9. Insuring Your Health
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1. More than 15% of the working-age population are not covered by health insurance.
a. True
b. False
2. Advances in medical technology, drug prescriptions, and treatments have substantially reduced the cost of health care
in recent decades.
a. True
b. False
3. Large employers are less likely to offer health insurance to their employees than small employers.
a. True
b. False
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4. The cost of workers’ compensation insurance is usually paid by the employees.
a. True
b. False
5. You would have a better chance of insurance coverage for medical services not provided by the network with a
preferred provider organization (PPO) plan than with a health maintenance organization (HMO) plan.
a. True
b. False
6. Health maintenance organizations (HMOs) provide health care to participants without requiring them to file insurance
claims.
a. True
b. False
9. Insuring Your Health
9. Insuring Your Health
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12. Group insurance plans are legally required to extend health insurance benefits to retirees.
a. True
b. False
13. Under the adjusted (modified) community rating approach to health insurance premium pricing, all policyholders in an
area pay the same premium without regard to their personal health, age, gender, or other factors.
a. True
b. False
14. Long-term-care insurance provides protection against the cost of extended hospital stays.
a. True
b. False
9. Insuring Your Health
9. Insuring Your Health
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a. The federal government is responsible for workers’ compensation legislation and regulation.
b. Workers’ compensation insurance includes only rehabilitation expenses.
c. Employees are required to bear half of the entire cost of workers’ compensation insurance.
d. Workers’ compensation insurance compensates workers who are injured on the job or become ill through work-
related causes.
e. Employers who file the most claims pay the lowest premiums on the insurance coverage.
20. Which of the following statements regarding private health insurance plans is true?
a. In fee-for-service plans, the health care provider is the same as the insurer.
b. In a traditional indemnity plan, the premium cost is low if it is a high-deductible plan.
c. In managed care plans, employers contract with the health care service provider.
d. In traditional indemnity plans, the insured pays 80% of the eligible health care expenses.
e. Group health insurance is a contract between pharmaceutical companies and the health care provider.
21. Funds for Medicare benefits come from:
a. monthly payments by users directly to the health care service organization.
b. the co-payment for health care services by the insured.
c. the premiums paid by the employers for the employees.
d. Social Security taxes paid by covered workers and their employers.
e. the health care service organization.
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24. Medicare’s supplementary medical insurance (SMI) provides health care protection beyond the basic hospital
coverage for:
a. all Medicare recipients.
b. all Social Security recipients.
c. all workers’ compensation insurance recipients.
d. Medicaid recipients who pay for SMI on a voluntary basis.
e. anyone age 65 or over who pays premiums on a voluntary basis.
25. Ben (age 40) pays a low ($15) co-payment each time he visits a doctor or hospital. Other than the low per-service
deductible, there is very little cost sharing. However, Ben has a relatively low deductible, has no exclusions, and does not
have to file insurance claims. Which of the following most likely provides Ben’s health coverage?
a. HMO
b. Blue Cross/Blue Shield association
c. Commercial insurer (major medical)
d. Medicare
e. Fee-for-service indemnity plan
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b. managed care plan that reimburses members only when affiliated providers are used.
c. managed care plan in which subscribers receive services from physicians practicing from their own offices.
d. hybrid form of health maintenance organization (HMO) that allows members to go outside the HMO network for
care.
e. prepaid hospital and medical expense plan that allows members to use nonaffiliated providers.
29. When offering a flexible-benefit plan, most employers will set up a salary reduction agreement with an employee if
the employee:
a. has paid hospitalization charges for a pre-existing condition.
b. has paid health care costs due to a lapse of insurance coverage.
c. needs additional insurance benefits.
d. does not look for ways to avoid exposure to health care loss before it occurs.
e. is injured on the job or becomes ill through work-related causes.
30. The community rating approach to health insurance premium pricing:
a. advocates offering the Social Security Medicare program to all individuals irrespective of their age.
b. favors the government’s contribution to the health savings account (HSA).
c. prohibits insurance companies from varying rates based on health status or claims history.
d. considers only medical insurance coverage from a private insurance company.
e. offers consumer-directed health plans that go one step beyond a flexible-benefit plan.
9. Insuring Your Health