Chapter 12: Health Insurance Essentials
Niedzwiecki: Kinn’s The Clinical Medical Assistant, 14th Edition
MULTIPLE CHOICE
1. The amount of money paid to keep an insurance policy in force is the:
a. premium.
b. deductible.
c. copayment.
d. co-insurance.
ANS: A
A premium is the periodic (monthly, quarterly, or annual) payment of a specific sum of
money to an insurance company, for which the insurer in return agrees to provide certain
benefits.
REF: p. 244 OBJ: 1 TOP: Insurance: Terminology
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
2. Health insurance designed for military dependents and retired military personnel is called:
a. CHAMPVA.
b. TRICARE.
c. Medicare.
d. Medicaid.
ANS: B
TRICARE is the military’s comprehensive healthcare program for family members of
active duty personnel, military retirees and their eligible family members under age 65,
and survivors of all uniformed services.
REF: p. 247 OBJ: 2. List and discuss various government health insurance plans.
TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
3. Veterans of the U.S. armed forces may be covered by:
a. CHAMPVA.
b. TRICARE.
c. workers’ compensation.
d. Blue Cross/Blue Shield.
ANS: A
CHAMPVA, which is similar to TRICARE, is a health benefits program for the spouses
and dependent children of veterans suffering total, permanent, service-connected
disabilities and for surviving spouses and dependent children of veterans who died as a
result of service-related disabilities.
REF: p. 247 OBJ: 2. List and discuss various government health insurance plans.
TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
4. Organizations that fund their own insurance programs offer their employees:
, a. group coverage.
b. individual coverage.
c. government plans.
d. self-funded plans.
ANS: D
When companies or organizations have an employee base large enough to allow them to
fund their own insurance program, it is called a self-funded plan.
REF: p. 247 OBJ: 3 TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
5. The federal- and state-sponsored health insurance program for the medically indigent is
called:
a. Medicare.
b. Medicaid.
c. Medigap.
d. MediCal.
ANS: B
Medicaid is a federal- and state-sponsored health insurance program for the medically
indigent.
REF: p. 246 OBJ: 2 TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
6. The amount of money the policyholder pays per claim before the insurance company will
pay on the claim is known as the:
a. exclusion.
b. premium.
c. deductible.
d. remittance.
ANS: C
A deductible is a specific amount of money a patient must pay out of pocket before the
insurance carrier begins paying. The deductible amount is met on a yearly or per-incident
basis.
REF: p. 244 OBJ: 1 TOP: Insurance: Terminology
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
7. Which of the following is not an advantage of managed care?
a. Healthcare costs are usually contained.
b. Access to specialized care and referrals is limited.
c. Most preventive medical treatment is covered.
d. Out-of-pocket expenses tend to be less than traditional insurance.
ANS: B
Limitations on referrals and on access to specialized care are disadvantages of managed
care.
REF: p. 249 OBJ: 5 TOP: Insurance: Insurance Models/Managed Care
, MSC: CAAHEP: VIII.C.2 | ABHES: 8.c
8. Which of the following is not a disadvantage of managed care?
a. Authorized services usually are covered.
b. Providers’ choices in the treatment of patients can be limited.
c. More paperwork may be necessary.
d. Reimbursement is historically less than with traditional health insurance.
ANS: A
Coverage of authorized services is an advantage of managed care.
REF: p. 249 OBJ: 5 TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.2 | ABHES: 8.c
9. Which part of Medicare covers prescription drug services?
a. A
b. B
c. C
d. D
ANS: D
Part D offers Medicare recipients the option of choosing, at a reduced cost, a plan that
pays for prescription drugs with just a small copayment from the patient.
REF: p. 245 OBJ: 2. List and discuss various government health insurance plans.
TOP: Insurance: Medicare/Medicaid MSC: CAAHEP: VIII.C.3.a | ABHES: 8.c
10. Which type of referral is usually processed immediately?
a. Regular
b. Urgent
c. STAT
d. All are correct
ANS: C
A STAT referral can be approved by telephone immediately after it is faxed to the
utilization review department. A STAT referral is used in an emergency situation as
indicated by the provider.
REF: p. 251 OBJ: 6 TOP: Insurance: Preauthorization/Referrals
MSC: CAAHEP: VIII.C.2 | ABHES: 8.c
11. If Mr. Jones’s insurance has a $500 deductible and then pays 80% of the charges, how
much will his policy pay on his bill of $4,359?
a. $3027.20
b. $3087.20
c. $3447.20
d. $3487.20
ANS: B
$4359 – $500= $3859 $3,859 0.8 = $3,087.20.
