CEBS GBA 1 Assignment 3 Questions and Answers All Correct

CEBS GBA 1 Assignment 3 Questions and Answers All Correct prepaid service plans - Answer-this type of plan provided a set allowance (level of benefit) for hospital/medical services and paid them directly to the provider ex: blue cross blue shield indemnity plans - Answer-plans that reimbursed or indemnified a set dollar amount to the subscriber first dollar coverage - Answer-plan pays benefits from the minute an expense is incurred. the subscriber pays no expense. this model was used in early hospital and medical plans when costs and utilization patterns were lower this type of coverage is not used often today it has been replaced with plans that use deductibles, coinsurance provisions or other cost containment measures. managed care has also replaced this type of coverage list the types of hospitalization benefits covered in health plans - Answer-1. inpatient room and board 2 emergency care 3 intensive and specialty care 4 maternity and newborn care 5 xray, diagnostic testing and laboratory expenses in a hospital 6 skilled nursing facility care 7 radiation and chemo 8 inpatient mental and nervous care 9 inpatient drup and alcohol abuse care 10 physical, inhalation andcardiac therapy 11 home health care 12 hospice 13 respite care list the types of medical benefits covered in health plans - Answer-1. surgeons 2 anesthesiologists 3 nurse and other surgical assistants 4 service fees assoc with inpatient medical care 5 second surgical opinions 6 xray and diagnostic and lab expenses 7 skilled nursing care 8 obs and pediatriacians assoc with prenatal delivery and newborn care 9 inpatient ICU 10 allergy testing 11 transplant services 12 administration of radiation and chemotherapy 13 inpatient physical therapy 14 immunizations for children what were the early cost sharing techniques used in major medical coverage? - Answerdeductibles and coinsurance deductibles - Answer-the amount of covered medical expense that a subscriber must pay before the plan pays benefits coinsurance - Answer-amount that is usually a percentage of total charges for which the plan participant is responsible once the deductible is exceeded what are the good parts to using deductibles and coinsurance as cost saving devices? - Answer-1. may lead to a reduction in the use of health services and thus a reduction in costs 2 may reduce premiums because the health plan pays less. saving are passed to the employer and or employee. but some of the cost is shifted from employer to employee 3 create equity because the amount insured persons pay is related to their use of health services what are the bad parts to using deductibles and coinsurance as cost saving devices? - Answer-1. may not reduce utilization of health services because physicians not consumers make decisions 2 may discourage preventive care 3 may present a financial barrier to necessary care how does major medical insurance work? - Answer-this plan was originally often combined with first dollar prepaid service plans. when the benefit allowances for hospital or medical services were exceeded by a participant then the plan would start paying a second level of reimbursement thru the major medical component coinsurance and deductibles would apply this policy was written as "all-except" coverage rather than as a named peril coverage can be issued as a stand alone policy named peril coverage - Answer-coverage which specifically identifies the services that are covered comprehensive plans - Answer-this plan is an adaptation of the major medical approach. up front deductibles and coinsurance are applied to all hospital and medical services and procedures, not just to the supplemental charges as in a major medical plan