1. Which of the following is not considered to be a type of defined health benefits plan? a. Individual health insurance

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1 Which Of The Following Is Not Considered To Be A Type Of Defined Health Benefits Plan A Individual Health Insurance 1 (29.65 KiB) Viewed 71 times

1 Which Of The Following Is Not Considered To Be A Type Of Defined Health Benefits Plan A Individual Health Insurance 2 (22.03 KiB) Viewed 71 times

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1. Which of the following is not considered to be a type of defined health benefits plan? a. Individual health insurance b. A self-funded employer plan C. A Medical Savings Account d. Medicare e. Medicaid 2. Copayment is: a. Money that a member must pay before the plan begins to pay. b. A fixed amount of money that a member pays for each office visitor prescription c. A percentage of the allowable charge that the member is responsible for paying d. Not a type of cost-sharing. Coinsurance is: a. Money that a member must pay before the plan begins to pay. b. A fixed amount of money that a member pays for each office visitor prescription c. A percentage of the allowable charge that the member is responsible for paying. d. Not a type of cost-sharing.
4. TF State mandated benefits coverage applies to all types of health benefits plans that provide coverage in that state. True or False 5. Which of the following is not used in the Affordable Care Act to describe a benefit level based on the amount of cost-sharing: a. Platinum b. Silver c. Gold d. Copper e. Bronze 1
6. TF Reinsurance and health insurance are subject to the same laws and regulations. True or False 7. TF Employer Group Benefits Plans are a form of Entitlement Benefits Programs True 8. Key common characteristics of PPOs do not include: a. Limited provider panels b. Discounted payment rates c. Consumer choice d. Utilization management e. Benefits limited to in-network care 9. TF Health insurers and Blue Cross Blue Shield plans can act as third party administrators (TPAs). True or False A Flexible Savings Account (FSA) is the same as a Medical Savings Account (MSA). True or False Commonly recognized types of HMOs include all but: 10. TF 11. a. IPAS b. Direct-contract plans C. PHOS d. Staff and group
12. TF Health insurers and HMOs are licensed differently. True or False TF IPAs are intermediaries between a payer such as an HMO, and its network physicians True or False 13. 14. TF The defining feature of a direct contract model HMO is the HMO contracting directly with a hospital to provide acute services to its members. True or False 15. Identity which of the following comes the closest to describing a "Rental PPO," also called a "Leased Network a. A PPO that rents space in physicians' offices for use by the PPO's own physicians b. A provider network that rents a PPO license c. A provider network that contracts with various payers to provide access and claims repricing d. A PPO that rents the product name and logo from a larger and better known payer so it can compete in the market 16. Blue Cross began as a physician service bureau in the 1930s. True or False
17. Prior to the 1970s, organized health maintenance organizations (HMOs) such as Kaiser Permanente were often referred to as: a. Hospital associations b. Preferred Provider Organizations c. Prepaid Group Practices d. Service Bureaus e. The future of healthcare 18. The Balanced Budget Act (BBA) of 1997 resulted in a major increase in HMO enrollment. True or False 19. The "managed care backlash" resulted in: a. A reduction in HMO membership b. New federal and state laws and regulations c. Improvements in quality of care d. Reduced administrative costs e. All of the above f. a & b only In What year was the Affordable Care Act signed into law ? a. 1920 b. 1955 C. 2010 d. 2015 20.