Loma 280 Chapter 13 Questions and Answers
Verified by Experts
maximum out-of-pocket provision Correct Ans-A major medical expense insurance policy
provision which states that the policy will cover 100 percent of allowable med-ical expenses
after the insured has paid a specified amount out-of-pocket to satisfy deductible and coinsurance
requirements
Medicaid Correct Ans-In the United States, a joint federal and state program that provides
basic medical expense and nursing home coverage to low-income individuals and to certain aged
and disabled individuals.
medical expense coverage Correct Ans-A type of health nsurance coverage that provides ben-
efits to pay for the treatment of an insured's illnesses and injuries.
Medicare Correct Ans-In the United States, a federal government program that provides med-
ical expense benefits to persons age 65 and older and persons with certain dis-abilities.
, network Correct Ans-A group of physicians, hospitals, and ancillary services providers that a
specific managed care plan has contracted with to deliver health care services to plan members
partial disability Correct Ans-A disability that prevents the insured either from performing
some of the duties of his usual occupation or from engaging in that occupation on a full-time
basis.
physicians' expenses Correct Ans-Medical expenses that include charges associated with phy-
sicians' visits both in and out of the hospital
point-of-service (POS) plan Correct Ans-A managed care plan that combines features of
HMOs and PPOs; plan members who need medical care choose, at the point of service, whether
to seek care in-network or out-of-network
preferred provider organization (PPO) Correct Ans-A health care benefit arrangement that
provides incentives for plan members to use network providers, but also pro-vides at least some
coverage for services rendered by non-network providers.
Verified by Experts
maximum out-of-pocket provision Correct Ans-A major medical expense insurance policy
provision which states that the policy will cover 100 percent of allowable med-ical expenses
after the insured has paid a specified amount out-of-pocket to satisfy deductible and coinsurance
requirements
Medicaid Correct Ans-In the United States, a joint federal and state program that provides
basic medical expense and nursing home coverage to low-income individuals and to certain aged
and disabled individuals.
medical expense coverage Correct Ans-A type of health nsurance coverage that provides ben-
efits to pay for the treatment of an insured's illnesses and injuries.
Medicare Correct Ans-In the United States, a federal government program that provides med-
ical expense benefits to persons age 65 and older and persons with certain dis-abilities.
, network Correct Ans-A group of physicians, hospitals, and ancillary services providers that a
specific managed care plan has contracted with to deliver health care services to plan members
partial disability Correct Ans-A disability that prevents the insured either from performing
some of the duties of his usual occupation or from engaging in that occupation on a full-time
basis.
physicians' expenses Correct Ans-Medical expenses that include charges associated with phy-
sicians' visits both in and out of the hospital
point-of-service (POS) plan Correct Ans-A managed care plan that combines features of
HMOs and PPOs; plan members who need medical care choose, at the point of service, whether
to seek care in-network or out-of-network
preferred provider organization (PPO) Correct Ans-A health care benefit arrangement that
provides incentives for plan members to use network providers, but also pro-vides at least some
coverage for services rendered by non-network providers.
