CEBS GBA 1 Assignment 3 Questions and Answers All
Correct | Verified
/ 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? -
Answer-deductibles 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
Correct | Verified
/ 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? -
Answer-deductibles 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
