-care plans?

Mortality tables and morbidity tables Signup and view all the answers

Who assumes the risk for paying medical claims in fully insured plans?

Insurance companies Signup and view all the answers

What do employers pay to establish and maintain health-care plans under fully insured plans?

Premiums Signup and view all the answers

What is the condition for companies to take deductions for their contribution to health plan premiums?

The plan must not provide preferential treatment to highly compensated employees Signup and view all the answers

What are the four areas of responsibility addressed by state laws regulating fully insured plans?

Length of time coverage must be available to employees after they leave the company Signup and view all the answers

How does a prepaid plan pay health-care providers?

It pays a fixed amount according to the number of individuals covered by the plan Signup and view all the answers

What distinguishes a fee-for-service plan from a managed care plan according to the U.S. Bureau of Labor Statistics?

The form of reimbursement to healthcare providers or patients Signup and view all the answers

What does the IRC allow companies to take deductions for?

Providing health plans or paying claims directly Signup and view all the answers

In a preferred provider organization (PPO), what do physicians receive in return for providing services at a lower level of reimbursement?

Guaranteed minimum patient load Signup and view all the answers

How is an exclusive provider organization similar to a PPO?

Both pay on a reimbursement basis Signup and view all the answers

What feature does a point-of-service (POS) plan share with HMOs?

Require a primary care physician Signup and view all the answers

What is a common feature shared by health-care plans according to the text?

Out-of-Pocket Maximum Signup and view all the answers

What must employees do before the health-care plan pays for benefits, according to the text?

Meet a deductible Signup and view all the answers

What percentage of private-sector employees used some form of employer-sponsored healthcare plans in 2015?

70% Signup and view all the answers

What is the average monthly premium for family coverage for union members in March 2015?

$1,263.16 Signup and view all the answers

What percentage of the cost did union workers contribute for single coverage in 2015?

13% Signup and view all the answers

What has been a significant change in health care benefits since the 1980s?

Extension of coverage to unmarried opposite sex or same-sex partners Signup and view all the answers

What is the primary reason for companies to provide employer-sponsored healthcare?

To reduce absenteeism Signup and view all the answers

What percentage of the overall cost did the lowest paid workers contribute for family coverage in 2015?

41% Signup and view all the answers

How has the availability of health care benefits changed for unmarried opposite sex or same-sex partners since the 1980s?

%Increased by 37% Signup and view all the answers

What is the average monthly premium for single coverage for employees in March 2015?

$390.79 Signup and view all the answers

What is the primary reason for extending coverage to unmarried opposite sex or same-sex partners?

%To promote diversity and inclusion Signup and view all the answers