Exam (elaborations) Accident and Health Insurance, Laws and Rules Pertinent to Insurance Exam Questions with Latest Update Exam (elaborations) Health Policy Units 2-5 2024 Exam Questions with Correct Answers Exam (elaborations) Chapter 14 The Health Care System of the United States Exam Questi...
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Do people in the US utilize health services more? - ANSWER-NO Do we pay more for those services? - ANSWER-Yes What males prices so high? - ANSWER-- Do we have more speciality physicians? No -Physicians Salaries? Kind of - Administrative costs? Kind of what is Insurance? - ANSWER-- The po...
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Add to cartDo people in the US utilize health services more? - ANSWER-NO Do we pay more for those services? - ANSWER-Yes What males prices so high? - ANSWER-- Do we have more speciality physicians? No -Physicians Salaries? Kind of - Administrative costs? Kind of what is Insurance? - ANSWER-- The po...
Violations of US Code Title 18 section 1033, may result in - ANSWER-Fine and/or imprisonment Charles is a producer who is licensed in Washington but resides in Oregon. Charles is considered to be a(n) - ANSWER-Nonresident producer Before a producer may sell, solicit, or negotiate insurance fro...
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Add to cartViolations of US Code Title 18 section 1033, may result in - ANSWER-Fine and/or imprisonment Charles is a producer who is licensed in Washington but resides in Oregon. Charles is considered to be a(n) - ANSWER-Nonresident producer Before a producer may sell, solicit, or negotiate insurance fro...
Which of the following role(s) does Medicaid contribute in our health care system? A Health insurance coverage. B Assistance to Medicare beneficiaries and state capacity for health coverage. C Long-term care assistance. D Support for health care system and safety-net. E All of the ab...
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Add to cartWhich of the following role(s) does Medicaid contribute in our health care system? A Health insurance coverage. B Assistance to Medicare beneficiaries and state capacity for health coverage. C Long-term care assistance. D Support for health care system and safety-net. E All of the ab...
How many Americans are uninsured? - ANSWER-50.7 million, or 16.7% List 5 characteristics that differentiate the US Healthcare system from others. - ANSWER-No central agency governs a system Access is selective and based on insurance Health care offered under imperfect market activity Third par...
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Add to cartHow many Americans are uninsured? - ANSWER-50.7 million, or 16.7% List 5 characteristics that differentiate the US Healthcare system from others. - ANSWER-No central agency governs a system Access is selective and based on insurance Health care offered under imperfect market activity Third par...
How many Americans are uninsured? - ANSWER-50.7 million, or 16.7% List 5 characteristics that differentiate the US Healthcare system from others - ANSWER-Choose 5 from the 10 : No central agency governs a system, access is selective and based on insurance, health care offered under imperfect mark...
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Add to cartHow many Americans are uninsured? - ANSWER-50.7 million, or 16.7% List 5 characteristics that differentiate the US Healthcare system from others - ANSWER-Choose 5 from the 10 : No central agency governs a system, access is selective and based on insurance, health care offered under imperfect mark...
Access to care as a first step to reduce health disparity: - ANSWER-health care as a private consumer good in America Before the 1940's: - ANSWER-- few people had private health insurance -Blue Cross and Blue Shield developed offering public health insurance -during WWII: price and wage cont...
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Add to cartAccess to care as a first step to reduce health disparity: - ANSWER-health care as a private consumer good in America Before the 1940's: - ANSWER-- few people had private health insurance -Blue Cross and Blue Shield developed offering public health insurance -during WWII: price and wage cont...
Medicare - ANSWER-Elderly, disabled Medicaid - ANSWER-Unemployed and uninsured, poor women with children SCHIP - ANSWER-State's Children Health Insurance Program, children in poverty Veterans Administration - ANSWER-War veterans TRICARE - ANSWER-For the active military personnel and ret...