REF: p. 244 OBJ: 1 TOP: Insurance: Determine Benefit Information
Niedzwiecki: Kinn’s The Clinical Medical Assistant, 14th Edition
MULTIPLE CHOICE
1. The amount of money paid to keep an insurance policy in force is the:
a. premium.
b. deductible.
c. copayment.
d. co-insurance.
ANS: A
A premium is the periodic (monthly, quarterly, or annual) payment of a specific sum of
money to an insurance company, for which the insurer in return agrees to provide certain
benefits.
REF: p. 244 OBJ: 1 TOP: Insurance: Terminology
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
2. Health insurance designed for military dependents and retired military personnel is called:
a. CHAMPVA.
b. TRICARE.
c. Medicare.
d. Medicaid.
ANS: B
TRICARE is the military’s comprehensive healthcare program for family members of
active duty personnel, military retirees and their eligible family members under age 65,
and survivors of all uniformed services.
REF: p. 247 OBJ: 2. List and discuss various government health insurance plans.
TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
3. Veterans of the U.S. armed forces may be covered by:
a. CHAMPVA.
b. TRICARE.
c. workers’ compensation.
d. Blue Cross/Blue Shield.
ANS: A
CHAMPVA, which is similar to TRICARE, is a health benefits program for the spouses
and dependent children of veterans suffering total, permanent, service-connected
disabilities and for surviving spouses and dependent children of veterans who died as a
result of service-related disabilities.
REF: p. 247 OBJ: 2. List and discuss various government health insurance plans.
TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
4. Organizations that fund their own insurance programs offer their employees:
, a. group coverage.
b. individual coverage.
c. government plans.
d. self-funded plans.
ANS: D
When companies or organizations have an employee base large enough to allow them to
fund their own insurance program, it is called a self-funded plan.
REF: p. 247 OBJ: 3 TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
5. The federal- and state-sponsored health insurance program for the medically indigent is
called:
a. Medicare.
b. Medicaid.
c. Medigap.
d. MediCal.
ANS: B
Medicaid is a federal- and state-sponsored health insurance program for the medically
indigent.
REF: p. 246 OBJ: 2 TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
6. The amount of money the policyholder pays per claim before the insurance company will
pay on the claim is known as the:
a. exclusion.
b. premium.
c. deductible.
d. remittance.
ANS: C
A deductible is a specific amount of money a patient must pay out of pocket before the
insurance carrier begins paying. The deductible amount is met on a yearly or per-incident
basis.
REF: p. 244 OBJ: 1 TOP: Insurance: Terminology
MSC: CAAHEP: VIII.C.1.a | ABHES: 8.c
7. Which of the following is not an advantage of managed care?
a. Healthcare costs are usually contained.
b. Access to specialized care and referrals is limited.
c. Most preventive medical treatment is covered.
d. Out-of-pocket expenses tend to be less than traditional insurance.
ANS: B
Limitations on referrals and on access to specialized care are disadvantages of managed
care.
REF: p. 249 OBJ: 5 TOP: Insurance: Insurance Models/Managed Care
, MSC: CAAHEP: VIII.C.2 | ABHES: 8.c
8. Which of the following is not a disadvantage of managed care?
a. Authorized services usually are covered.
b. Providers’ choices in the treatment of patients can be limited.
c. More paperwork may be necessary.
d. Reimbursement is historically less than with traditional health insurance.
ANS: A
Coverage of authorized services is an advantage of managed care.
REF: p. 249 OBJ: 5 TOP: Insurance: Insurance Models/Managed Care
MSC: CAAHEP: VIII.C.2 | ABHES: 8.c
9. Which part of Medicare covers prescription drug services?
a. A
b. B
c. C
d. D
ANS: D
Part D offers Medicare recipients the option of choosing, at a reduced cost, a plan that
pays for prescription drugs with just a small copayment from the patient.
REF: p. 245 OBJ: 2. List and discuss various government health insurance plans.
TOP: Insurance: Medicare/Medicaid MSC: CAAHEP: VIII.C.3.a | ABHES: 8.c
10. Which type of referral is usually processed immediately?
a. Regular
b. Urgent
c. STAT
d. All are correct
ANS: C
A STAT referral can be approved by telephone immediately after it is faxed to the
utilization review department. A STAT referral is used in an emergency situation as
indicated by the provider.
REF: p. 251 OBJ: 6 TOP: Insurance: Preauthorization/Referrals
MSC: CAAHEP: VIII.C.2 | ABHES: 8.c
11. If Mr. Jones’s insurance has a $500 deductible and then pays 80% of the charges, how
much will his policy pay on his bill of $4,359?
a. $3027.20
b. $3087.20
c. $3447.20
d. $3487.20
ANS: B
$4359 – $500= $3859 $3,859 0.8 = $3,087.20.
REF: p. 244 OBJ: 1 TOP: Insurance: Determine Benefit Information
