Q: Under what type of care do insurers negotiate contracts with health care providers to allow subscribers access to health care services at a favorable cost?
A: Preferred Provider Organization (PPO)
A: Preferred Provider Organization (PPO)
Q: What is the purpose of the coinsurance provision in health insurance policies?
A: To prevent overutilization of the policy benefits
A: To prevent overutilization of the policy benefits
Q: What is the main difference between coinsurance and copay?
A: Copay is a set dollar amount; coinsurance is a percentage of the expenses
A: Copay is a set dollar amount; coinsurance is a percentage of the expenses
Q: What provision provides for the sharing of expenses between the insured and the insurance company?
A: Coinsurance
A: Coinsurance
Q: In what type of health plans are providers paid for services in advance, regardless of the services provided?
A: Prepaid plans
A: Prepaid plans
Q: What are the five basic characteristics of managed care plans?
A: Controlled access to providers, comprehensive case management, preventive care, risk sharing, and high quality care
A: Controlled access to providers, comprehensive case management, preventive care, risk sharing, and high quality care
Q: What are usual/reasonable and customary charges based on?
A: Average charge for a given procedure in the specific geographic area
A: Average charge for a given procedure in the specific geographic area
Q: What is the main principle of an HMO plan?
A: Preventive care
A: Preventive care
Q: What types of injuries and services will be excluded from major medical coverage?
A: Injuries caused by war, intentionally self-inflicted injuries, injuries covered by workers compensation, regular dental/vision/hearing care, custodial care, and elective cosmetic surgery
A: Injuries caused by war, intentionally self-inflicted injuries, injuries covered by workers compensation, regular dental/vision/hearing care, custodial care, and elective cosmetic surgery
Q: What are the two types of Flexible Spending Accounts?
A: Health care accounts and dependent care accounts
A: Health care accounts and dependent care accounts
Q: When are newborns covered in individual health insurance policies?
A: From the moment of birth
A: From the moment of birth
Q: What type of health insurance plans cover all accidents and sicknesses that are not specifically excluded in the policy?
A: Comprehensive plans
A: Comprehensive plans
Q: Can an insured who belongs to a POS plan use an out-of-network physician?
A: Yes, but the copays and deductibles may be higher
A: Yes, but the copays and deductibles may be higher
Q: What are the tax implications for contributions to a Health Savings Accounts by the individual insured?
A: Contributions are tax deductible
A: Contributions are tax deductible
Q: Why do HMOs encourage members to get regular checkups?
A: To help catch health problems early when treatment has the greatest chance for success (i.e. preventive care)
A: To help catch health problems early when treatment has the greatest chance for success (i.e. preventive care)
Q: What is a fee-for-service health plan?
A: Under a fee-for-service plan, providers receive payments for each service provided
A: Under a fee-for-service plan, providers receive payments for each service provided
Q: How are HMO territories typically divided?
A: Geographic areas
A: Geographic areas
Q: What is the role of the gatekeeper in an HMO plan?
A: To control costs for the services of specialists
A: To control costs for the services of specialists
Q: What are the three types of basic medical expense insurance?
A: Hospital, surgical and medical
A: Hospital, surgical and medical