Exam 412757rr – group medical expense benefits


Exam: 412757RR – Group Medical Expense Benefits

When you have completed your exam and reviewed your answers, click Submit Exam. Answers will not be recorded until you hit Submit Exam. If you need to exit before completing the exam, click Cancel Exam.

Questions 1 to 20: 

Select the best answer to each question. Note that a question and its answers may be split across a page break, so be sure that you have seen the entire question and all the answers before choosing an answer.

1. Which of the following statements concerning extended-care facility benefits is correct?

A. Benefits are usually provided only if 24-hour-a-day nursing care is needed.

B. Benefits are not contingent upon a prior hospitalization.

C. Benefits usually are provided for domiciliary care for the aged.

D. Benefits usually are provided for inpatient treatment of drug or alcohol abuse.

2. An HMO that contracts solely with two or more independent groups of physicians to provide medical services to its subscribers is called a

A. mixed-model HMO.

B. group-model HMO.

C. network-model HMO.

D. individual practice association.

3. Which of the following statements about second opinions is correct?

A. If the first and second opinion conflict, the patient must make a decision or pay for a third opinion out of pocket.

B. More plans are requiring mandatory second opinions because it has proven to contain costs.

C. Mandatory provisions often apply only to a specified list of procedures.

D. Voluntary provisions require the insured to accept the final opinion or face financial consequences.

4. Which of the following statements concerning the NAIC Small Employer Health Insurance Availability Model Act is correct?

A. Insurance companies can use the same policies in multiple states.

B. If coverage is made available to employees, it must also be made available to their dependents.

C. All providers of medical expense coverage are required to offer coverage to small employers.

D. Pre-existing conditions provisions are not allowed.

5. The use of health savings accounts and other self-directed medical expense plans typically involve the use of medical expense policies.

A. Blue Cross and Blue Shield

B. self-insured

C. high-deductible

D. traditional

6. When Blue Cross first began, it was in the business of providing coverage for

A. physician care for the financially needy.

B. physician care for the elderly.

C. hospitalization.

D. prescriptions.

7. State reactions to managed care backlash include prohibitions against which of the following?

A. Point-of-service options

B. Direct access to specialists

C. Any-willing-provider laws

D. Provider gag clauses

8. All the following expenses are often subject to internal limitations under major medical policies except

A. diagnostic X-rays and laboratory services.

B. home healthcare benefits.

C. treatment for mental and nervous disorders.

D. hospital room and board.

9. The medical expense insurance-like organizations that eventually came to be called Blue Cross plans were initially run by

A. charity organizations.

B. employers.

C. physicians.

D. hospitals.

10. Jim and Betty are married with one child, and both are employed by the same company. Jim, who was born on February 9, 1968, has been with the company for 10 years. Betty, who was born on May 12, 1965, has been with the company for 8 years. Who is the primary provider of health care coverage for the child?

A. Betty, because she’s older than Jim

B. Jim, because of his date of birth

C.Both Betty and Jim, because they have the same insurance

D. Jim, because he’s been with the company longer than Betty

11. Mary goes to the doctor and pays for her visit. When she gets home, she must fill out a form and submit it to the insurance company so she can be reimbursed. What type of insurance does she most likely have?


B. The Blues

C. Indemnity


12. Which of the following would typically be covered under home healthcare benefits?

A. 24-hour nursing care

B. Prescription drugs

C. Physical therapy

D. Diagnostic testing

13. Which of the following statements concerning the Mental Health Parity Act is correct?

A. It requires employers to make benefits available for mental illness.

B. The provisions of the act only apply to employers with more than 50 employees.

C. It requires alcoholism and drug addiction to be treated like any other mental illness.

D. It prohibits different cost-sharing provisions for mental health benefits and other medical and surgical benefits.

14. Which of the following statements concerning basic medical expense benefits is correct?

A. Hospital expense coverage usually provides coverage for emergency room treatment of accidental injuries at any time following an accident.

