MA Chapter 14: Medical Insurance
Final Exam Questions and Actual
Detailed Answers.
claim - Answer bills medical offices send to insurance companies on behalf of patients.
disability income insurance - Answer Health insurance began in the US in the mid 1800's as
this type of insurance to replace income of people injured in accidents/diseases.
First group policy giving comprehensive benefits - Answer 1847- Massachusetts health
insurance Boston
Blue cross plan- 1929 - Answer origin of hospital insurance coverage--guarantees up to 21 days
of hospital care for a $6 yearly premium.
Employee benefit plans - Answer Became popular in 40's and 50's when unions bargained for
better benefit packages, including tax free employer sponsored health insurance.
In 1965, the federal government enacted these two programs for health care reimbursement for
the elderly and low income families - Answer Medicare and Medicaid
These decades saw a rapid rise in cost of health care as a result of advancing technology and
medic/are/aid funding - Answer 70's and 80's
Federal HMO act of 1973 - Answer allowed the use of federal fund/policy to promote HMO's
Managed care - Answer A form of health care coverage that offers economic incentives for
physicians/patients who choose less costly forms of care, intended to reduce costs.
Diagnosis Related Groups (DRG) - Answer A hospital payment program implemented by
Medicare in the 1980's to help control spending.
60% - Answer The percent of Americans who have health insurance through an employer
sponsored plan.
, Patient Protection and Affordable Care Act (PPACA) - Answer aka Obamacare; intended to
decrease the number of uninsured americans by creating a market for purchase of healthcare
insurance policies with mandates and incentives.
Health Insurance Exchange (HIE) - Answer A organized/competitive health insurance "market"
available to individuals and small businesses.
Who sponsors HIE's? - Answer Each state's department provides information about HIE's
available and identifies whether the state sponsors its own HIE or whether residents should use
the federal sites.
Individual Mandate - Answer A requirement by PPACA that individuals acquire health
insurance or pay a tax penalty if they do not.
member - Answer aka subscriber, policy holder, insured, a person who OWNS the health
insurance policy (not necessarily the ones who receive it)
beneficiary - Answer a person who is eligible for government health policy coverage.
Verification of Benefits (VOB) - Answer determining if a patient is qualified to receive benefits
or payment for a service under the guidelines of the insurance policy.
eligibility - Answer condition of being qualified to receive benefits according to insurance
policy guidelines.
dependent - Answer A family member NOT automatically included in the care of a health care
member.
It is important for MA's to know how each dependent is ? related to the member - Answer
legally
members can update dependent coverage when the policy renews once/year or under certain
circumstances. This is why it's important to - Answer verify dependent eligibility each visit.
premium - Answer amount paid for insurance, usually in monthly installments.
Final Exam Questions and Actual
Detailed Answers.
claim - Answer bills medical offices send to insurance companies on behalf of patients.
disability income insurance - Answer Health insurance began in the US in the mid 1800's as
this type of insurance to replace income of people injured in accidents/diseases.
First group policy giving comprehensive benefits - Answer 1847- Massachusetts health
insurance Boston
Blue cross plan- 1929 - Answer origin of hospital insurance coverage--guarantees up to 21 days
of hospital care for a $6 yearly premium.
Employee benefit plans - Answer Became popular in 40's and 50's when unions bargained for
better benefit packages, including tax free employer sponsored health insurance.
In 1965, the federal government enacted these two programs for health care reimbursement for
the elderly and low income families - Answer Medicare and Medicaid
These decades saw a rapid rise in cost of health care as a result of advancing technology and
medic/are/aid funding - Answer 70's and 80's
Federal HMO act of 1973 - Answer allowed the use of federal fund/policy to promote HMO's
Managed care - Answer A form of health care coverage that offers economic incentives for
physicians/patients who choose less costly forms of care, intended to reduce costs.
Diagnosis Related Groups (DRG) - Answer A hospital payment program implemented by
Medicare in the 1980's to help control spending.
60% - Answer The percent of Americans who have health insurance through an employer
sponsored plan.
, Patient Protection and Affordable Care Act (PPACA) - Answer aka Obamacare; intended to
decrease the number of uninsured americans by creating a market for purchase of healthcare
insurance policies with mandates and incentives.
Health Insurance Exchange (HIE) - Answer A organized/competitive health insurance "market"
available to individuals and small businesses.
Who sponsors HIE's? - Answer Each state's department provides information about HIE's
available and identifies whether the state sponsors its own HIE or whether residents should use
the federal sites.
Individual Mandate - Answer A requirement by PPACA that individuals acquire health
insurance or pay a tax penalty if they do not.
member - Answer aka subscriber, policy holder, insured, a person who OWNS the health
insurance policy (not necessarily the ones who receive it)
beneficiary - Answer a person who is eligible for government health policy coverage.
Verification of Benefits (VOB) - Answer determining if a patient is qualified to receive benefits
or payment for a service under the guidelines of the insurance policy.
eligibility - Answer condition of being qualified to receive benefits according to insurance
policy guidelines.
dependent - Answer A family member NOT automatically included in the care of a health care
member.
It is important for MA's to know how each dependent is ? related to the member - Answer
legally
members can update dependent coverage when the policy renews once/year or under certain
circumstances. This is why it's important to - Answer verify dependent eligibility each visit.
premium - Answer amount paid for insurance, usually in monthly installments.
