Question 1

Eric is an HMO subscriber. Which of the following is not a supplemental service he can add to his coverage?

Accepted Answer

A) Prescription coverage 
B) Vision 
C) Dental 
D) Contact lens replacement 
A) Prescription coverage 
B) Vision 
C) Dental 
D) Contact lens replacement D

Question 2

Serendipity HMO contracts with an independent medical group that specializes in a variety of medical services to provide the HMO subscribers comprehensive coverage. Under this arrangement, Serendipity HMO pays the medical group entity not the individual service providers. Serendipity HMO most likely operates as:

Accepted Answer

A) Group model 
B) Staff model 
C) Network model 
D) Closed panel 
A) Group model 
B) Staff model 
C) Network model 
D) Closed panel A

Question 3

Which of the following is not something an HMO must do to receive government grants?

Accepted Answer

A) Require only nominal "use charges" 
B) Provide undefined health care to cover any situation 
C) Maintain certain minimum financial requirements in terms of net worth 
D) Establish premiums on a community rating basis 
A) Require only nominal "use charges" 
B) Provide undefined health care to cover any situation 
C) Maintain certain minimum financial requirements in terms of net worth 
D) Establish premiums on a community rating basis B

Question 4

Hereford HMO allows any provider that wants to provide services to the HMO subscribers to do so as long as they agree to Hereford HMO requirements. What type of HMO is this?

Accepted Answer

A) Open panel 
B) Closed panel 
C) Network panel 
D) Individual practice associations 
A) Open panel 
B) Closed panel 
C) Network panel 
D) Individual practice associations

Question 5

HMOs focus on preventative medicine. What does this lead to for the industry and consumer?

Accepted Answer

A) Increased health care costs 
B) Increased doctor visits 
C) Decreased health care costs 
D) Decreased doctor visits 
A) Increased health care costs 
B) Increased doctor visits 
C) Decreased health care costs 
D) Decreased doctor visits

Question 6

Which type of plan gives members control of seeing health care specialists?

Accepted Answer

A) Open access 
B) Open ended 
C) Point of service 
D) Open panel 
A) Open access 
B) Open ended 
C) Point of service 
D) Open panel

Question 7

When contracting physicians are paid as employees generally in a clinic type setting, this is most likely what type of HMO model?

Accepted Answer

A) Group model 
B) Staff model 
C) Network model 
D) Open panel 
A) Group model 
B) Staff model 
C) Network model 
D) Open panel

Question 8

Which of the following is true about HMOs?

Accepted Answer

A) HMOs are not-for-profit 
B) HMOs are for-profit 
C) HMOs can be either not-for-profit or for-profit 
D) HMOs are government programs and do not fall into either of these categories 
A) HMOs are not-for-profit 
B) HMOs are for-profit 
C) HMOs can be either not-for-profit or for-profit 
D) HMOs are government programs and do not fall into either of these categories

Question 9

Fred has a heart condition that has prevented him from obtaining traditional insurance. If he wants to purchase HMO coverage, what should he do?

Accepted Answer

A) Apply for the HMO during open enrollment 
B) Apply for an HMO anytime 
C) Not mention his heart condition on the application 
D) Falsify his medical records to eliminate notes about his problem 
A) Apply for the HMO during open enrollment 
B) Apply for an HMO anytime 
C) Not mention his heart condition on the application 
D) Falsify his medical records to eliminate notes about his problem

Question 10

What pre-existing condition can prevent HMO coverage during open enrollment?

Accepted Answer

A) Heart disease 
B) Diabetes 
C) Physical disabilities 
D) None 
A) Heart disease 
B) Diabetes 
C) Physical disabilities 
D) None

Question 11

One way HMOs differ from traditional health insurance is?

Accepted Answer

A) HMO provides health care from medical groups 
B) Traditional provides for both health care and financial coverage 
C) HMO provides financial coverage 
D) HMO provides health care and financial coverage. 
A) HMO provides health care from medical groups 
B) Traditional provides for both health care and financial coverage 
C) HMO provides financial coverage 
D) HMO provides health care and financial coverage.

Question 12

Preventative health services include all of the following except:

Accepted Answer

A) Well-child from birth 
B) Periodic health evaluations 
C) Dental care 
D) Immunizations 
A) Well-child from birth 
B) Periodic health evaluations 
C) Dental care 
D) Immunizations

Question 13

Bill is out of town on a skiing trip in a small village with limited communication to the surrounding areas. Coming down a black diamond run, Bill misses the final turn and breaks his leg as he tumbles to the bottom of the hill. At the emergency room, Bill notes in his paperwork that he is an HMO member. What will the HMO most likely do when Bill notifies them of the accident?

Accepted Answer

A) Reimburse Bill the set amount they would have paid someone in network 
B) Pay the claim even though Bill is outside of his network 
C) Deny payment because it was not pre-authorized 
D) Pay the claim if an affiliate and charge Bill the overage amount. 
A) Reimburse Bill the set amount they would have paid someone in network 
B) Pay the claim even though Bill is outside of his network 
C) Deny payment because it was not pre-authorized 
D) Pay the claim if an affiliate and charge Bill the overage amount.

