#1
What is the main function of health insurance?
To provide financial protection against medical expenses
ExplanationFinancial protection against medical expenses.
#2
Which of the following is a characteristic of managed care?
Providers are incentivized to deliver cost-effective care
ExplanationIncentivized cost-effective care delivery by providers.
#3
Which of the following is NOT typically covered by health insurance?
Cosmetic surgery
ExplanationCosmetic surgery is typically not covered by health insurance.
#4
What is the purpose of a health insurance premium?
To cover administrative costs of insurance companies
ExplanationPurpose: Covering administrative costs of insurance companies.
#5
What is the main purpose of a health insurance claim?
To request reimbursement for medical expenses
ExplanationClaim purpose: Requesting reimbursement for medical expenses.
#6
What is a deductible in health insurance?
The amount paid by the insured before the insurance coverage begins
ExplanationAmount paid by insured before coverage starts.
#7
Which government program provides health insurance coverage for individuals over 65?
Medicare
ExplanationGovernment program for health insurance for individuals over 65.
#8
What is the primary goal of utilization management in managed care?
To ensure timely access to appropriate care
ExplanationPrimary goal: Timely access to appropriate care in managed care.
#9
What is a preferred provider organization (PPO) known for?
Offering flexibility in choosing healthcare providers
ExplanationPPOs are known for offering flexibility in choosing healthcare providers.
#10
What is a health insurance copayment?
A fixed amount paid by the insured for each medical service
ExplanationCopayment: Fixed amount paid by insured for each medical service.
#11
What is a Health Maintenance Organization (HMO) known for?
Emphasis on preventive care and care coordination
ExplanationEmphasis on preventive care and care coordination by HMOs.
#12
Which entity typically determines the coverage and reimbursement policies of managed care plans?
Insurance companies
ExplanationInsurance companies determine coverage and reimbursement policies.
#13
What is the purpose of a health insurance network?
To limit the number of healthcare providers available to the insured
ExplanationNetwork purpose: Limiting healthcare providers available to the insured.
#14
What is the main goal of disease management programs in managed care?
To provide coordinated care for patients with chronic conditions
ExplanationDisease management goal: Coordinated care for chronic conditions.