Question 1

Health insurance benefits are determined by:

Accepted Answer

A) indemnity schedules 
B) service benefit plans 
C) relative value studies 
D) all of the above

Question 2

Which of the following is not a disadvantage of managed care?

Accepted Answer

A) Authorized services usually are covered. 
B) Physicians' choices in the treatment of patients can be limited. 
C) More paperwork may be necessary. 
D) Reimbursement is historically less than with traditional health insurance.

Question 3

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called:

Accepted Answer

A) an individual policy 
B) workers' compensation 
C) unemployment insurance 
D) disability insurance

Question 4

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether the person sees the provider that month, is called a ______ plan.

Accepted Answer

A) capitation 
B) self-insured 
C) managed care 
D) fee-for-service

Question 5

The purpose of health insurance is to help individuals and families offset the costs of medical care.

Accepted Answer

A) True 
 B)False

Question 6

Which of the following expenses would be paid by Medicare Part B?

Accepted Answer

A) Inpatient hospital charges 
B) Hospice services 
C) Physician's office visits 
D) Home healthcare charges

Question 7

Which of the following is a type of insurance verification method?

Accepted Answer

A) Asking about the patient's insurance during the initial appointment telephone call 
B) Copying the insurance card when the patient arrives for an appointment 
C) Calling the carrier to verify benefits and eligibility 
D) All 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

Veterans of the U.S.armed forces may be covered by:

Accepted Answer

A) CHAMPVA 
B) TRICARE 
C) workers' compensation 
D) Blue Cross/Blue Shield

Question 10

A document that explains what expenses were paid after submission to Medicaid and sent to the physician's office is called a(n):

Accepted Answer

A) remittance advice 
B) estimate of benefits 
C) explanation of benefits 
D) utilization review

Question 11

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

Question 12

If Mr.Jones's insurance has a $500 deductible, a $50 surgery co-pay, and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

Accepted Answer

A) $3027.20 
B) $3047.20 
C) $3047.00 
D) $3067.50

Question 13

Which type of referral is usually processed immediately?

Accepted Answer

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

Exam 20: Basics of Health Insurance