Question 14

HMOs can terminate services for all of the following except:

Accepted Answer

A) Violation in terms of contract 
B) Pre-existing conditions 
C) Termination of group contract 
D) Non-payment of premiums 
A) Violation in terms of contract 
B) Pre-existing conditions 
C) Termination of group contract 
D) Non-payment of premiums

Question 15

Which of the following is not a required service of an HMO?

Accepted Answer

A) Inpatient hospital and physician services 
B) Preventative health care 
C) Outpatient medical care 
D) Long-term care 
A) Inpatient hospital and physician services 
B) Preventative health care 
C) Outpatient medical care 
D) Long-term care

Question 16

What is an open ended HMO plan?

Accepted Answer

A) Unlimited coverage 
B) Option to add covered services 
C) Hybrid arrangement to use non-HMO providers 
D) A plan without a termination date 
A) Unlimited coverage 
B) Option to add covered services 
C) Hybrid arrangement to use non-HMO providers 
D) A plan without a termination date

Question 17

As an HMO basic member, services

Accepted Answer

A) May be subject to a copayment 
B) Are subject to additional fees at the time of service 
C) Are free to members 
D) Are limited to a minimum number of services per period 
A) May be subject to a copayment 
B) Are subject to additional fees at the time of service 
C) Are free to members 
D) Are limited to a minimum number of services per period

Question 18

Diagnostic and treatment services fall into which of the following required basic health care services?

Accepted Answer

A) Inpatient 
B) Outpatient 
C) Preventative 
D) In and out of area emergency services 
A) Inpatient 
B) Outpatient 
C) Preventative 
D) In and out of area emergency services

Question 19

Dr. Bobwhite has decided to contract with an HMO because many of his current patients are already subscribers. Dr. Bobwhite will most likely be participating in what type of HMO?

Accepted Answer

A) Group model 
B) Network model 
C) Individual Practice Association model 
D) Staff model 
A) Group model 
B) Network model 
C) Individual Practice Association model 
D) Staff model

Question 20

Fletcher HMO contracts with three medical groups and several independent doctors. What type of HMO model is this most likely to be?

Accepted Answer

A) Group model 
B) Staff model 
C) Network model 
D) Closed panel 
A) Group model 
B) Staff model 
C) Network model 
D) Closed panel

Eric is an HMO subscriber. Which of the following is not a supplemental service he can add to his coverage?

Which of the following is not something an HMO must do to receive government grants?

Hereford HMO allows any provider that wants to provide services to the HMO subscribers to do so as long as they agree to Hereford HMO requirements. What type of HMO is this?

HMOs focus on preventative medicine. What does this lead to for the industry and consumer?

Which type of plan gives members control of seeing health care specialists?

When contracting physicians are paid as employees generally in a clinic type setting, this is most likely what type of HMO model?

Which of the following is true about HMOs?

Fred has a heart condition that has prevented him from obtaining traditional insurance. If he wants to purchase HMO coverage, what should he do?

What pre-existing condition can prevent HMO coverage during open enrollment?

One way HMOs differ from traditional health insurance is?

Preventative health services include all of the following except:

HMOs can terminate services for all of the following except:

Which of the following is not a required service of an HMO?

What is an open ended HMO plan?

As an HMO basic member, services

Diagnostic and treatment services fall into which of the following required basic health care services?

Dr. Bobwhite has decided to contract with an HMO because many of his current patients are already subscribers. Dr. Bobwhite will most likely be participating in what type of HMO?

Fletcher HMO contracts with three medical groups and several independent doctors. What type of HMO model is this most likely to be?

Health: Health and Life Insurance

Health: Disability

Health: Health and Dental

Health: Tax Issues in Life Insurance

Health: Theory in Life Insurance

Comprehensive Examination: English and Language Usage

Comprehensive Examination: Mathematics

Comprehensive Examination: Reading

Comprehensive Examination: Science

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Exam 4: Health: Health Maintenance Organizations

Eric is an HMO subscriber. Which of the following is not a supplemental service he can add to his coverage?

Which of the following is not something an HMO must do to receive government grants?

Hereford HMO allows any provider that wants to provide services to the HMO subscribers to do so as long as they agree to Hereford HMO requirements. What type of HMO is this?

HMOs focus on preventative medicine. What does this lead to for the industry and consumer?

Which type of plan gives members control of seeing health care specialists?

When contracting physicians are paid as employees generally in a clinic type setting, this is most likely what type of HMO model?

Which of the following is true about HMOs?

Fred has a heart condition that has prevented him from obtaining traditional insurance. If he wants to purchase HMO coverage, what should he do?

What pre-existing condition can prevent HMO coverage during open enrollment?

One way HMOs differ from traditional health insurance is?

Preventative health services include all of the following except:

HMOs can terminate services for all of the following except:

Which of the following is not a required service of an HMO?

What is an open ended HMO plan?

As an HMO basic member, services

Diagnostic and treatment services fall into which of the following required basic health care services?

Dr. Bobwhite has decided to contract with an HMO because many of his current patients are already subscribers. Dr. Bobwhite will most likely be participating in what type of HMO?

Fletcher HMO contracts with three medical groups and several independent doctors. What type of HMO model is this most likely to be?

Health: Health and Life Insurance

Health: Disability

Health: Health and Dental

Health: Tax Issues in Life Insurance

Health: Theory in Life Insurance

Comprehensive Examination: English and Language Usage

Comprehensive Examination: Mathematics

Comprehensive Examination: Reading

Comprehensive Examination: Science

Filters