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Add to cartMedicare - ANSWER-Elderly, disabled Medicaid - ANSWER-Unemployed and uninsured, poor women with children SCHIP - ANSWER-State's Children Health Insurance Program, children in poverty Veterans Administration - ANSWER-War veterans TRICARE - ANSWER-For the active military personnel and ret...
A patient gets a hip replacement but needs a few weeks of specialized rehabilitation care outside of a hospital before going home. What is this called? - ANSWER-Post-acute care Most people who lack health insurance are unemployed. - ANSWER-False A health insurance company wants its patients to...
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Add to cartA patient gets a hip replacement but needs a few weeks of specialized rehabilitation care outside of a hospital before going home. What is this called? - ANSWER-Post-acute care Most people who lack health insurance are unemployed. - ANSWER-False A health insurance company wants its patients to...
Which is the last step of a cost-benefit analysis? - ANSWER-See if the benefits outweigh the costs. People come to different decisions using cost-benefit analysis even under the same conditions because costs and benefits are both what? - ANSWER-Subjective What is one of the monetary benefits o...
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Add to cartWhich is the last step of a cost-benefit analysis? - ANSWER-See if the benefits outweigh the costs. People come to different decisions using cost-benefit analysis even under the same conditions because costs and benefits are both what? - ANSWER-Subjective What is one of the monetary benefits o...
The Patient Protection and Affordable Care Act (ACA) was signed into law in March of ____________. Also known as ________________________. - ANSWER-2010, Obamacare True or false: The Affordable Care Act is the most significant U.S. health care reform since 1965 when Medicare and Medicaid were cr...
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Add to cartThe Patient Protection and Affordable Care Act (ACA) was signed into law in March of ____________. Also known as ________________________. - ANSWER-2010, Obamacare True or false: The Affordable Care Act is the most significant U.S. health care reform since 1965 when Medicare and Medicaid were cr...
The primary reason why millions of Americans lack health insurance is - ANSWER-the cost of insurance is too high Most Americans who have health insurance - ANSWER-get it through employer-based programs The reasons health care costs in the U.S. are so high include - ANSWER-the cost of prescript...
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Add to cartThe primary reason why millions of Americans lack health insurance is - ANSWER-the cost of insurance is too high Most Americans who have health insurance - ANSWER-get it through employer-based programs The reasons health care costs in the U.S. are so high include - ANSWER-the cost of prescript...
Why was health insurance developed? - ANSWER-To provide financial protection to an employee in the event they required health care. Most insurance policies require a monetary contribution from the covered individual which is called a: - ANSWER-co-payment, deductible, and co-insurance. The Flex...
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Add to cartWhy was health insurance developed? - ANSWER-To provide financial protection to an employee in the event they required health care. Most insurance policies require a monetary contribution from the covered individual which is called a: - ANSWER-co-payment, deductible, and co-insurance. The Flex...
What are the 2 main categories of health insurance? - ANSWER-private insurance, public insurance Public insurance programs are ___programs - ANSWER-categorical programs Medicare criteria are set at a _____ level - ANSWER-federal level Public insurance services are provided mostly through wh...
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Add to cartWhat are the 2 main categories of health insurance? - ANSWER-private insurance, public insurance Public insurance programs are ___programs - ANSWER-categorical programs Medicare criteria are set at a _____ level - ANSWER-federal level Public insurance services are provided mostly through wh...
Two general categories of health insurance in the United States: - ANSWER-Private Government/Public Health Insurance Three types of Private Insurance: - ANSWER-Indemnity or Traditional Fee-or-Service Insurance Managed-Care Insurance Consumer-directed Health Plans Indemnity or Traditio...
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Add to cartTwo general categories of health insurance in the United States: - ANSWER-Private Government/Public Health Insurance Three types of Private Insurance: - ANSWER-Indemnity or Traditional Fee-or-Service Insurance Managed-Care Insurance Consumer-directed Health Plans Indemnity or Traditio...
1868-Paul v. Virginia - ANSWER-This case, which the U.S. Supreme Court decided, involved one state's attempt to regulate an insurance company domiciled in another state. The Supreme Court sided against the insurance company, ruling that the sale and issuance of insurance is not interstate commerce,...
