RMI 3011 EXAM 3 FSU | Florida State University |
UPDATED Questions with 100% Verified Answers
Q1: Medical Expense Insurance
A: Protects an individual or family for covered medical expenses because of illness or injury
Q2: Out-of-Pocket Maximum Limits
A: 100% of the covered medical expenses in excess of the deductible are paid after the
insured pays a certain amount out-of-pocket
(Health Insurance)
Q3: Coinsurance
A: Percentage of the bill in excess of the deductible, which the insured must pay out-of
pocket up to some maximum annual dollar limit.
Counts towards deductible and out-of-pocket maximum.
(Health Insurance)
Q4: What is the purpose of Coinsurance Provision in health?
A: Prevents Over-Utilization of Policy Benefits
Q5: Copayment
A: A flat amount that the insured must pay for certain benefits at each visit or type of visit
Does not count towards deductible but does count toward out of pocket maximum
(Health insurance)
Q6: Individual Market
A: Health insurance is purchased through state healthcare exchange
Q7: Group Market
A: Health insurance is purchased through employer
Q8: Social Insurance
A: Health insurance is sponsored by government
Q9: Individual Medical Expense Insurance Plan
A: Protects an individual or family for covered medical expenses because of sickness and
injury
No Lifetime Limits or Annual Limits
Comprehensive plans
Available through healthcare exchanges
, Q10: Social Security Amendments of 1965
A: Created Medicare and Medicaid
Q11: Federal Insurance Contributions Act (FICA) Tax
A: Funds Medicare
Financed by payroll tax paid by
Employees and employers
7.65% your wages (6.2% to Social Security and 1.45% to Medicare)
Individuals over age 65
Q12: Managed Care Plans
A: Medical expense insurance plans that provide covered services to members in a cost
effective manner
Q13: Types of Managed Care Plans
A: 1. HMO
2. PPO
3. POS
Q14: Health Maintenance Organization (HMO)
A: Organized system of health care that provides comprehensive medical services to its
members on a prepaid basis
Limited choice of providers; must be "in-network"
Payment of fixed premiums
Cost-sharing includes annual deductibles and copayments
Gatekeeper physician
Prior approval to see specialists
Q15: Preferred Provider Organization (PPO)
A: Plan that contracts with health care providers to provide medical services to plan
members at discounted fees
"In-network" vs. "Out-of-network"
No prior approval to see specialists
Financial incentive to use "in-network" providers (through reduced deductibles and
copayments)
No gatekeeper
Q16: Point-of-Service Plans (POS)
A: Combines characteristics of HMO and PPO with freedom of choice
gatekeeper
Option to go out-of-network at substantially higher deductibles and coinsurance
charges
No prior approval to see specialists.
UPDATED Questions with 100% Verified Answers
Q1: Medical Expense Insurance
A: Protects an individual or family for covered medical expenses because of illness or injury
Q2: Out-of-Pocket Maximum Limits
A: 100% of the covered medical expenses in excess of the deductible are paid after the
insured pays a certain amount out-of-pocket
(Health Insurance)
Q3: Coinsurance
A: Percentage of the bill in excess of the deductible, which the insured must pay out-of
pocket up to some maximum annual dollar limit.
Counts towards deductible and out-of-pocket maximum.
(Health Insurance)
Q4: What is the purpose of Coinsurance Provision in health?
A: Prevents Over-Utilization of Policy Benefits
Q5: Copayment
A: A flat amount that the insured must pay for certain benefits at each visit or type of visit
Does not count towards deductible but does count toward out of pocket maximum
(Health insurance)
Q6: Individual Market
A: Health insurance is purchased through state healthcare exchange
Q7: Group Market
A: Health insurance is purchased through employer
Q8: Social Insurance
A: Health insurance is sponsored by government
Q9: Individual Medical Expense Insurance Plan
A: Protects an individual or family for covered medical expenses because of sickness and
injury
No Lifetime Limits or Annual Limits
Comprehensive plans
Available through healthcare exchanges
, Q10: Social Security Amendments of 1965
A: Created Medicare and Medicaid
Q11: Federal Insurance Contributions Act (FICA) Tax
A: Funds Medicare
Financed by payroll tax paid by
Employees and employers
7.65% your wages (6.2% to Social Security and 1.45% to Medicare)
Individuals over age 65
Q12: Managed Care Plans
A: Medical expense insurance plans that provide covered services to members in a cost
effective manner
Q13: Types of Managed Care Plans
A: 1. HMO
2. PPO
3. POS
Q14: Health Maintenance Organization (HMO)
A: Organized system of health care that provides comprehensive medical services to its
members on a prepaid basis
Limited choice of providers; must be "in-network"
Payment of fixed premiums
Cost-sharing includes annual deductibles and copayments
Gatekeeper physician
Prior approval to see specialists
Q15: Preferred Provider Organization (PPO)
A: Plan that contracts with health care providers to provide medical services to plan
members at discounted fees
"In-network" vs. "Out-of-network"
No prior approval to see specialists
Financial incentive to use "in-network" providers (through reduced deductibles and
copayments)
No gatekeeper
Q16: Point-of-Service Plans (POS)
A: Combines characteristics of HMO and PPO with freedom of choice
gatekeeper
Option to go out-of-network at substantially higher deductibles and coinsurance
charges
No prior approval to see specialists.
