Question 1

Under which of the following Medicare plans for primary care and specialists' services is the patient required to pay a monthly premium?

Accepted Answer

A)   Part A
B)   Part B
C)   Part C
D)   Part D

Question 2

The amount of money paid to keep an insurance policy in force is the

Accepted Answer

A)   premium.
B)   deductible.
C)   co-pay.
D)   co-insurance.

Question 3

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Accepted Answer

A)   benefit.
B)   allowable amount.
C)   allowed service.
D)   incurred amount.

Question 4

Organizations that fund their own insurance programs offer their employees

Accepted Answer

A)   group coverage.
B)   individual coverage.
C)   government plans.
D)   self-funded plans.

Question 5

If Mr. Jones's insurance has a $500 deductible and a $50 surgery co-pay and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

Accepted Answer

A)   $3027.20
B)   $3047.20
C)   $3047.00
D)   $3067.50

Question 6

Which of the following are not reviewed by a utilization review committee?

Accepted Answer

A)   Physician referrals
B)   Cases of emergency department visits and urgent care
C)   Individual cases to ensure medical care services are medically necessary
D)   Fees for services provided

Question 7

Which of the following is not an advantage of managed care?

Accepted Answer

A)   Healthcare costs are usually contained.
B)   Access to specialized care and referrals is limited.
C)   Most preventive medical treatment is covered.
D)   Out-of-pocket expenses tend to be less than traditional insurance.

Question 8

Health insurance designed for military dependents and retired military personnel is called

Accepted Answer

A)   CHAMPVA.
B)   TRICARE.
C)   Medicare.
D)   Medicaid.

Question 9

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n)

Accepted Answer

A)   credentialing committee review.
B)   peer review committee evaluation.
C)   utilization review.
D)   audit committee review.

Question 10

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

Accepted Answer

A)   Medicare/Medicaid
B)   PPOs
C)   HMOs
D)   BC/BS
E)   IPA

Question 11

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Accepted Answer

A)   an individual policy.
B)   workers' compensation.
C)   unemployment insurance.
D)   disability insurance.

Question 12

Which of the following individuals would not normally be eligible for Medicare?

Accepted Answer

A)   A 66-year-old retired woman
B)   A blind teenager
C)   A 23-year-old recipient of AFDC
D)   A person on dialysis

Question 13

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

Accepted Answer

A)   Staff model
B)   Independent practice association
C)   Group model
D)   None of the above

Question 14

Which of the following managed care plans require preauthorization for medical services such as surgery?

Accepted Answer

A)   HMOs
B)   PPOs
C)   EPOs
D)   Both A and B
E)   All of the above

Question 15

Which part of Medicare covers prescription drug services?

Accepted Answer

A)   A
B)   B
C)   C
D)   D

Question 16

Most of today's health insurance policies cover which of the following?

Accepted Answer

A)   Preventive care
B)   Procedures deemed medically necessary
C)   Elective procedures
D)   All of the above
E)   Both A and B

Question 17

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Accepted Answer

A)   participating
B)   paying
C)   physician
D)   None of the above

Question 18

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Accepted Answer

A) True 
 B)False

Question 19

Medigap polices cover which of the following?

Accepted Answer

A)   Difference between major medical reimbursement and patient financial responsibilities
B)   Difference between Medicare reimbursement and patient financial responsibilities
C)   Any services not covered under Medicare
D)   Any services not covered under Major medical

Question 20

Veterans of the U.S. armed forces may be covered by

Accepted Answer

A)   CHAMPVA.
B)   TRICARE.
C)   workers' compensation.
D)   Blue Cross/Blue Shield.

Exam 14: Basics of Health Insurance

Which of the following individuals would not normally be eligible for Medicare?

Correct AnswerverifiedShow Answer

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

Correct AnswerverifiedShow Answer

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n)

Correct AnswerverifiedShow Answer

Most of today's health insurance policies cover which of the following?

Correct AnswerverifiedShow Answer

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Correct AnswerverifiedShow Answer

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Correct AnswerverifiedShow Answer

Health insurance designed for military dependents and retired military personnel is called

Correct AnswerverifiedShow Answer

Which of the following managed care plans require preauthorization for medical services such as surgery?

Correct AnswerverifiedShow Answer

Under which of the following Medicare plans for primary care and specialists' services is the patient required to pay a monthly premium?

Correct AnswerverifiedShow Answer

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Correct AnswerverifiedShow Answer

Organizations that fund their own insurance programs offer their employees

Correct AnswerverifiedShow Answer

Which part of Medicare covers prescription drug services?

Correct AnswerverifiedShow Answer

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

Correct AnswerverifiedShow Answer

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Correct AnswerverifiedShow Answer

Which of the following are not reviewed by a utilization review committee?

Correct AnswerverifiedShow Answer

Which of the following is not an advantage of managed care?

Correct AnswerverifiedShow Answer

The amount of money paid to keep an insurance policy in force is the

Correct AnswerverifiedShow Answer

Veterans of the U.S. armed forces may be covered by

Correct AnswerverifiedShow Answer

If Mr. Jones's insurance has a $500 deductible and a $50 surgery co-pay and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

Correct AnswerverifiedShow Answer

Medigap polices cover which of the following?

Correct AnswerverifiedShow Answer

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