Managed Care Organizations and Health Insurance Options Quiz
Test your knowledge on managed care options. Learn about HMOs, PPOs, POS plans, and key terms like gatekeeper and capitation.
#1
Which of the following is a characteristic of a Health Maintenance Organization (HMO)?
Requires a primary care physician (PCP) referral for specialist visits
Offers out-of-network coverage
Allows members to see specialists directly without a referral
Provides reimbursement for any healthcare provider visits
#2
Preferred Provider Organizations (PPOs) typically offer:
Restricted network of healthcare providers
Unlimited out-of-pocket expenses
Greater flexibility in choosing healthcare providers
No coverage for out-of-network services
#3
Which of the following statements best describes a Health Savings Account (HSA)?
It is a type of managed care organization
It allows individuals to save money tax-free for medical expenses
It provides coverage for out-of-network services
It requires referrals for specialist visits
#4
What is a common feature of a Point of Service (POS) plan?
No requirement for a primary care physician (PCP)
Exclusively covers out-of-network services
Requires a PCP referral for specialist visits
Limited coverage for prescription drugs
#5
In managed care, the term 'gatekeeper' refers to:
The primary healthcare provider who coordinates a patient's care
The insurance company's CEO
The government regulator overseeing managed care organizations
A computer program used for managing patient records
#6
Which of the following is a key role of utilization review in managed care?
To limit access to healthcare services
To maximize profits for insurance companies
To ensure appropriate and cost-effective use of healthcare resources
To offer discounts on healthcare premiums
#7
Which of the following is NOT a typical characteristic of an Exclusive Provider Organization (EPO)?
Requires members to choose a primary care physician (PCP)
Offers coverage only for in-network providers
Does not require referrals to see specialists
Provides coverage for out-of-network services
#8
Which of the following statements accurately describes a Health Reimbursement Arrangement (HRA)?
It is funded by employee contributions only
It allows employees to carry over unused funds to the next year
It is not tied to a high deductible health plan (HDHP)
It does not cover preventive care services
#9
What is a common feature of a Health Savings Account (HSA)?
Allows individuals to save money tax-free for medical expenses
Requires referrals for specialist visits
Covers out-of-network services
Offers unlimited out-of-pocket expenses
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