LOMA 280 CHAPTER 13 EXAM
QUESTIONS WITH ALL CORRECT
ANSWERS
health maintenance organization (HMO) - Answer-A health care financing and deliv-ery
system that provides comprehensive health care services to plan members, often
referred to as subscribers, in a particular geographic area
hospital expenses - Answer-Medical expenses that include charges for specific inpatient
and outpatient hospital services, such as room and board, medications, labora-tory
services, and other fees associated with a hospital stay
indemnity benefits - Answer-Contractual benefits that are provided under insurance poli-
cies based on the actual amount of the insured's financial loss
indemnity method - Answer-A method of determining the amount of benefit payable
under a long-term care insurance policy under which the insurer pays the insured the
daily benefit amount regardless of the actual expenses for long-term care of the insured.
inflation protection provision - Answer-A long-term care insurance policy provision that
either automatically increases the benefit amount each year by a specified per-centage
or allows the insured to opt for a higher daily benefit amount at speci-fied intervals
during the lifetime of the policy without having to show evidence of insurability.
key person disability coverage - Answer-Disability income coveragee that provides ben-
efit payments to a business if an insured key person becomes disabled
long-term care (LTC) coverage - Answer-Health insurance that provides benefits for
med-ical and other services to insureds who need care for an extended period in their
own homes or in a qualified facility.
long-term group disability income coverage - Answer-Group disability income coverage
that provides a minimum benefit period of one year
long-term individual disability income coverage - Answer-Individual disability income
coverage that provides a minimu benefit period of five years or more
major medical expense coverage - Answer-Medical expense insurance coverage that
provides substantial benefits for (1) basic hospital, surgical, and physicians' expenses,
(2) additional medical services related to illness or injuries, and (3) preventive care.
, managed care - Answer-A method of integrating the financing and delivery of health
care services within a system that manages the access to health care services and the
cost of those services.
managed care plan - Answer-An arrangement that integrates the financing and
manage-ment of health care with the delivery of health care services to a group of indi-
viduals who have enrolled in the plan.
maximum out-of-pocket provision - Answer-A major medical expense insurance policy
provision which states that the policy will cover 100 percent of allowable med-ical
expenses after the insured has paid a specified amount out-of-pocket to satisfy
deductible and coinsurance requirements
Medicaid - Answer-In the United States, a joint federal and state program that provides
basic medical expense and nursing home coverage to low-income individuals and to
certain aged and disabled individuals.
medical expense coverage - Answer-A type of health nsurance coverage that provides
ben-efits to pay for the treatment of an insured's illnesses and injuries.
Medicare - Answer-In the United States, a federal government program that provides
med-ical expense benefits to persons age 65 and older and persons with certain dis-
abilities.
network - Answer-A group of physicians, hospitals, and ancillary services providers that
a specific managed care plan has contracted with to deliver health care services to plan
members
partial disability - Answer-A disability that prevents the insured either from performing
some of the duties of his usual occupation or from engaging in that occupation on a full-
time basis.
physicians' expenses - Answer-Medical expenses that include charges associated with
phy-sicians' visits both in and out of the hospital
point-of-service (POS) plan - Answer-A managed care plan that combines features of
HMOs and PPOs; plan members who need medical care choose, at the point of service,
whether to seek care in-network or out-of-network
preferred provider organization (PPO) - Answer-A health care benefit arrangement that
provides incentives for plan members to use network providers, but also pro-vides at
least some coverage for services rendered by non-network providers.
prescription drug coverage - Answer-Medical expense insurance coverage that provides
benefits for the purchase of drugs and medicines that are prescribed by a physi-cian
and are not available over-the-counter
QUESTIONS WITH ALL CORRECT
ANSWERS
health maintenance organization (HMO) - Answer-A health care financing and deliv-ery
system that provides comprehensive health care services to plan members, often
referred to as subscribers, in a particular geographic area
hospital expenses - Answer-Medical expenses that include charges for specific inpatient
and outpatient hospital services, such as room and board, medications, labora-tory
services, and other fees associated with a hospital stay
indemnity benefits - Answer-Contractual benefits that are provided under insurance poli-
cies based on the actual amount of the insured's financial loss
indemnity method - Answer-A method of determining the amount of benefit payable
under a long-term care insurance policy under which the insurer pays the insured the
daily benefit amount regardless of the actual expenses for long-term care of the insured.
inflation protection provision - Answer-A long-term care insurance policy provision that
either automatically increases the benefit amount each year by a specified per-centage
or allows the insured to opt for a higher daily benefit amount at speci-fied intervals
during the lifetime of the policy without having to show evidence of insurability.
key person disability coverage - Answer-Disability income coveragee that provides ben-
efit payments to a business if an insured key person becomes disabled
long-term care (LTC) coverage - Answer-Health insurance that provides benefits for
med-ical and other services to insureds who need care for an extended period in their
own homes or in a qualified facility.
long-term group disability income coverage - Answer-Group disability income coverage
that provides a minimum benefit period of one year
long-term individual disability income coverage - Answer-Individual disability income
coverage that provides a minimu benefit period of five years or more
major medical expense coverage - Answer-Medical expense insurance coverage that
provides substantial benefits for (1) basic hospital, surgical, and physicians' expenses,
(2) additional medical services related to illness or injuries, and (3) preventive care.
, managed care - Answer-A method of integrating the financing and delivery of health
care services within a system that manages the access to health care services and the
cost of those services.
managed care plan - Answer-An arrangement that integrates the financing and
manage-ment of health care with the delivery of health care services to a group of indi-
viduals who have enrolled in the plan.
maximum out-of-pocket provision - Answer-A major medical expense insurance policy
provision which states that the policy will cover 100 percent of allowable med-ical
expenses after the insured has paid a specified amount out-of-pocket to satisfy
deductible and coinsurance requirements
Medicaid - Answer-In the United States, a joint federal and state program that provides
basic medical expense and nursing home coverage to low-income individuals and to
certain aged and disabled individuals.
medical expense coverage - Answer-A type of health nsurance coverage that provides
ben-efits to pay for the treatment of an insured's illnesses and injuries.
Medicare - Answer-In the United States, a federal government program that provides
med-ical expense benefits to persons age 65 and older and persons with certain dis-
abilities.
network - Answer-A group of physicians, hospitals, and ancillary services providers that
a specific managed care plan has contracted with to deliver health care services to plan
members
partial disability - Answer-A disability that prevents the insured either from performing
some of the duties of his usual occupation or from engaging in that occupation on a full-
time basis.
physicians' expenses - Answer-Medical expenses that include charges associated with
phy-sicians' visits both in and out of the hospital
point-of-service (POS) plan - Answer-A managed care plan that combines features of
HMOs and PPOs; plan members who need medical care choose, at the point of service,
whether to seek care in-network or out-of-network
preferred provider organization (PPO) - Answer-A health care benefit arrangement that
provides incentives for plan members to use network providers, but also pro-vides at
least some coverage for services rendered by non-network providers.
prescription drug coverage - Answer-Medical expense insurance coverage that provides
benefits for the purchase of drugs and medicines that are prescribed by a physi-cian
and are not available over-the-counter
