Which is created when a number of people are grouped for insurance purposes and the cost of health care coverage is determined by employees' health status, age, sex, and occupation?
a. cafeteria plan
b. managed care
c. risk pool
d. self-referral
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Q. 2) Triple option plans are intended to prevent the problem of covering members who are sicker than the general population, which is called __________ selection.
a. adverse
b. indeterminate
c. risk
d. pool
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Q. 3) A triple option plan is also called a __________ or flexible benefit plan because of the different benefit plans and extra coverage options provided through the insurer or third-party administrator.
a. cafeteria plan
b. optional contract
c. rider
d. underwriter
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Q. 4) Which is usually offered either by a single insurance plan or as a joint venture among two or more insurance payers and provides subscribers or employees with a choice of HMO, PPO, or traditional health insurance plans?
a. independent practice association
b. point-of-service plan
c. preferred provider organization
d. triple option plan
(
Q. 5) A managed care network of physicians and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee is called a(n) __________.
a. independent practice association
b. point-of-service plan
c. preferred provider organization
d. triple option plan
(
Q. 6) To create flexibility in managed care plans, some HMOs and preferred provider organizations have implemented a(n) __________, under which patients have freedom to use the managed care panel of providers or to self-refer to out-of-network providers.
a. independent practice association
b. point-of-service plan
c. preferred provider organization
d. triple option plan
(
Q. 7) Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings?
a. independent practice association
b. point-of-service plan
c. preferred provider organization
d. triple-option plan
(
Q. 8) Which is associated with contracted health care services that are provided to subscribers by two or more physician multispecialty group practices?
a. direct contract model HMO
b. group model HMO
c. network model HMO
d. staff model HMO
(
Q. 9) Which is associated with contracted health care services that are delivered to subscribers by individual physicians in the community?
a. direct contract model HMO
b. group model HMO
c. network model HMO
d. staff model HMO
(
Q. 10) Health care services provided to subscribers by physicians employed by the HMO are associated with a __________. Premiums and other revenue are paid to the HMO, and usually all ambulatory services are provided within HMO corporate buildings.
a. direct contract model HMO
b. group model HMO
c. network model HMO
d. staff model HMO
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