Insurance MCQ

Medicare Part A and Part B do NOT pay for Answer: dental work

Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)? Answer: PPO's are NOT a type of managed care systems

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures? Answer: Commercial insurer

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a Answer: Primary Care Physician

Which type of provider is known for stressing preventative medical care? Answer: Health Maintenance Organizations (HMO's)

Medicare is intended for all of the following groups, EXCEPT Answer: Those enrolled as a full-time student

Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)? Answer: More physicians to choose from

J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to? Answer: Health Maintenance Organization

The health insurance program which is administered by each state and funded by both the federal and state governments is called Answer: Medicaid

Medicaid was designed to assist individuals who are Answer: below a specific income limit

Which of the following is NOT a general category by which Basic Medical Coverage Expense policies classify their coverages? A) Loss of income expense. B) Physicians nonsurgical expense. C) Hospital expense. D) Surgical expense. Answer: A) Loss of income expense.

Which of the following best describes the characteristics of Preferred Provider Organizations (PPO's)? A) If service is obtained outside the PPO, benefits are reduced and costs increase. B) PPO's are generally public in nature rather than private. C) Health care providers themselves are barred from forming a PPO due to conflict of interest. D) PPO's operate like an HMO on a prepaid basis. Answer: A) If service is obtained outside the PPO, benefits are reduced and costs increase.

When a group of doctors and hospitals in a designated area contract with an insurer to provide health care at a prearranged figure to the insured, the arrangement is known as? A) Professional Service Organization (PSO). B) Designated Provider Organization (DPO). C) Preferred Provider Organization (PPO). D) Health Maintenance Organization (HMO). Answer: C) Preferred Provider Organization (PPO).

Comprehensive Medical Expense insurance combines features of which types of insurance? A) Major Medical and Basic Medical Insurance. B) Hospital Indemnity and Major Medical Insurance. C) Hospital Indemnity and Major Medical Insurance. D) Hospital and Surgical Insurance. Answer: A) Major Medical and Basic Medical Insurance.

Basic Medical Expense policies generally begin to pay benefits? A) on the 5th day in the hospital. B) after 10 days. C) after 45 days. D) on day 1. Answer: D) on day 1.

An insured has a Major Medical policy with a $500 deductible, 80% coinsurance, and a $1,500 stop-loss provision. How much of $4,500 in covered claims will the policy pay? A) $4,500. B) $1,300. C) $3,200. D) $1,500. Answer: C) $3,200.

An insurance policy that lists an operation as a specified number of units has which feature? A) Physicians expense benefit. B) Stop-loss. C) Relative value schedule. D) Coinsurance. Answer: C) Relative value schedule.

A corridor deductible is used primarily to? A) help control the cost of the premium. B) enable the health insurer to make a profit. C) deter people from seeking second opinions. D) prevent the filing of large medical claim. Answer: A) help control the cost of the premium.

HSA's are designed for? A) helping an individual accumulate funds to cover health insurance. B) helping an individual obtain medical insurance. C) helping an individual accumulate funds to cover medical expenses. D) helping an individual save for retirement. Answer: C) helping an individual accumulate funds to cover medical expenses.

Basic surgical expense policies generally provide coverage for all of the following EXCEPT? A) Surgeon services. B) Postoperative care. C) Anesthesiologist services. D) Miscellaneous expenses, such as lab fees and x-rays. Answer: D) Miscellaneous expenses, such as lab fees and x-rays.