#1
Which health insurance model is characterized by a network of healthcare providers who agree to provide services at a reduced cost?
Preferred Provider Organization (PPO)
ExplanationPPO involves a network of providers offering discounted services.
#2
What is the primary purpose of a Health Savings Account (HSA) in the context of health insurance?
To accumulate tax-free funds for medical expenses
ExplanationHSA's main purpose is tax-free accumulation of funds for medical expenses.
#3
What is the primary purpose of a Preferred Provider Organization (PPO) in health insurance?
To negotiate discounted rates with a network of healthcare providers
ExplanationPPO's primary purpose is negotiating discounted rates with healthcare providers.
#4
What is the primary purpose of a Catastrophic Health Insurance Plan?
To protect against high out-of-pocket costs in case of a serious illness or injury
ExplanationCatastrophic plans safeguard against high costs in serious health events.
#5
What is the primary purpose of the Affordable Care Act (ACA) in the United States?
To expand access to health insurance coverage and improve healthcare quality
ExplanationACA aims to enhance access to health insurance and improve healthcare quality in the United States.
#6
In a Health Maintenance Organization (HMO), how are healthcare services typically arranged?
Through a network of preferred providers
ExplanationHMO organizes services via a network of preferred healthcare providers.
#7
What is the key characteristic of a Point of Service (POS) health insurance plan?
Requires a primary care physician referral for specialists
ExplanationPOS plans need a referral from a primary care physician for specialist services.
#8
Which federal program provides health insurance coverage for individuals aged 65 and older?
Medicare
ExplanationMedicare provides health insurance for individuals aged 65 and older.
#9
In the context of health insurance, what is the purpose of 'utilization management'?
Managing the use of healthcare resources to control costs
ExplanationUtilization management controls costs by managing healthcare resource usage.
#10
In the context of health insurance, what does the term 'co-insurance' refer to?
A percentage of covered expenses paid by the insured
ExplanationCo-insurance involves the insured paying a percentage of covered expenses.
#11
Which provider structure involves a group of healthcare providers who share facilities and equipment, collaborating to deliver comprehensive care?
Integrated delivery network (IDN)
ExplanationIDN comprises providers collaborating for comprehensive care.
#12
In the context of health insurance, what does the term 'capitation' refer to?
A fixed fee per insured person, regardless of services rendered
ExplanationCapitation is a fixed fee per insured person, irrespective of services provided.
#13
What is a common characteristic of High Deductible Health Plans (HDHPs)?
Low monthly premiums
ExplanationHDHPs typically have low monthly premiums.
#14
What role does a Health Reimbursement Arrangement (HRA) play in health insurance?
It provides tax-free funds for qualified medical expenses
ExplanationHRA provides tax-free funds for qualified medical expenses in health insurance.
#15
What is the main objective of Managed Care Organizations (MCOs) in health insurance?
To control and coordinate healthcare services to reduce costs
ExplanationMCOs aim to control and coordinate services to cut costs in health insurance.