Question 1

Dental insurance policies are available in both the individual and group market.In these policies, procedures such as fillings, crowns, and bridges are included under:

Accepted Answer

Fillings, crowns, and bridges are considered restorative services because they restore the function and integrity of damaged teeth.

Question 2

Describe basic health care benefits of traditional fee-for-service medical expense insurance.

Accepted Answer

The answer of Describe basic health care benefits of traditional...

Question 3

Write a short note on health reimbursement arrangements.

Accepted Answer

The answer of Write a short note on health reimbursement...

Question 4

If a gatekeeper is removed or taken off from a point of service, it becomes a(n) _____.

Accepted Answer

The answer of If a gatekeeper is removed or taken...

Question 5

The costs of health care services that insurers generally agree to cover in fee-for-service or managed care arrangements, based on studies of the appropriate cost for each medical procedure is known as _____ cost.

Accepted Answer

The answer of The costs of health care services that...

Question 6

The coordination of benefits provision reduces the total cost of health insurance by over 10 percent by:

Accepted Answer

The coordination of benefits provision specifically aims to reduce duplicate payments when an individual is covered by more than one health insurance plan, ensuring that the total amount paid does not exceed the actual cost of the healthcare services.

Question 7

In traditional fee-for-service policies, the second surgical opinion provision is included in the _____ technique of cost containment.

Accepted Answer

The second surgical opinion provision is a part of the utilization review technique of cost containment, which aims to ensure that the proposed medical procedures are necessary and performed in a cost-effective manner.

Question 8

Which of the following statements is true about cancer or critical insurance policy?

Accepted Answer

The answer of Which of the following statements is true...

Question 9

Write a short note of Medigap insurance.

Accepted Answer

The answer of Write a short note of Medigap insurance....

Question 10

In 1983, the federal government adopted the practice of paying a flat fee for each Medicare patient based on the patient's diagnostic-related group.This cost containment technique provided an economic incentive to providers, specifically hospitals, to minimize the length of stay and other cost parameters.Identify this cost containment technique.

Accepted Answer

The correct answer is B) Prospective payment. This system pays a flat fee for services based on the diagnosis of the patient, encouraging hospitals to control costs by managing the length of stay and resources used more efficiently.

Question 11

Explain the important features of cancer or critical illness policy.

Accepted Answer

The answer of Explain the important features of cancer or...

Question 12

The health savings account can be part of a health maintenance organization, preferred provider organization, or indemnity plan, as long as it has a:

Accepted Answer

Health Savings Accounts (HSAs) are designed to be paired with high-deductible health plans (HDHPs). The high deductible is a key feature that makes a health plan eligible to work with an HSA, allowing individuals to save money pre-tax for medical expenses.

Question 13

Under these plans, there is less incentive to abuse sick leave and more reward to employees who never use sick leave.These plans consolidate sick leave, personal leave, and vacation leave into a total number of personal days off each year.Identify these plans.

Accepted Answer

Paid time off plans combine various types of leave into a single pool of days that employees can use at their discretion, reducing the incentive to misuse specific types of leave and rewarding those who use fewer days.

Question 14

This disability insurance policy provision coordinates benefits under different disability policies by providing for a reduction in benefit payments if the total amount of income payments under all insurance policies covering the loss exceeds earnings at the time disability commences, or exceeds the average earnings for two years preceding disability, whichever is greater.Identify this provision.

Accepted Answer

The average earnings provision ensures that the total disability benefits do not exceed the insured's earnings prior to the disability, coordinating benefits across multiple policies.

Question 15

Which of the following statements is true about comprehensive medical insurance?

Accepted Answer

The answer of Which of the following statements is true...

Question 16

These health plans were created by the Medicare bill signed by President Bush on December 8, 2003, and are designed to help individuals save for future qualified medical and retiree health expenses on a tax-free basis.Identify these health plans.

Accepted Answer

Health Savings Accounts (HSAs) were established as part of the Medicare Prescription Drug, Improvement, and Modernization Act signed by President Bush on December 8, 2003. They are designed to help individuals save for future qualified medical and retiree health expenses on a tax-free basis.

Question 17

Managed-care fee-for-service plans control access to procedures by:

Accepted Answer

Managed-care fee-for-service plans use provisions like preadmission certification to control access to procedures. Preadmission certification requires the patient to obtain approval from the health plan before receiving certain non-emergency services. This helps to ensure that the services are necessary and appropriate, and that the patient is receiving care from a qualified provider.

Question 18

A cost containment initiative by employers has been to sponsor these programs designed to promote healthy lifestyles and reduce the incidence and severity of employee medical expenses.They vary greatly in scope.Some are limited to educational sessions on good health habits and screening for high blood pressure, cholesterol, diabetes, cancer symptoms, and other treatable conditions.More extensive programs provide physical fitness gymnasiums for aerobic exercise such as biking, running, and walking.Identify cost containment programs.

Accepted Answer

Wellness programs are designed to promote healthy lifestyles among employees, aiming to reduce medical expenses by preventing diseases and managing health conditions effectively.

Question 19

Keira is a health maintenance organization subscriber.She sees a specialist without a referral from the health maintenance organization.Which of the following will most like follow?

Accepted Answer

Health Maintenance Organizations (HMOs) typically require a referral from a primary care physician before seeing a specialist. If a subscriber sees a specialist without a referral, the HMO usually will not cover the cost, making the subscriber responsible for the full cost of care.

Question 20

This provision establishes a system of primary and secondary insurers.The primary insurer pays the normal benefit amount, as if no other insurance were in force.Then the secondary insurer pays the balance of the covered health care expenses.The total payments by the primary and secondary insurers are limited to 100 percent of the covered charges for the applicable policies.Identify this provision.

Accepted Answer

The described provision is the Coordination of Benefits (COB), which outlines how insurance policies work together when an individual is covered by more than one policy. It ensures that the total amount paid does not exceed 100% of the covered charges.

Quiz 22: Employment and Individual Health Risk Management