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Exam 5: Employer-Sponsored Health-Care Plans

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Question 21

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Network model HMOs primarily use contracts with established practices of physicians that cover multiple specialties,but do not directly employ physicians.(Prepaid Group Practice Model)

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Question 22

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Employers can offer health-care plans using fully insured or self-funded plans.(Defining and Exploring Health-Care Plans)

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Question 23

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What are the three specific forms of prepaid group practices? (Prepaid Group Practice Model)

Fee-for-service plans pay benefits on a reimbursement basis and they generally do not rely on networks of health-care providers.(Fee-For-Service Plans)

_____ pay medical service providers a fixed amount based on the number of people enrolled,regardless of services received.(Health Plan Design Alternatives)

This prescription drug plan is usually associated with indemnity plans,pays benefits after the employee has met the deductible and tends to charge the most for filling the prescriptions.(Prescription Drug Benefits)

The National Association of Insurance Commissioners deals with state level issues relating to supervision of insurance.(State Regulations)

In consumer-driven health care plans,the first tier is a pretax account that allows employees to pay for services using pretax dollars.(Consumer-Driven Health Care)

Which of the following statements is true of health care costs? (Health-Care Coverage and Costs)

These types of insurance plans are set up to cover things like dental care,vision care and prescription drugs (Other Health-Care-Related Benefits)

State health instructor laws address all BUT which of the following (State Regulations)

The Patient Protection and Affordable Care Act distinguishes between health plans that existed prior to the enactment date (grandfathered plans)and those that come into existence afterward (non-grandfathered plans).(Patient Protection and Affordable Care Act of 2010)

A premium is the amount an employer pays to establish and maintain a health-care plans.(Defining and Exploring Health-Care Plans) 29.Company-sponsored care benefits appeared in the late 1800s for mining and railroad workers when companies hired doctors to provide medical services to employees.(Origins of Health-Care Benefits)

Discuss consumer-driven health-care plans briefly.(Consumer-Driven Health Care)

Morbidity tables express annual probabilities of the occurrence of health problems.(Defining and Exploring Health-Care Plans)

In 2015,half of the private-sector workers in opposite-sex partnerships had access to health-care benefits.(Health-Care Coverage and Costs)

What are the three common forms of managed care plans? (Managed Care Plans)

A point-of-service plan requires the selection of a primary care physician,similar to HMOs.(Point-of-Service Plans)

Formularies are lists of drugs proven to be clinically appropriate and cost effective.(Prescription Drug Benefits)

Which of the following does not fall within the scope of the role of a primary care physician? (Exhibit 5.4,Role of Primary Care Physicians)