Deck 13: Bluecross Blueshield

Question 1

The BlueCross BlueShield Federal Employee Program (FEP) is a(n) __________ health benefits program established by an Act of Congress in 1959.

A) employer-sponsored
B) government-sponsored
C) payer-sponsored
D) state-sponsored

Answer 1

employer-sponsored

Question 2

The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments.

A) basic
B) major medical

Answer 2

basic

Question 3

BCBS indemnity coverage offers choice and flexibility to subscribers who want to receive a full range of benefits along with the __________.

A) freedom to use any licensed health care provider
B) option to use network-based health care providers
C) requirement of obtaining referrals to providers
D) restriction of selecting a primary care provider

Answer 3

freedom to use any licensed health care provider

Question 4

Participating providers contract to participate in a BCBS plan's preferred provider network (PPN), which is a program that requires providers to adhere to __________ care provisions.

A) hospital
B) managed
C) prospective
D) retrospective

Question 5

The BCBS outpatient pretreatment authorization plan (OPAP) requires preauthorization of outpatient physical, occupational, and speech therapy services. Other terms for OPAP include precertification and __________ authorization.

A) point-of-service
B) preferred
C) prospective
D) retrospective

Question 6

For-profit corporations pay taxes on profits generated by the corporation's enterprises and pay dividends to __________ on after-tax profits.

A) beneficiaries
B) patients
C) providers
D) shareholders

Question 7

BCBS corporations offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by the word __________ on the patient's plan ID card.

A) Medicaid
B) Medicare
C) Medigap
D) MediSupp

Question 8

BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.

A) basic
B) contractual
C) major medical
D) traditional

Question 9

The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or __________ for policyholder.

A) member
B) patient
C) payer
D) provider

Question 10

BlueCross plans originally covered only hospital bills, and BlueShield plans covered fees for physician services, and there was close cooperation between the plans that resulted in joint ventures where the two corporations were housed in one building. In these joint ventures, BlueCross BlueShield (BCBS) __________.

A) contracted with providers to offer hospital and physician services, regardless of plan
B) merged as a single corporate entity and was able to significantly reduce premium costs
C) provided health care services and procedures to subscribed patients in the building
D) shared one building and computer services but maintained separate corporate identities

Question 11

By 1932 some plans modified the prepaid plan concept and organized community-wide programs that allowed the subscriber to be hospitalized in one of several member hospitals in accordance with signed contracts to provide services __________.

A) at no charge to the patient
B) for negotiated special rates
C) on an emergency basis only
D) when the patient needed surgery

Question 12

BCBS has a mandatory second surgical opinion (SSO) requirement necessary when a patient is considering elective, nonemergency surgical care. The initial surgical recommendation must be made by a physician qualified to perform the anticipated surgery. If a second surgical opinion is not obtained prior to surgery, the patient's out-of-pocket expenses may be __________.

A) eliminated
B) increased
C) reduced
D) waived

Question 13

The BCBS coordinated home health and hospice care program allows patients with this option to elect an alternative to __________ or long-term care settings.

A) acute
B) emergency
C) outpatient
D) rehabilitation

Question 14

Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract.

A) combined into
B) instead of
C) over and above
D) that is part of

Question 15

Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.

A) distributed to shareholders and officers
B) paid to the federal government as taxes
C) returned to the nonprofit corporation
D) sent to beneficiaries who paid premiums

Question 16

BlueShield plans were created as the result of a resolution passed by the House of Delegates at an American Medical Association meeting in 1938. This resolution supported the concept of __________ health insurance that would encourage physicians to cooperate with prepaid health care plans.

A) commercial
B) mandatory
C) profit
D) voluntary

Question 17

BCBS fee-for-service __________ coverage includes minimum benefits, such as inpatient hospitalizations and diagnostic laboratory services.

A) basic
B) contractual
C) major medical
D) traditional

Question 18

The medical emergency care rider covers __________ treatment sought and received for sudden, severe, and unexpected conditions that if not treated would place the patient's health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or body part.

A) continuous
B) immediate
C) protracted
D) recurring

Question 19

FEP cards contain the phrase __________ under the BCBS trademark.

A) BCBS Supplemental Plan
B) Federal Employee Program
C) Government-Wide Service Benefit Plan
D) Healthcare Anywhere

Question 20

The forerunner of what is known today as the BlueCross plan began in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents, in exchange for a $6 annual premium. This was considered a __________ plan.

A) postpaid
B) prepaid
C) retrospective
D) traditional

Question 21

BlueGeo provides global medical coverage for active employees and their dependents who spend more than __________ months outside the United States.

A) 2
B) 6
C) 12
D) 18

Question 22

BCBS Healthcare Anywhere coverage allows members of the independently owned and operated BCBS plans to have access to health care benefits throughout the __________, depending on their home plan benefits.

A) preferred provider network
B) state in which they reside
C) United States only
D) United States and world

Question 23

The BlueCard and BlueCard Worldwide programs enable members to obtain health care services while traveling or living in another BCBS plan's service area, which means they can receive __________.

A) benefits of their home plan contract and access to local provider networks
B) health care services from out-of-network providers where they are traveling
C) optional services and procedures not in their contract, if they are traveling
D) reimbursement if they have to receive services from nonparticipating providers

Question 24

The Away From Home Care Program allows participating BCBS plan members who are temporarily residing outside of their home HMO service area for at least 90 days to temporarily enroll with a local __________.

A) health maintenance organization
B) managed care company
C) nonparticipating provider
D) out-of-network provider