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Lesson 12 Quiz

The following quiz is provided for your information to help you measure your retention level on the material covered within this lesson. It is not graded. Only the final examination is graded.

Answer or complete each question to the best of your knowledge and click on the "Check your answer" button. If your answer is incorrect, you will be instructed where to find the correct answer. It is not necessary to repeat the quiz if you exit this page; however, your answers will not be saved once you exit. This feature is provided for future practice purposes.

1
Commercial Insurance Providers

When health care is provided first and then charges are submitted to the insurer, it is referred to as:

a)
b)
c)
d)
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2

The means health care is provided first and then the charges are submitted to the insurer for reimbursement. The allows policyowners to assign benefit payments from the insurer directly to the health care provider.


Word bank: Reimbursement Approach, Right of Assignment

The Reimbursement Approach means health care is provided first and then the charges are submitted to the insurer for reimbursement. The Right of Assignment allows policyowners to assign benefit payments from the insurer directly to the health care provider.

Lesson 12.1Check your answer

3
HMO Overview

HMOs must hold an open enrollment period of not less than ______ during every 18-month period.

a)
b)
c)
d)
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4

are known for stressing preventive care and pay for curative medicine on a reimbursement plan.


Word bank: HMOs, PPOs

HMOs are known for stressing preventive care and PPOs pay for curative medicine on a reimbursement plan.

Lesson 12.3, 12.4Check your answer

5

HMOs are required to file a report of activities within _____ months of the end of each fiscal year.

a)
b)
c)
d)
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6

A complete examination of all of an HMO's affairs is conducted at least every:

a)
b)
c)
d)
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7

The person who is covered by a health maintenance contract is referred to as the:

a)
b)
c)
d)
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8

Referring to an HMO's CAP to reassure prospects is prohibited.

a)
b)
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9

There is no Florida law stating that maternity benefits must be offered under an HMO.

a)
b)
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10

The penalties in Florida for violating the Unfair Trade Practices Act can result in a fine up to $200,000.

a)
b)
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11

Though an HMO in Florida cannot exclude coverage for HIV infection, coverage limits may be different from those that apply to other sicknesses or medical conditions.

a)
b)
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12

Direct Access under an HMO plan means that the member has to get a referral from the PCP.

a)
b)
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13

If a member is covered under an HMO plan that provides optional family coverage, any newborn of the member must be covered at birth until ________ of age.

a)
b)
c)
d)
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14
Medicare

Medicare provides hospital coverage, provides medical coverage, provides new options, and provides prescription coverage.


Word bank: Part A, Part B, Part C, Part D

Medicare Part A provides hospital coverage, Part B provides medical coverage, Part C provides new options, and Part D provides prescription coverage.

Lesson 12.6Check your answer

15

Under Medicare Part A, a copayment for post-hospital skilled nursing facility care is applicable from the _____ to the _____ day of care.

a)
b)
c)
d)
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16

Each Medicare enrollee is given a one-time only lifetime reserve of ______ days hospital stay in addition to the regular 90 days of benefits.

a)
b)
c)
d)
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17

Under Medicare Part B, once the deductible is satisfied, Medicare will pay ______ of the covered expenses.

a)
b)
c)
d)
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18
Workers' Compensation Programs

Workers' compensation laws are governed by the:

a)
b)
c)
d)
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19

Under certain qualifying circumstances, workers' comp can provide a lump sum benefit.

a)
b)
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20

If a worker is killed in an industrial accident, workers' comp law provides for payment of burial expenses.

a)
b)
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21

Depending upon the existence of negligence or due care, the employer may be held liable for employee work-related disabilities.

a)
b)
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22

An employee may sue their employer for workers' comp benefits.

a)
b)
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23
Alternative Methods

Nontraditional health insurance plans have increased due to:

a)
b)
c)
d)
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24

ASO or TPA entities are paid a fee to provide the service of handling paperwork and processing claims.

a)
b)
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25

A(n) ______________ details the relationship between the trust and the employer and the coverages the employer has chosen to offer its employees.

a)
b)
c)
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26
Definitions

A(n) plan is an arrangement under which an insurance company handles the administrative functions for a self-insured group. A(n) plan is an organization outside the members of a self-insurance group which processes claims, completes benefits paperwork and often analyzes claims information.


Word bank: ASO, TPA

A(n) ASO plan is an arrangement under which an insurance company handles the administrative functions for a self-insured group. A(n) TPA plan is an organization outside the members of a self-insurance group which processes claims, completes benefits paperwork and often analyzes claims information.

(Key Concepts)

CONGRATULATIONS on completing Lesson 12. Now complete the Florida study manual Units 16 and 20 Questions for Review.

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