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AHM 250

A health plan can best be defined as an organization that
Provides coverage for healthcare expenses and is sponsored by an employer for its employees
Maintains a network of affiliated healthcare providers and limits coverage to services rendered by those providers
Integrates the delivery and financing of healthcare and seeks to manage healthcare costs, access, and quality
The earliest verisions of health plans appeared in
1954
1973
1910
Which is not an early form of health plan?
Prepaid group practice
Individual practice association
Preferred provider organization
Which is a provision of the HMO Act of 1973?
Federally qualified HMOs were expempted from some state laws
All employers had to sponsor an HMO for their employees
All HMOS had to meet certain federal standards
For an HMO, which was not an advantage of federal qualifications?
In the marketing of the HMO, federal qualification served as a "stamp of approval"
The HMO might be eligible for federal loans and grants to expand its service area
The HMO did not have to meet certain requirements that applied to other health plans
The HMO Act of 1973
Played a major role in the early growth of HMOs
Was a failue in promoting the growth of HMOs
Played a minor role in the early growth of HMOs
In the 1990s HMOs
Were not popular because they were expensive and did not offer a wide choice of providers
Were popular because they held down costs, but people objected to the lack of provider choices
Were popular because they held down costs and offered a wide choice of providers
Janine can go to any doctor she chooses, but if she goes to one not in her plan's network, she has to pay a larger share of the cost. Janine is covered by
A preferred provider organization
A traditional health maintenance organization
Traditional indemnity insurance
Jacob must pay $2,000 in healthcare expenses each year before he receives benefits from his health plan, but he can use money from a tax-advantage savings account. Jacob has
A consumer-directed health plan
A specialty carve-out plan
A point-of-service plan
What are the roles of the state and federal governments in regulating health plans?
The state regulates health insurance, and the federal government plays only a minor role
The states regulate health insurance, but the federal government also passes laws affecting it
The federal government takes the primary role in regulating and legislating in this area
Have government health care programs been a significant factor in the evolution of health plan
Yes, because these programs have increasingly relied on health plans to provide coverage
No, because health plans are not involved in these programs in any major way
No, because these programs do not cover very many people
Which is not a cause of higher healthcare spending
A younger population because of immigration
Expensive new technology
The aging of the Baby Boomers
Under the fee-for-service approach, healthcare providers have a financial incentive to provide
Only appropriate services
More services
As few services as possible
Which is not typical of managed care?
Preventative healthcare
Fee-for-service compensation
Utlization management
Which will probably have the lost premium?
A traditonal idemnity insurance policy
A preferred provider organization
A consumer-directed health plan
In relation to health plans, over the years the definition of quality
Has become narrower
Has become broader
Has remained more or less the same
Which is not an accrediting organization
NCQA
HEDIS
URAC
What happens in adverse selection?
Many insured do not pay their premiums and let their policies lapse
People who need healthcare enroll in greater numbers than average people
An unexpectedly high percentage of employees choose to enroll
 
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