This quiz in 'Chapter 5 Medical Plans' assesses knowledge on health insurance plans, including Managed Care, Health Reimbursement Accounts, PPOs, and Major Medical Plans. It evaluates understanding of payment systems and eligibility criteria pertinent to healthcare management.
The insurer would pay $2,880, and Crystal would pay $4,320
The insurer would pay $4,440, and Crystal would pay $2,960
The insurer would pay $2,960, and Crystal would pay $4,440
The insurer would pay $4,320, and Crystal would pay $2,880
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Never
If a Non PPO doctor is used for services
If the service fee is too high
When the gatekeeper provides a referral for a specialist
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24
6
9
12
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Self-Insurer plan
Preferred Care plan
Limited Care plan
Managed Care plan
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To increase costs
To contain costs
To provide more services
To provide preventive care
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HIPAA
POS
MET
PPM
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On a prepaid basis
A fee for each service they provide
Monthly
Only when providing services in their geographic area
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Nonpayment of premium
Frequency of claims
Noncompliance with plan provisions
Participation requirements not fulfilled
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First-dollar coverage
No deductibles
Coverage for catastrophic medical expenses
Low dollar limits
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Coinsurance
Deductible
No catastrophic protection
High maximum limits
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Concurrent Review
Prospective Review
HIPPA Review
Guaranteed Issue Review
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Provides specific benefits for specific injuries from specific causes.
Only covers for a limited time after the accident.
Limited in geographical scope
All answers are correct
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Case Management
Concurrent Review
Managed Health Review
Precertification
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To reduce the 6 month waiting period for pre-existing conditions
To reduce the 5 month waiting period for pre-existing conditions
To reduce the 1 year waiting period for pre-existing conditions
To reduce and discontinue coverage
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The employee
The employer
The employee’s account
The employee’s credit
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Custodial Care
Self-inflicted injuries
Catastrophic loss
Injuries from an act of war
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Concurrent Review
Consideration Clause
Mandatory Second Surgical Clause
Ambulatory Services
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High Maximum benefits
Low Maximum benefits
Deductible benefits
Indemnity benefits
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Eligible Plans
Deductible Plans
Comprehensive Plans
Indemnity Plans
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