What is the primary goal of Health Maintenance Organizations (HMOs) in terms of patient care? Reducing the number of hospital visits Early detection through regular checkups Maximizing profit margins Increasing the number of specialists

Early detection through regular checkups

How has the requirement for employers to offer HMO plans changed since the HMO Act of 1973? Employers are required to offer HMO plans to all employees Employers are no longer forced to offer HMO plans Employers must offer only HMO plans Employers can only offer HMO plans if they have more than 50 employees

Employers are no longer forced to offer HMO plans

What is the primary purpose of managed care health insurance plans? Maximize hospital revenue Control health insurance claims expenses Eliminate the need for primary care physicians Increase patient choice of providers

Control health insurance claims expenses

How can a new physician be added to a Preferred Provider Organization's (PPO) approved list? Have a referral from another physician Complete a residency program Pay a membership fee Agree to follow the PPO standards and charge the appropriate fees

Agree to follow the PPO standards and charge the appropriate fees

Which of the following is true regarding inpatient hospital care for HMO members? It is only available within the service area It is not covered for mental health treatment It requires a separate insurance policy It is available both in and out of the service area

It is available both in and out of the service area

Managed Healthcare Models: HMOs, PPOs & Service Delivery Systems in Health Insurance

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Business - Insurance

charlotte1oxhi Created by 10 mon ago

Cards in this deck(12)

What is a health insurance plan called that involves financing, managing, and delivery of health care services, and includes a group of providers who share in the financial risk or have an incentive to deliver cost-effective service?

What term describes when a medical caregiver provides services only to members or subscribers of a health organization and is contractually prohibited from treating other patients?

All of the following can be insurers EXCEPT:

What is the primary goal of Health Maintenance Organizations (HMOs) in terms of patient care?

How has the requirement for employers to offer HMO plans changed since the HMO Act of 1973?

What is the maximum amount of coinsurance allowed in New York's major medical plans?

What is the primary purpose of managed care health insurance plans?

In a Point of Service (POS) plan, how are benefits for covered services affected when self-referring without a primary care physician's arrangement?

How can a new physician be added to a Preferred Provider Organization's (PPO) approved list?

Which of the following is true regarding inpatient hospital care for HMO members?

Regarding cost containment in medical plans, what type of review process do employers and insurers use to evaluate the utilization review process and the effectiveness of professionals involved in large insurance claims?

In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary, and reasonable, what happens to the extra cost?

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Managed Healthcare Models: HMOs, PPOs & Service Delivery Systems in Health Insurance

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