B. Surgical expense coverage usually provides benefits for surgery in a hospital only.

C. Hospital expense coverage usually expresses room-and-board benefits as the full cost of semiprivate accommodations.

D. Physicians’ visits expense coverage must always include out-of-hospital visits.

15. A benefit that does not try to cure a person’s ailments, but rather attempts to make a patient comfortable in his or her last days or weeks before death, is called

A. home health care.

B. terminal care.

C. extended care.

D. hospice.

16. Which of the following statements concerning point-of-service plans is correct?

A. The term point-of-service implies a lesser degree of managed care than is found in most PPOs.

B. They are hybrid arrangements that combine aspects of an HMO with a PPO.

C. A member of a point-of-service plan can never go outside the plan’s network without informing the plan.

D. They prohibit treatment outside an exclusive-provider network unless the network does not contain an appropriate specialist.

17. Company X must make sure that it provides HMO coverage as an option in its benefit-selection process. What act would require Company X to do this?

A. Financial Services Modernization Act

B. Health Insurance Portability and Accountability Act

C. Americans with Disabilities Act

D. Health Maintenance Organization Act

18. Which of the following types of medical expense plans has the highest degree of managed care?

A. Point-of-service plans

B. Independent practice association HMOs

C. Closed-panel HMOs

D. Preferred provider organizations

19. A benefit plan that provides a less expensive choice for treatment is often a smart way to reduce costs. An example of this type of plan is

A. implementing maximum benefits.

B. allowing the use of birthing centers.

C. allowing longer hospital stays.

D. requiring higher deductibles.

20. Which of the following statements concerning multiple-option plans is correct?

A. Because the plans are subject to experience rating, costs may be higher.

B. Non-federally qualified HMOs are never used in multiple-option plans.

C. They may allow experience rating of an employer’s entire medical expense plan, including HMO coverage.

D. They increase administrative complexity if an employer offers more than one type of medical expense coverage.

Calculate your paper price
Pages (550 words)
Approximate price: -

Why Choose Us

Quality Papers

We value our clients. For this reason, we ensure that each paper is written carefully as per the instructions provided by the client. Our editing team also checks all the papers to ensure that they have been completed as per the expectations.

Professional Academic Writers

Over the years, our Acme Homework has managed to secure the most qualified, reliable and experienced team of writers. The company has also ensured continued training and development of the team members to ensure that it keep up with the rising Academic Trends.

Affordable Prices

Our prices are fairly priced in such a way that ensures affordability. Additionally, you can get a free price quotation by clicking on the "Place Order" button.

On-Time delivery

We pay strict attention on deadlines. For this reason, we ensure that all papers are submitted earlier, even before the deadline indicated by the customer. For this reason, the client can go through the work and review everything.

100% Originality

At Essay USA, all papers are plagiarism-free as they are written from scratch. We have taken strict measures to ensure that there is no similarity on all papers and that citations are included as per the standards set.

Customer Support 24/7

Our support team is readily available to provide any guidance/help on our platform at any time of the day/night. Feel free to contact us via the Chat window or support email: support@acmehomework.com.

Try it now!

Calculate the price of your order

We'll send you the first draft for approval by at
Total price:

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

Essay USA has stood as the world’s leading custom essay writing services providers. Once you enter all the details in the order form under the place order button, the rest is up to us.


Essay Writing Services

At Essay USA, we prioritize on all aspects that bring about a good grade such as impeccable grammar, proper structure, zero-plagiarism and conformance to guidelines. Our experienced team of writers will help you completed your essays and other assignments.


Admission and Business Papers

Be assured that you’ll definitely get accepted to the Master’s level program at any university once you enter all the details in the order form. We won’t leave you here; we will also help you secure a good position in your aspired workplace by creating an outstanding resume or portfolio once you place an order.


Editing and Proofreading

Our skilled editing and writing team will help you restructure you paper, paraphrase, correct grammar and replace plagiarized sections on your paper just on time. The service is geared toward eliminating any mistakes and rather enhancing better quality.


Technical papers

We have writers in almost all fields including the most technical fields. You don’t have to worry about the complexity of your paper. Simply enter as much details as possible in the place order section.