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

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

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

AHM 250

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