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Add to cart1868-Paul v. Virginia - ANSWER-This case, which the U.S. Supreme Court decided, involved one state's attempt to regulate an insurance company domiciled in another state. The Supreme Court sided against the insurance company, ruling that the sale and issuance of insurance is not interstate commerce,...
An agent has committed an insurance crime that violates US Code 1033 (interstate commerce). Who would be responsible for the prosecution of this crime? - ANSWER-US attorney general An agent's appointment may only be terminated by the - ANSWER-insurer Long-term care insurance applications MUST...
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Add to cartAn agent has committed an insurance crime that violates US Code 1033 (interstate commerce). Who would be responsible for the prosecution of this crime? - ANSWER-US attorney general An agent's appointment may only be terminated by the - ANSWER-insurer Long-term care insurance applications MUST...
The first health plans in the U.S. were designed to __ ___for loss of income when an accident or illness caused extended disability, rather than to ___ ___ for medical expenses because physicians' abilities to treat or cure illnesses were very limited before 1900. - ANSWER-compensate workers reimb...
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Add to cartThe first health plans in the U.S. were designed to __ ___for loss of income when an accident or illness caused extended disability, rather than to ___ ___ for medical expenses because physicians' abilities to treat or cure illnesses were very limited before 1900. - ANSWER-compensate workers reimb...
maximum benefits - ANSWER-upper limit of total lifetime benefits that the insurance company will pay Misrepresentation - ANSWER-falsifying terms, benefits, advantages, or conditions of insurance policy defamation - ANSWER-publishing information that is false and maliciously critical to an insu...
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Add to cartmaximum benefits - ANSWER-upper limit of total lifetime benefits that the insurance company will pay Misrepresentation - ANSWER-falsifying terms, benefits, advantages, or conditions of insurance policy defamation - ANSWER-publishing information that is false and maliciously critical to an insu...
In the National Health Insurance model, health care is provided by the private sector and financed by non-profit sickness funds (insurers) T/F - ANSWER-T W Compared to other nations, the U.S. uses a larger share of its economic resources for health care T/F - ANSWER-T The postindustrial...
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Add to cartIn the National Health Insurance model, health care is provided by the private sector and financed by non-profit sickness funds (insurers) T/F - ANSWER-T W Compared to other nations, the U.S. uses a larger share of its economic resources for health care T/F - ANSWER-T The postindustrial...
Provide a brief history of U.S. healthcare - ANSWER-Prior to WWII, most expenses were paid out-of-pocket by the consumer (including cash payments and bartering of goods/services). During WWII, the government imposed caps on wages paid to civilian workers due to civilian and military manpower shortag...
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Add to cartProvide a brief history of U.S. healthcare - ANSWER-Prior to WWII, most expenses were paid out-of-pocket by the consumer (including cash payments and bartering of goods/services). During WWII, the government imposed caps on wages paid to civilian workers due to civilian and military manpower shortag...
About half of US adults are insured through: - ANSWER-Their employers The health insurance program that covers Americans aged 65 and older is: - ANSWER-Medicare Medicare plans that are administered by private insurance companies are part of: - ANSWER-Medicare Advantage Doctor groups that co...
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Add to cartAbout half of US adults are insured through: - ANSWER-Their employers The health insurance program that covers Americans aged 65 and older is: - ANSWER-Medicare Medicare plans that are administered by private insurance companies are part of: - ANSWER-Medicare Advantage Doctor groups that co...
The "Progressive Era" - ANSWER-Around 1900 Changes in workers' compensation laws - ANSWER-— 32 states enacted WC insurance, saying that if employers purchased insurance, they could retain negligence defenses — Employers viewed as a way to increase payouts, but reduce overall (legal) costs...
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Add to cartThe "Progressive Era" - ANSWER-Around 1900 Changes in workers' compensation laws - ANSWER-— 32 states enacted WC insurance, saying that if employers purchased insurance, they could retain negligence defenses — Employers viewed as a way to increase payouts, but reduce overall (legal) costs...
