Exam Fx - Medical Plans – Questions With Complete Solutions

Regarding a PPO, which of the following is correct when selecting a primary care physician? A The insured may choose medical providers not found on the preferred list and still retain coverage. B The insured is allowed to receive care from any provider, but if the insured selects a PPO provider, the insured will realize lower out-of-pocket costs. C If a non-network provider is used, the insured's out-of-pocket costs will be higher. D All of the above are correct correct answer: All of the above are correct Which of the following are responsible for making premium payments in an HMO plan? A Payors B Subscribers C Producers D Insureds correct answer: Subscribers An insured is admitted to the hospital for surgery on a herniated disk. The insurance company monitors the treatment and progress in order to make sure that everything proceeds according to the insurer's schedule. This is called A Prospective review. B Comprehensive review. C Schedule of benefits. D Concurrent review correct answer: Concurrent Review Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage? A Basic medical expense plan B Health Maintenance Organization plan C Group dental insurance plan D Medical-surgical expense plan correct answer: Health Maintenance Organization plan Which of the following would be a typical maximum benefit offered by major medical plans? A $10 million B $50,000 C $500,000 D $1 Million correct answer: $1 Million When health care insurers negotiate contracts with health care providers or physicians to provide health care services for