MBC Ch 5 BLUE'S/PVT INS

The Blue Cross plans were established primarily to cover

• hospital expenses.

• physician services.

• both hospital expenses and physician services.

Fee-for-service plans offered by private health insurance companies are also referred to as

• traditional insurance plans.

• indemnity insurance plans.

• managed care plans.

• both traditional insurance plans and indemnity insurance plans.

America’s oldest privately owned, prepaid medical group is the

• Ross-Loos Medical Group.

• INA Healthplan, Inc.

• Kaiser Permanente Medical Care Program.

• Health Net HMO, Inc.

In managed care, the health care provider who controls patient access to specialists and diagnostic testing services is referred to as:

• the preferred provider

• the primary care provider

• the participating provider

• the network provider

Which of the following is NOT considered a health maintenance organization model?

• Group model

• Staff model

• Individual Practice Association

• Indirect contract model

A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a/an

• point-of-service (POS) plan.

• exclusive provider organization (EPO).

• managed care organization (MCO).

• physician provider group (PPG).

A managed care plan owned and operated by a health system instead of an insurance company.

• PPO

• EPO

• POS

• PSO

A managed care plan which shifts more of the payment responsibility to the plan member by requiring payment of a large deductible before insurance benefits will commence.

• Triple-option health plan

• Point-of-service plan

• Consumer directed health plan

• Indemnity insurance plan

A plan which incorporates cost containment measures but allows members to select from HMOs, PPOs or traditional indemnity insurance.

• Triple-option health plan

• Point-of-service plan

• Consumer directed health plan

• Indemnity insurance plan

Referral of a patient recommended by one specialist to another specialist is known as

• primary care

• secondary care

• concurrent care

• tertiary care