Explain a "fee-for-service" arrangement between patient and doctor - ANSWER-money would go straight from patient to doctor Before the invention of health insurance plans, "mutual benefit" was a principle that many communities followed for health emergencies. Explain the notion of mutual benef...
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Add to cartExplain a "fee-for-service" arrangement between patient and doctor - ANSWER-money would go straight from patient to doctor Before the invention of health insurance plans, "mutual benefit" was a principle that many communities followed for health emergencies. Explain the notion of mutual benef...
Most Americans receive their insurance coverage through their employers. - ANSWER-True It is fair to say that the US health care system is massive, complex involving multiple players & payers and easily accessible - ANSWER-False The Quad function model is a type of health insurance program - A...
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Add to cartMost Americans receive their insurance coverage through their employers. - ANSWER-True It is fair to say that the US health care system is massive, complex involving multiple players & payers and easily accessible - ANSWER-False The Quad function model is a type of health insurance program - A...
Health care is a mix of 4 basic functional components: - ANSWER-financing, insurance, delivery, payment The gov finances public insurance through these 3 organizations - ANSWER-Medicare, Medicaid, CHIP An acceptable healthcare delivery system should have 2 primary objectives: - ANSWER-1. It mu...
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Add to cartHealth care is a mix of 4 basic functional components: - ANSWER-financing, insurance, delivery, payment The gov finances public insurance through these 3 organizations - ANSWER-Medicare, Medicaid, CHIP An acceptable healthcare delivery system should have 2 primary objectives: - ANSWER-1. It mu...
What are the 6 main functions of health insurance in the US? - ANSWER-1. financial protection for catastrophic health events*** access for small usage fees 3. negotiating health services 4. enhancing and ensuring the quality of clinicians and hospitals 5. nudging individuals toward staying hea...
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Add to cartWhat are the 6 main functions of health insurance in the US? - ANSWER-1. financial protection for catastrophic health events*** access for small usage fees 3. negotiating health services 4. enhancing and ensuring the quality of clinicians and hospitals 5. nudging individuals toward staying hea...
Insurance companies that are organized in countries outside the United States are referred to as? Alien. (An insurance company that is organized or chartered in a country other than the United States is defined as alien.) - ANSWER- A life insurance policyowner may sell their policy to a(n) ____...
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Add to cartInsurance companies that are organized in countries outside the United States are referred to as? Alien. (An insurance company that is organized or chartered in a country other than the United States is defined as alien.) - ANSWER- A life insurance policyowner may sell their policy to a(n) ____...
Which of the following criteria apply to Medicare eligibility? - ANSWER-Age 65 or older Which of the following healthcare programs is available for members of the uniformed services, their families, and survivors, and retired members and their families? - ANSWER-TRICARE Medicare Part _______ i...
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Add to cartWhich of the following criteria apply to Medicare eligibility? - ANSWER-Age 65 or older Which of the following healthcare programs is available for members of the uniformed services, their families, and survivors, and retired members and their families? - ANSWER-TRICARE Medicare Part _______ i...
Blue Cross/Blue Shield - ANSWER-designed to protect doctors and hospitals; fee-for service insurance In terms of BSBS, what is community rating? - ANSWER-each person charged based on average risk of entire community Health Maintenance Organizations (HMOs) - ANSWER-designed to provide affordabl...
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Add to cartBlue Cross/Blue Shield - ANSWER-designed to protect doctors and hospitals; fee-for service insurance In terms of BSBS, what is community rating? - ANSWER-each person charged based on average risk of entire community Health Maintenance Organizations (HMOs) - ANSWER-designed to provide affordabl...
An insurance company may NOT reject a prospective insured's life application on the basis of which of the following factors? - ANSWER-Gender ABC Insurance Company has accepted a life insurance application which contains unanswered questions. The company then makes the application part of the lif...
