Chapter 15 test

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Feb 20, 2024

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QUESTION 1 The amount of money paid to keep an insurance policy in force is the: a. premium. b. deductible. c. copayment. d. co-insurance. 1 points QUESTION 2 Health insurance designed for military dependents and retired military personnel is called: a. TRICARE. b. CHAMPVA. c. Medicare. d. Medicaid. 1 points QUESTION 3 Veterans of the U.S. armed forces may be covered by: a. CHAMPVA. b. workers’ compensation. c. Blue Cross/Blue Shield. d. TRICARE. 1 points QUESTION 4 Organizations that fund their own insurance programs offer their employees: a. self-funded plans. b. individual coverage. c. government plans. d. group coverage. 1 points QUESTION 5 The federal- and state-sponsored health insurance program for the medically indigent is called: a. Medicaid. b. MediCal.
c. Medigap. d. Medicare. 1 points QUESTION 6 The amount of money the policyholder pays per claim before the insurance company will pay on the claim is known as the: a. deductible. b. premium. c. exclusion. d. remittance. 1 points QUESTION 7 Which of the following is not an advantage of managed care? a. Most preventive medical treatment is covered. b. Out-of-pocket expenses tend to be less than traditional insurance. c. Healthcare costs are usually contained. d. Access to specialized care and referrals is limited. 2 points QUESTION 8 Which of the following is not a disadvantage of managed care? a. Providers’ choices in the treatment of patients can be limited. b. Reimbursement is historically less than with traditional health insurance. c. Authorized services usually are covered. d. More paperwork may be necessary. 2 points QUESTION 9 Which part of Medicare covers prescription drug services? a. C b. B c. A
d. D 2 points QUESTION 10 Which type of referral is usually processed immediately? a. Regular b. STAT c. Urgent d. All are correct 2 points QUESTION 11 If Mr. Jones’s insurance has a $500 deductible and then pays 80% of the charges, how much will his policy pay on his bill of $4,359? a. $3487.20 b. $3447.20 c. $3027.20 d. $3087.20 2 points QUESTION 12 Most of today’s health insurance policies cover which of the following? a. All are correct b. Preventive care and procedures deemed medically necessary c. Preventive care d. Procedures deemed medically necessary e. Elective procedures 2 points QUESTION 13 Employee group plans usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However, these employee group health insurance plans offer limited benefits, and healthcare access is limited to healthcare providers that are contracted with them. a. The first statement is true; the second is false. b. The first statement is false; the second is true. c. Both statements are false.
d. Both statements are true. 2 points QUESTION 14 Medigap polices cover which of the following? a. Services not covered under Medicare b. Medicare deductible c. Medicare co-insurance d. All are correct 2 points QUESTION 15 Which of the following plans require healthcare providers to become participating providers? a. All government-sponsored health plans and most privately sponsored health plans b. All are correct c. Indemnity health insurance plans d. Most privately sponsored health plans e. All government-sponsored health plans 2 points QUESTION 16 Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility? a. IPA b. BC/BS c. HMOs d. Medicare/Medicaid e. PPOs 2 points QUESTION 17 Which of the following referrals can be approved online when it is submitted through the provider’s web portal to the utilization review department? a. All are correct b. Urgent referral
c. STAT referral d. Regular referral 2 points QUESTION 18 Which of the following managed care plans require preauthorization for medical services such as surgery? a. PPOs b. EPOs c. All are correct d. HMOs e. HMOs and PPOs 2 points QUESTION 19 Which of the following are not reviewed by a utilization review committee? a. Fees for services provided b. Individual cases to ensure medical care services are medically necessary c. Cases of emergency department visits and urgent care d. Provider referrals 2 points QUESTION 20 Dependents of military personnel are covered by which of the following government-sponsored health insurance plans? a. TRICARE b. Medicaid c. CHAMPVA d. Workers’ compensation e. Medicare 2 points QUESTION 21 Under which of the following Medicare plans for primary care and specialists’ services is the patient required to pay a monthly premium? a. Part A b. Part D
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