Question 1

Most of today's health insurance policies cover which of the following?

Accepted Answer

A)  Preventive care 
B)  Procedures deemed medically necessary 
C)  Elective procedures 
D)  All of the above 
E)  Both A and B 
A)  Preventive care 
B)  Procedures deemed medically necessary 
C)  Elective procedures 
D)  All of the above 
E)  Both A and B

Question 2

The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the

Accepted Answer

A)  benefits. 
B)  deductible. 
C)  premium. 
D)  co-pay. 
A)  benefits. 
B)  deductible. 
C)  premium. 
D)  co-pay.

Question 3

Which of the following individuals would not normally be eligible for Medicare?

Accepted Answer

A)  A 66-year-old retired woman 
B)  A blind teenager 
C)  A 23-year-old recipient of AFDC 
D)  A person on dialysis 
A)  A 66-year-old retired woman 
B)  A blind teenager 
C)  A 23-year-old recipient of AFDC 
D)  A person on dialysis

Question 4

A physician can choose whether to accept Medicaid patients.

Accepted Answer

A) True 
 B)False

Question 5

Organizations that fund their own insurance programs offer their employees

Accepted Answer

A)  group coverage. 
B)  individual coverage. 
C)  government plans. 
D)  self-funded plans. 
A)  group coverage. 
B)  individual coverage. 
C)  government plans. 
D)  self-funded plans.

Question 6

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Accepted Answer

A)  benefit. 
B)  allowable amount. 
C)  allowed service. 
D)  incurred amount. 
A)  benefit. 
B)  allowable amount. 
C)  allowed service. 
D)  incurred amount.

Question 7

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Accepted Answer

A)  participating 
B)  paying 
C)  physician 
D)  None of the above 
A)  participating 
B)  paying 
C)  physician 
D)  None of the above

Question 8

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Accepted Answer

A) True 
 B)False

Question 9

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

Accepted Answer

A) True 
 B)False

Question 10

The TRICARE option that is similar to a preferred provider network is TRICARE

Accepted Answer

A)  Prime. 
B)  Extra. 
C)  Standard. 
D)  Basic. 
A)  Prime. 
B)  Extra. 
C)  Standard. 
D)  Basic.

Question 11

Which type of referral is usually processed immediately?

Accepted Answer

A)  Regular 
B)  Urgent 
C)  STAT 
D)  All of the above 
A)  Regular 
B)  Urgent 
C)  STAT 
D)  All of the above

Question 12

The federal- and state-sponsored health insurance program for the medically indigent is called

Accepted Answer

A)  Medicare. 
B)  Medicaid. 
C)  Medigap. 
D)  MediCal. 
A)  Medicare. 
B)  Medicaid. 
C)  Medigap. 
D)  MediCal.

Question 13

Which of the following managed care plans require preauthorization for medical services such as surgery?

Accepted Answer

A)  HMOs 
B)  PPOs 
C)  EPOs 
D)  Both A and B 
E)  All of the above 
A)  HMOs 
B)  PPOs 
C)  EPOs 
D)  Both A and B 
E)  All of the above

Question 14

Employee-sponsored group policies usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However, these employee-sponsored group health insurance plans offer limited benefits, and healthcare access is limited to healthcare providers that are contracted with them.

Accepted Answer

A)  Both statements are true. 
B)  Both statements are false. 
C)  The first statement is true; the second is false. 
D)  The first statement is false; the second is true. 
A)  Both statements are true. 
B)  Both statements are false. 
C)  The first statement is true; the second is false. 
D)  The first statement is false; the second is true.

Question 15

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

Accepted Answer

A)  Medicaid 
B)  Medicare 
C)  TRICARE 
D)  CHAMPVA 
E)  Workers' compensation 
A)  Medicaid 
B)  Medicare 
C)  TRICARE 
D)  CHAMPVA 
E)  Workers' compensation

Question 16

The medical assistant should always verify which of the following prior to the patient's appointment?

Accepted Answer

A)  Eligibility 
B)  Benefits and exclusions 
C)  Effective date of insurance 
D)  All of the above 
A)  Eligibility 
B)  Benefits and exclusions 
C)  Effective date of insurance 
D)  All of the above

Question 17

Which of the following are not reviewed by a utilization review committee?

Accepted Answer

A)  Physician referrals 
B)  Cases of emergency department visits and urgent care 
C)  Individual cases to ensure medical care services are medically necessary 
D)  Fees for services provided 
A)  Physician referrals 
B)  Cases of emergency department visits and urgent care 
C)  Individual cases to ensure medical care services are medically necessary 
D)  Fees for services provided

Question 18

Which part of Medicare covers prescription drug services?

Accepted Answer

A)  A 
B)  B 
C)  C 
D)  D 
A)  A 
B)  B 
C)  C 
D)  D

Question 19

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

Accepted Answer

A)  exclusion. 
B)  premium. 
C)  deductible. 
D)  remittance. 
A)  exclusion. 
B)  premium. 
C)  deductible. 
D)  remittance.

Question 20

The amount of money paid to keep an insurance policy in force is the

Accepted Answer

A)  premium. 
B)  deductible. 
C)  co-pay. 
D)  co-insurance. 
A)  premium. 
B)  deductible. 
C)  co-pay. 
D)  co-insurance.

Exam 14: Basics of Health Insurance

Most of today's health insurance policies cover which of the following?

The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the

Which of the following individuals would not normally be eligible for Medicare?

A physician can choose whether to accept Medicaid patients.

Organizations that fund their own insurance programs offer their employees

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

The TRICARE option that is similar to a preferred provider network is TRICARE

Which type of referral is usually processed immediately?

The federal- and state-sponsored health insurance program for the medically indigent is called

Which of the following managed care plans require preauthorization for medical services such as surgery?

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

The medical assistant should always verify which of the following prior to the patient's appointment?

Which of the following are not reviewed by a utilization review committee?

Which part of Medicare covers prescription drug services?

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

The amount of money paid to keep an insurance policy in force is the

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