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Add to cartAn insurance company may NOT reject a prospective insured's life application on the basis of which of the following factors? - ANSWER-Gender ABC Insurance Company has accepted a life insurance application which contains unanswered questions. The company then makes the application part of the lif...
Paul vs. Virginia - ANSWER-1) Affirmed states rights to regulate insurance 2) VA agent Paul was trying to represent NY clients National Insurance Convention Goals - ANSWER-1) Establish regulatory goals 2) Uniform accounting statement 3) Guidelines for taxation 4) Draft model law Early Issu...
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Add to cartPaul vs. Virginia - ANSWER-1) Affirmed states rights to regulate insurance 2) VA agent Paul was trying to represent NY clients National Insurance Convention Goals - ANSWER-1) Establish regulatory goals 2) Uniform accounting statement 3) Guidelines for taxation 4) Draft model law Early Issu...
Security laws passed by Congress are enforced by which Federal agency? - ANSWER-Security and Exchange Commission If a life insurance applicant is shown future premiums are to be paid out of non-guaranteed values, the illustration used in the sales presentation MUST - ANSWER-disclose that premium ...
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Add to cartSecurity laws passed by Congress are enforced by which Federal agency? - ANSWER-Security and Exchange Commission If a life insurance applicant is shown future premiums are to be paid out of non-guaranteed values, the illustration used in the sales presentation MUST - ANSWER-disclose that premium ...
The ceding company - ANSWER-Which is an insurance company that transfers risk to another company called? No capital stock - ANSWER-What is a trademark of a mutual insurer? A statement that is guaranteed to be true. - ANSWER-What is a warranty? An invitation to make an offer. - ANSWER-What i...
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Add to cartThe ceding company - ANSWER-Which is an insurance company that transfers risk to another company called? No capital stock - ANSWER-What is a trademark of a mutual insurer? A statement that is guaranteed to be true. - ANSWER-What is a warranty? An invitation to make an offer. - ANSWER-What i...
US Population size - ANSWER-over 300 million US health care spending - ANSWER-$2.7 trillion What percent of GDP do we spend on healthcare - ANSWER-17% How much per person do we spend on Healthcare? - ANSWER-$8,000 US healthcare spending is how much more than every other country? - ANSWER...
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Add to cartUS Population size - ANSWER-over 300 million US health care spending - ANSWER-$2.7 trillion What percent of GDP do we spend on healthcare - ANSWER-17% How much per person do we spend on Healthcare? - ANSWER-$8,000 US healthcare spending is how much more than every other country? - ANSWER...
T/F: Will the ACA change the private/public systems of paying for health care - ANSWER--True What is the predominate source of health insurance to working Americans - ANSWER--Employer-based health insurance What is the evolution of health care payment sources - ANSWER--evolved from out-of-pock...
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Add to cartT/F: Will the ACA change the private/public systems of paying for health care - ANSWER--True What is the predominate source of health insurance to working Americans - ANSWER--Employer-based health insurance What is the evolution of health care payment sources - ANSWER--evolved from out-of-pock...
What is the general state of America's health-care system? How does ours compare to other similar countries? - ANSWER-The healthcare system in America is much more complex compared to other systems around the world. Americans also pay the most for healthcare yet our health outcomes are not good! We...
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Add to cartWhat is the general state of America's health-care system? How does ours compare to other similar countries? - ANSWER-The healthcare system in America is much more complex compared to other systems around the world. Americans also pay the most for healthcare yet our health outcomes are not good! We...
An agent is required to keep replacement forms on file for at least ____ years. - ANSWER-5 Maria the agent would like to advertise an annuity product on a highway billboard. which of the following must be included in the advertisement? - ANSWER-Her name Employer sponsored group health insuranc...
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Add to cartAn agent is required to keep replacement forms on file for at least ____ years. - ANSWER-5 Maria the agent would like to advertise an annuity product on a highway billboard. which of the following must be included in the advertisement? - ANSWER-Her name Employer sponsored group health insuranc...
