Week 9 Review

What do the benefits of a health insurance policy provide?

• Liability protection in case of an accident
• Payments to help cover the cost of healthcare services
• Free health care
• Payments to survivors after a person’s death

Which of the following is true of health insurance companies?

• They all offer the same policies and benefits
• They all have the same claim procedures
• They only offer policies through employers’ group plans
• They offer many different policies and costs vary widely

Where is an MA most likely to find detailed information about an insurance company’s claim procedures and benefits?

• In a printed manual that contains information on all insurance companies
• On a patient’s insurance card
• On a website or online portal for the insurance company
• In the facility’s policy and procedure manual

What does it mean for a person to be eligible in relation to health insurance?

• The person has passed a physical examination.
• The person is able to receive benefits.
• The person is up-to-date with filing claims.
• The person has not made any major claims yet in the calendar year.

Juanita pays 10% of all charges for health care she receives from a provider in her insurance company’s network. She pays 30% of charges if the provider is not in the network. What are these payments called?

• Coinsurance
• Copayments
• Premiums
• Deductibles

Each year the Okechi family must pay healthcare costs in full until they have spent $1000. After that, their insurance company’s benefits pay for part of their costs. What is the $1000 payment called?

• Coinsurance
• Copayment
• Premium
• Deductible

The Woods family has had a lot of healthcare expenses this year. Two family members have been in the hospital and one has had a long course of physical therapy. Because they have spent so much on their share of healthcare costs, their insurance company will pay 100% of healthcare costs for the rest of the year. This is because they have paid their

• Premium
• Deductible
• Out-of-pocket maximum
• Allowable amount

After healthcare claims are made, the subscriber gets a(n) ____________________ and the provider gets a(n) ____________________.

• Coverage alert document; summary of payments
• Summary of payments; coverage alert document
• Remittance advice statement; explanation of benefits
• Explanation of benefits; remittance advice statement

The standard fee an insurance company will pay for a healthcare service is called the

• Charge limit
• Allowable amount
• Capitation fee
• Premium

What are the four tiers of insurance plans on healthcare.gov’s insurance marketplace?

• Basic, enhanced, standard, and premium
• Bronze, silver, gold, and platinum
• Small, medium, large, and extra-large
• Minimal, complete, comprehensive, and expanded