#1
Which of the following best defines a health insurance premium?
The amount paid by the insured person to the insurance company for coverage
ExplanationPremium is the fee paid for insurance coverage.
#2
What is the primary function of a Health Maintenance Organization (HMO) in managed care?
To emphasize preventive care and coordinate healthcare services
ExplanationHMOs focus on prevention and coordination of care.
#3
In a Preferred Provider Organization (PPO), what is a characteristic feature regarding healthcare provider choice?
Members have more freedom to choose their healthcare providers
ExplanationPPOs offer more provider flexibility to members.
#4
What does the term 'co-payment' refer to in health insurance?
The fixed amount a patient pays at each healthcare visit or for each prescription
ExplanationCo-payment is a fixed fee paid per healthcare visit or prescription.
#5
What is the purpose of a Health Savings Account (HSA) in relation to health insurance?
To save money for medical expenses on a tax-advantaged basis
ExplanationHSAs help save for medical expenses with tax advantages.
#6
What is a characteristic of a Health Reimbursement Arrangement (HRA) in employer-sponsored health plans?
Employers contribute funds to an account that employees can use for medical expenses
ExplanationHRAs involve employer contributions for employee medical expenses.
#7
Which of the following is a characteristic of a High-Deductible Health Plan (HDHP)?
Low premiums and high out-of-pocket expenses
ExplanationHDHPs offer lower premiums but higher out-of-pocket costs.
#8
What is a characteristic feature of a Point of Service (POS) plan in managed care?
Members must obtain a referral from a primary care physician to see specialists
ExplanationPOS plans require referrals to see specialists.
#9
In managed care, what is the role of utilization review?
To determine the appropriate level of care and ensure cost-effectiveness
ExplanationUtilization review assesses care necessity and cost-effectiveness.
#10
What is a characteristic feature of a Health Maintenance Organization (HMO) in managed care?
Members must obtain a referral from a primary care physician to see specialists
ExplanationHMOs require referrals for specialist visits.
#11
What is a characteristic feature of a Health Maintenance Organization (HMO) plan in managed care?
Coordination of care through a primary care physician
ExplanationHMOs coordinate care through primary care physicians.