MIT 217 Chapter 7 Insurance And Coding Exam
Questions And Answers 100% Solved
Which of the following is a policy, or certificate of coverage, between a person, called
the policyholder, and an insurance company, or carrier? - ANSWER Medical insurance
Another term for the insured is ______. - ANSWER policyholder
Premiums are paid by ______. - ANSWER policyholders
Who is considered the second party in an insurance relationship? - ANSWER The patient
A patient who does not have insurance is referred to as ______. - ANSWER self-pay
Medical insurance is a policy, or certificate of coverage, between a person, called the
____________ , and an insurance company, or _________________ . - ANSWER Blank 1:
policyholder, policyholders, policy holder, or policy holders
Blank 2: carrier or carriers
Under the terms of the coordination-of-benefits clause, one insurance carrier is named
the _____________ carrier. - ANSWER Blank 1: primary or first
The term policyholder in the strict sense of the term refers to which of the following? -
ANSWER The person making the payments
What rule is used as a guideline for determining which of two parents with medical
coverage has the primary insurance for a child? - ANSWER Birthday rule
Which of the following is a charge for keeping an insurance policy in effect? - ANSWER
,Premium
In general, how do the cost of policies written for groups compare to those written for
individuals? - ANSWER Policies written for groups are cheaper.
Insurance contract participants:
First Party ->
Second Party ->
Third Party -> - ANSWER <- Physician
<- Patient (Policyholder)
<- Health Plan
Which of the following is a common reason why people elect to enroll in individual
insurance? - ANSWER Because they're not eligible for group insurance
A "self-pay" patient is responsible for paying the __________ directly for all services
rendered. - ANSWER Blank 1: physician, doctor, or MD
Charges for anesthesia are generally covered by ____________ _____________. - ANSWER
Blank 1: surgical
Blank 2: insurance
A health insurance policy clause that applies to an individual covered by more than one
medical policy and requires that the combined benefits paid by the policies do not
exceed 100 percent of the medical expenses is called ______. - ANSWER coordination of
benefits
Select all that apply
In which of the following situations would major medical offer protection?
, ER visits
Extensive injuries from a car accident
Prolonged illness
Routine labwork - ANSWER Extensive injuries from a car accident
Prolonged illness
The birthday rule insures that the maximum benefit will not exceed ______% of the
charge for covered services. - ANSWER 100
Which type of insurance is activated when an insured individual is injured or disabled for
nonwork-related reasons? - ANSWER Disability insurance
Which of the following type of plan do employers or employee organizations offer to
their employees? - ANSWER Group health plan
Which type of health care payment plan may use a negotiated discounted payment
schedule? - ANSWER Fee-for-service
In general, how do the cost of policies written for individuals compare to those written
for groups? - ANSWER Policies written for individuals are more expensive.
Regardless of the number of patients seen by a provider, the same ______ rate is paid
per patient. - ANSWER capitation
The definition of outpatient under medical insurance, is someone who receives medical
care at a hospital or other medical facility but is generally admitted for less than _____
hours. - ANSWER 23
The 2 major types of health plans are ______. - ANSWER managed care and indemnity
Questions And Answers 100% Solved
Which of the following is a policy, or certificate of coverage, between a person, called
the policyholder, and an insurance company, or carrier? - ANSWER Medical insurance
Another term for the insured is ______. - ANSWER policyholder
Premiums are paid by ______. - ANSWER policyholders
Who is considered the second party in an insurance relationship? - ANSWER The patient
A patient who does not have insurance is referred to as ______. - ANSWER self-pay
Medical insurance is a policy, or certificate of coverage, between a person, called the
____________ , and an insurance company, or _________________ . - ANSWER Blank 1:
policyholder, policyholders, policy holder, or policy holders
Blank 2: carrier or carriers
Under the terms of the coordination-of-benefits clause, one insurance carrier is named
the _____________ carrier. - ANSWER Blank 1: primary or first
The term policyholder in the strict sense of the term refers to which of the following? -
ANSWER The person making the payments
What rule is used as a guideline for determining which of two parents with medical
coverage has the primary insurance for a child? - ANSWER Birthday rule
Which of the following is a charge for keeping an insurance policy in effect? - ANSWER
,Premium
In general, how do the cost of policies written for groups compare to those written for
individuals? - ANSWER Policies written for groups are cheaper.
Insurance contract participants:
First Party ->
Second Party ->
Third Party -> - ANSWER <- Physician
<- Patient (Policyholder)
<- Health Plan
Which of the following is a common reason why people elect to enroll in individual
insurance? - ANSWER Because they're not eligible for group insurance
A "self-pay" patient is responsible for paying the __________ directly for all services
rendered. - ANSWER Blank 1: physician, doctor, or MD
Charges for anesthesia are generally covered by ____________ _____________. - ANSWER
Blank 1: surgical
Blank 2: insurance
A health insurance policy clause that applies to an individual covered by more than one
medical policy and requires that the combined benefits paid by the policies do not
exceed 100 percent of the medical expenses is called ______. - ANSWER coordination of
benefits
Select all that apply
In which of the following situations would major medical offer protection?
, ER visits
Extensive injuries from a car accident
Prolonged illness
Routine labwork - ANSWER Extensive injuries from a car accident
Prolonged illness
The birthday rule insures that the maximum benefit will not exceed ______% of the
charge for covered services. - ANSWER 100
Which type of insurance is activated when an insured individual is injured or disabled for
nonwork-related reasons? - ANSWER Disability insurance
Which of the following type of plan do employers or employee organizations offer to
their employees? - ANSWER Group health plan
Which type of health care payment plan may use a negotiated discounted payment
schedule? - ANSWER Fee-for-service
In general, how do the cost of policies written for individuals compare to those written
for groups? - ANSWER Policies written for individuals are more expensive.
Regardless of the number of patients seen by a provider, the same ______ rate is paid
per patient. - ANSWER capitation
The definition of outpatient under medical insurance, is someone who receives medical
care at a hospital or other medical facility but is generally admitted for less than _____
hours. - ANSWER 23
The 2 major types of health plans are ______. - ANSWER managed care and indemnity
