#1
What is a deductible in health insurance?
The amount you pay for covered health care services before your insurance plan starts to pay.
ExplanationInitial payment for healthcare before insurance coverage kicks in.
#2
Which of the following is a type of managed care plan?
Health Maintenance Organization (HMO)
ExplanationCommon managed care plan emphasizing preventive care.
#3
What is the purpose of a health insurance premium?
To provide coverage for health care services
ExplanationFunding for healthcare coverage.
#4
What is the main goal of managed care?
To control healthcare costs and improve quality
ExplanationCost management and quality enhancement in healthcare.
#5
Which of the following is NOT a characteristic of a Health Maintenance Organization (HMO)?
Allows members to see any healthcare provider without referrals
ExplanationRequirement of referrals for specialist visits.
#6
What is the difference between coinsurance and copayment in health insurance?
Coinsurance is a percentage of the cost you pay for covered health care services, while copayment is a fixed amount.
ExplanationPayment mechanisms for health services - percentage vs. fixed amount.
#7
What is utilization management in managed care?
A process to ensure appropriate use of healthcare services
ExplanationEnsuring proper utilization of healthcare resources.
#8
What is the role of a case manager in managed care?
To coordinate and manage the care of patients
ExplanationCoordinating patient care in managed healthcare systems.
#9
What is the purpose of preauthorization in managed care?
To ensure that certain services are medically necessary before they are provided
ExplanationVerifying medical necessity prior to service provision.