Which of the following is NOT a hazard? - ANSWER-A fire started in a waste basket. Which of the following is the PRIMARY source of information used by insurance companies during the underwriting process? - ANSWER-The application for insurance An insurance contract must comply with the "Princi...
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Add to cartWhich of the following is NOT a hazard? - ANSWER-A fire started in a waste basket. Which of the following is the PRIMARY source of information used by insurance companies during the underwriting process? - ANSWER-The application for insurance An insurance contract must comply with the "Princi...
Health Maintenance Organization - ANSWER-Organization contracted by individuals or insurance companies to provide health care for a yearly fee. Medicare - ANSWER-A program added to the Social Security system in 1965 that provides hospitalization insurance for the elderly and permits older America...
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Add to cartHealth Maintenance Organization - ANSWER-Organization contracted by individuals or insurance companies to provide health care for a yearly fee. Medicare - ANSWER-A program added to the Social Security system in 1965 that provides hospitalization insurance for the elderly and permits older America...
Which of the following entities is NOT reimbursed by most medical health insurance companies? - ANSWER-Consumer Which of the following is NOT a classic principle of insurance? - ANSWER-Service is desirable by the patient. Who is the gatekeeper under managed care and prospective payment systems...
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Add to cartWhich of the following entities is NOT reimbursed by most medical health insurance companies? - ANSWER-Consumer Which of the following is NOT a classic principle of insurance? - ANSWER-Service is desirable by the patient. Who is the gatekeeper under managed care and prospective payment systems...
Insurance Companies (IC's) - ANSWER-the primary function of insurance companies is to compensate policyholders if a pre specified event occurs, in exchange for premiums paid -sell a variety of investment products similar to other FI's insurance underwriters - ANSWER-assess and price risk in...
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Add to cartInsurance Companies (IC's) - ANSWER-the primary function of insurance companies is to compensate policyholders if a pre specified event occurs, in exchange for premiums paid -sell a variety of investment products similar to other FI's insurance underwriters - ANSWER-assess and price risk in...
What is the MINIMUM benefit period that must be offered by a long-term care policy? - ANSWER-12 months Under Texas insurance law, the term "transacting business" includes - ANSWER-collecting premiums Which Unfair Trade Practice involves an agent telling a prospective client that a policy's ...
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Add to cartWhat is the MINIMUM benefit period that must be offered by a long-term care policy? - ANSWER-12 months Under Texas insurance law, the term "transacting business" includes - ANSWER-collecting premiums Which Unfair Trade Practice involves an agent telling a prospective client that a policy's ...
In terms of access and outcomes... - ANSWER-US health care is less than effective US healthcare spending - ANSWER-more than any other country; >47million people w/out health insurance What is a large component of US health care system? - ANSWER-profit-making What accounts for the largest...
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Add to cartIn terms of access and outcomes... - ANSWER-US health care is less than effective US healthcare spending - ANSWER-more than any other country; >47million people w/out health insurance What is a large component of US health care system? - ANSWER-profit-making What accounts for the largest...
Which of the following is an experiment that tells us about the impact of health insurance on health care or health? RAND Health Insurance Experiment Oregon Health Insurance Experiment Accelerated Benefits Demonstration all of the above - ANSWER-all of the above True or false: The U.S...
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Add to cartWhich of the following is an experiment that tells us about the impact of health insurance on health care or health? RAND Health Insurance Experiment Oregon Health Insurance Experiment Accelerated Benefits Demonstration all of the above - ANSWER-all of the above True or false: The U.S...
Which term refers to insurance written on the interests of the licensee, the licensee's employer, or the licensee's immediate family? - ANSWER-Controlled Business Which of the following is considered to be a prohibited business practice - ANSWER-Failing to submit premiums to an insurer A pro...
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Add to cartWhich term refers to insurance written on the interests of the licensee, the licensee's employer, or the licensee's immediate family? - ANSWER-Controlled Business Which of the following is considered to be a prohibited business practice - ANSWER-Failing to submit premiums to an insurer A pro...
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