Question 1

When an employer wishes to reduce the price of the standard employer-sponsored plan, he/she would negotiate with the health plan to change the options offered to the employees using what process?

Accepted Answer

A)   rider
B)   options
C)   carve out
D)   preferences

Question 2

Who sends the claim to BlueCross and BlueShield when the provider participates?

Accepted Answer

A)   the POS
B)   the provider
C)   the patient
D)   the employer

Question 3

_____ is a managed care program where physicians and other health care providers sign participation contracts agreeing to accept reduced fees in exchange for membership in the network.

Accepted Answer

A)   HMO
B)   AARP
C)   PPO
D)   POS

Question 4

Which of the following is a nationwide program that makes it easy for patients to receive treatment when outside their local service area?

Accepted Answer

A)   Outsource Program
B)   BlueCross Program
C)   BlueCard Program
D)   Subcontract Program

Question 5

______ handles TRICARE operations in the Southeast.

Accepted Answer

A)   Humana
B)   AARP
C)   Medicare
D)   Medicaid

Question 6

During specified periods, employees choose the plan they prefer for the coming benefit period; this is called _______.

Accepted Answer

A)   open enrollment
B)   selection period
C)   constraint period
D)   selection period

Question 7

_______ operates health plans in the West and has group, individual, Medicare, Medicaid, and TRICARE programs.

Accepted Answer

A)   Health Net
B)   Aetna
C)   Allstate
D)   State Farm

Question 8

EBSA is the abbreviation for _______.

Accepted Answer

A)   Federal Department of Insurance Benefits and Pension Administration
B)   Federal Department of Retired Benefits and Pension Administration
C)   Federal Department of Covered Insurance Benefits Administration
D)   Federal Department of Labor's Pension and Welfare Benefits Administration

Question 9

The _____ is an independent nonprofit organization and is the leader in accrediting HMOs and PPOs.

Accepted Answer

A)   National Committee for Quality Assurance
B)   National Organization for Quality Assurance
C)   National Association for Quality Assurance
D)   National Correlation for Quality Assurance

Question 10

A (n)  ____ is a fixed amount that must be met periodically by each individual of an insured/dependent group.

Accepted Answer

A)   individual deductible
B)   group deductible
C)   separate deductible
D)   family deductible

Question 11

BCBS administers the BlueCard Program, which is a (n)  ____.

Accepted Answer

A)   out-of-area program
B)   local area program
C)   home plan
D)   coast to coast plan

Question 12

______ is an HMO program that provides emergency room coverage if the subscriber needs care when traveling.

Accepted Answer

A)   Visa Care Program
B)   Permit Care Program
C)   Endorsement Care Program
D)   Away From Home Care Program

Question 13

The participation contract stipulates some responsibilities of the plan toward the provider. Which of the following is not one of the responsibilities?

Accepted Answer

A)   protection against loss
B)   payments
C)   contacting AARP
D)   identification of enrolled patients

Question 14

FEHB is the abbreviation for _____.

Accepted Answer

A)   Federal Equality Health Benefits program
B)   Federal Equivalence Health Benefits program
C)   Federal Employees Health Benefits program
D)   Federal Equal Opportunity Health Benefits program

Question 15

Before services in capitated plans can begin, insurance coverage must be ____.

Accepted Answer

A)   documented
B)   verified
C)   reported
D)   conveyed

Question 16

The largest employer-sponsored health program in the United States, which covers more than 8 million federal employees, retirees, and their families through over 250 health plans from number of carriers, is called _______.

Accepted Answer

A)   Personal Health Care Benefits program
B)   Federal Employees Health Benefits program
C)   Workforce Health Benefit program
D)   Organizational Workforce Benefits program

Question 17

When the practice decides to participate in a health care plan, it must follow the rules of the contract. Which is not one of the points to consider?

Accepted Answer

A)   quality assurance/utilization review
B)   acceptance of plan members
C)   covered services
D)   how many employees the facility must have

Question 18

______ is a large health insurer with strong enrollment in the Northeast and the West.

Accepted Answer

A)   CIGNA
B)   Allstate
C)   Northeast Insurance Group
D)   West Insurance Group

Question 19

________ sets and monitors standards for many types of patient care.

Accepted Answer

A)   The Health Care Organization
B)   The Government Commission on Health Standards
C)   The Joint Commission
D)   The BlueCross Commission on Health Standards

Question 20

____ was founded in the 1930s to provide low-cost medical insurance.

Accepted Answer

A)   the HealthProviders Association
B)   the Travelers HealthProviders Association
C)   the BlueCross BlueShield Association
D)   the Health Contributors Association

Exam 8: Private Payers/Blue Cross and Blue Shield

_______ operates health plans in the West and has group, individual, Medicare, Medicaid, and TRICARE programs.

Correct AnswerverifiedShow Answer

The participation contract stipulates some responsibilities of the plan toward the provider. Which of the following is not one of the responsibilities?

Correct AnswerverifiedShow Answer

_____ is a managed care program where physicians and other health care providers sign participation contracts agreeing to accept reduced fees in exchange for membership in the network.

Correct AnswerverifiedShow Answer

EBSA is the abbreviation for _______.

Correct AnswerverifiedShow Answer

______ handles TRICARE operations in the Southeast.

Correct AnswerverifiedShow Answer

BCBS administers the BlueCard Program, which is a (n) ____.

Correct AnswerverifiedShow Answer

FEHB is the abbreviation for _____.

Correct AnswerverifiedShow Answer

The largest employer-sponsored health program in the United States, which covers more than 8 million federal employees, retirees, and their families through over 250 health plans from number of carriers, is called _______.

Correct AnswerverifiedShow Answer

A (n) ____ is a fixed amount that must be met periodically by each individual of an insured/dependent group.

Correct AnswerverifiedShow Answer

When an employer wishes to reduce the price of the standard employer-sponsored plan, he/she would negotiate with the health plan to change the options offered to the employees using what process?

Correct AnswerverifiedShow Answer

____ was founded in the 1930s to provide low-cost medical insurance.

Correct AnswerverifiedShow Answer

Which of the following is a nationwide program that makes it easy for patients to receive treatment when outside their local service area?

Correct AnswerverifiedShow Answer

Who sends the claim to BlueCross and BlueShield when the provider participates?

Correct AnswerverifiedShow Answer

During specified periods, employees choose the plan they prefer for the coming benefit period; this is called _______.

Correct AnswerverifiedShow Answer

Before services in capitated plans can begin, insurance coverage must be ____.

Correct AnswerverifiedShow Answer

______ is a large health insurer with strong enrollment in the Northeast and the West.

Correct AnswerverifiedShow Answer

______ is an HMO program that provides emergency room coverage if the subscriber needs care when traveling.

Correct AnswerverifiedShow Answer

When the practice decides to participate in a health care plan, it must follow the rules of the contract. Which is not one of the points to consider?

Correct AnswerverifiedShow Answer

________ sets and monitors standards for many types of patient care.

Correct AnswerverifiedShow Answer

The _____ is an independent nonprofit organization and is the leader in accrediting HMOs and PPOs.

Correct AnswerverifiedShow Answer

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