HCA 320 CCU Health Insurance and Managed Healthcare in The United States MCQs

HCA320 Rev. 09/2019Unit Exam 1
Exam ID: 97f92521-850c-40dc-b4fc-c035c7c9270f
1. A broad form of risk bearing occurs when the ______.
a. government bears the risk
b. payer bears the risk
c. employer bears the risk
d. all of the above
2. Identify which of the following comes the closest to describing a “rental PPO,” also called a “leased
a. a PPO that rents space in physicians’ offices for use by the PPO’s own physicians
b. a provider network that rents a PPO license
c. a provider network that contracts with various payers to provide access and claims repricing
d. a PPO that rents the product name and logo from a larger and better known payer so it can
compete in the market
3. Guaranteed issue means ______.
a. health plans cannot deny coverage or vary premiums based on preexisting conditions or health
b. people with preexisting conditions or health status receive priority service ahead of other patients
c. health plans generally cannot deny coverage or vary premiums based on preexisting conditions or
health status with some exceptions
d. all of the above
4. The origin of health insurance and managed healthcare in the United States was through _____ not
through insurance.
a. government subsidies
b. financing
c. loans
d. none of the above
5. Under the ACA, guaranteed issue results in ______.
a. higher premium costs
b. lower premium costs
c. premium costs remaining unchanged
d. none of the above
6. The 1972 Social Security Amendments authorized professional standards review organizations
(PSROs) to review the appropriateness of care provided to Medicare and Medicaid beneficiaries.
Today such organizations are known as ______.
a. quality review organizations (QIOs)
b. professional review organizations (PROs)
c. quality peer review organizations (QPROs)
d. peer assessment organizations (PAOs)
7. Under the ACA, the individual mandate refers to ______.
a. those who can afford health insurance but choose not to buy it may pay a fee
b. those with low income or other hardships who must still buy health insurance or pay a fee
c. the responsibility of the individual to make sure their employer provides them with health
d. none of the above
8. The central point of health insurance is that the risk for medical expenses belongs to ______.
a. the payer
b. the provider
c. the beneficiary
d. none of the above
9. Which of the following is a type of a member-owned plan?
a. mutual insurers
b. cooperatives (co-ops)
c. consumer-owned-and-operated plans (CO-OPs)
d. all of the above
10. The Medicare Modernization Act (MMA) ______.
a. changed the name of the Medicare managed care program from Medicare+Choice to Medicare
Advantage (MA)
b. promoted new forms of managed care such as private fee-for-service (PFFS) plans
c. created the first major benefit expansion in Medicare since the passage of the initial legislation in
d. all of the above
11. Among other provisions, the Health Insurance Portability and Accountability Act (HIPAA) limits the
ability of health plans to ______.
a. deny insurance based on health status to individuals who were previously insured for 18 months
or more
b. exclude coverage of preexisting conditions
c. switch patients from one plan to another without warning
d. both a and b
12. The expression of moral hazard is seen in four interrelated ways in most types of insurance. Which
one of the following is NOT one of those ways?
a. asymmetric knowledge
b. induced demand
c. the agent-principle problem
d. the pooling of equal risks
13. Congress passed the HMO Act in ______.
a. 1971
b. 1972
c. 1973
d. 1974
14. Self-funded health insurance is mostly used by large businesses because ______.
a. a risk pool must be made up of healthy people to be able to predict costs
b. a risk pool must be large enough to be able to predict costs
c. both a and b
d. none of the above
15. FFS stands for ______.
a. fee-for-service
b. fair-fee-standards
c. fee-for-sales
d. free-fee-schedules
16. The “managed care backlash” resulted in ______.
a. a reduction in HMO membership
b. new federal and state laws and regulations
c. improvements in quality of care
d. a & b only
17. Commonly recognized types of HMOs include all but ______.
a. IPAs
b. direct-contract plans
c. PHOs
d. staff and group
18. The HMO Act included:
a. a feature that made federal grants and loan guarantees available for planning, starting, and/or
expanding HMOs
b. a feature that preempted state laws that restricted the development of HMOs
c. a feature called the “dual choice” provision which required employers with 25 or more employees
that offered indemnity coverage to also offer at least one group or staff model and one IPA-model
federally qualified HMO, but only if the HMOs formally requested to be offered
d. all of the above
19. In most cases, for individual health insurance, individuals pay their premiums with ______.
a. before-tax dollars
b. after-tax dollars
c. rebates
d. none of the above
20. Under ERISA, self-funded benefits plans are ______.
a. regulated by state laws and regulations but not federal law
b. exempt from state laws and regulations
c. exempt from state laws and regulations only if they pay additional taxes
d. none of the above
21. A risk pool is ______.
a. a fund set up to cover health insurance costs
b. a lottery that determines who will receive health insurance
c. a group of people covered by health insurance
d. none of the above
22. The term health maintenance organization (HMO) was coined in the ______.
a. 1950s
b. 1960s
c. 1970s
d. 1960s
23. Technically speaking, a service plan is not insurance, but rather a form of ______.
a. government subsidized healthcare
b. prepaid healthcare
c. pay on demand healthcare
d. none of the above
24. In health benefits plans, defined benefits refer to ______.
a. the type of medical good or service and what it costs to provide coverage for that benefit
b. what type of medical goods and services are covered, and under which circumstances coverage
applies, regardless of what it costs to provide coverage for that benefit
c. the type of medical goods or services not covered by a plan
d. none of the above
25. In the U.S. marketplace, the share accounted for by traditional insurance has now shrunk to less
than ______ of the total market for healthcare coverage.
a. 1%
b. 2%
c. 3%
d. 4%

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