Question: Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?

Answer: A Health Maintenance Organization (HMO) is a prepaid group health plan, where members pay in advance for the services of participating physicians and hospitals that have agreements.

Question: Which of the following does Social Security NOT provide benefits for?

Survivorship

Dismemberment

Disability

Retirement

Answer: Dismemberment

Social Security provides for all of these types of benefits EXCEPT dismemberment.

Question: The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)

Answer: closed panel

A closed panel is when an HMO is represented by a group of physicians who are salaried employees and work out of the HMO’s facility.

Question: Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?

Answer: PPO’s are NOT a type of managed care systems

PPO’s ARE considered to be a managed health care system.

Question: Medicaid was designed to assist individuals who are

Answer: The correct answer is “below a specific income limit”. Medicaid was enacted to provide medical assistance to those whose income is below a specific limit.

Question: Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?

Answer: The correct answer is “Commercial insurer”. Commercial health insurance companies use the reimbursement approach, which allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement.

Question: What is the maximum Social Security Disability benefit amount an insured can receive?

Answer: 100% of the insured’s Primary Insurance Amount (PIA)

The MAXIMUM Social Security Disability benefit an insured may receive is equal to 100% of the insured’s Primary Insurance Amount (PIA).

Question: A medical care provider which typically delivers health services at its own local medical facility is known as a

Answer: Health Maintenance Organizations (HMO’s) traditionally provide services to its members at its own local health care facilities.

Question: The health insurance program which is administered by each state and funded by both the federal and state governments is called

Answer: Medicaid

Question: Medicare Part A and Part B do NOT pay for

Answer: dental work