Healthcare Business Models Quiz
39 Questions
3 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

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?

    <p>Carve-out plan</p> Signup and view all the answers

    What reduces unnecessary surgical procedures and costs for health plans?

    <p>Second surgical opinion</p> Signup and view all the answers

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

    <p>Both cover routine and necessary procedures</p> Signup and view all the answers

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

    <p>Both focus on managing health-care plans</p> Signup and view all the answers

    What do prescription card programs offer?

    <p>Prepaid benefits with nominal copayments</p> Signup and view all the answers

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

    <p>Pregnancy Discrimination Act of 1978</p> Signup and view all the answers

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

    <p>The length of hospital stays for mothers and newborns</p> Signup and view all the answers

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

    <p>All of the above</p> 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?

    <p>ERISA</p> Signup and view all the answers

    What does the Health Maintenance Organization Act of 1973 regulate?

    <p>Federal and state level regulations for HMOs</p> Signup and view all the answers

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

    <p>Failing to offer coverage</p> Signup and view all the answers

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

    <p>Outpatient benefits</p> Signup and view all the answers

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

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

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

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

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

    <p>Mortality tables and morbidity tables</p> Signup and view all the answers

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

    <p>Insurance companies</p> Signup and view all the answers

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

    <p>Premiums</p> Signup and view all the answers

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

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

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

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

    How does a prepaid plan pay health-care providers?

    <p>It pays a fixed amount according to the number of individuals covered by the plan</p> 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?

    <p>The form of reimbursement to healthcare providers or patients</p> Signup and view all the answers

    What does the IRC allow companies to take deductions for?

    <p>Providing health plans or paying claims directly</p> 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?

    <p>Guaranteed minimum patient load</p> Signup and view all the answers

    How is an exclusive provider organization similar to a PPO?

    <p>Both pay on a reimbursement basis</p> Signup and view all the answers

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

    <p>Require a primary care physician</p> Signup and view all the answers

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

    <p>Out-of-Pocket Maximum</p> Signup and view all the answers

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

    <p>Meet a deductible</p> Signup and view all the answers

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

    <p>70%</p> Signup and view all the answers

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

    <p>$1,263.16</p> Signup and view all the answers

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

    <p>13%</p> Signup and view all the answers

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

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

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

    <p>To reduce absenteeism</p> Signup and view all the answers

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

    <p>41%</p> 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?

    <p>%Increased by 37%</p> Signup and view all the answers

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

    <p>$390.79</p> Signup and view all the answers

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

    <p>%To promote diversity and inclusion</p> Signup and view all the answers

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser