Course: MHA 628

(3.) Which of the following is NOT true for Preferred Provider Organizations (PPOs)?

Group of answer choices:

PPOs have fewer market shares than HMOs.

PPOs contract with providers to form a provider network.

PPOs participating providers agree to accept a discount rate as the payment term.

Medical services rendered by out-of-network providers will be paid for with a lower rate than in-the-network.

(4.) ________ is NOT a managed care organization.

Group of answer choices:

A Preferred Provider Organization

A Point of Service Organization

An Indemnity Insurance Organization

A Health Maintenance Organization

(5.) HMOs grew rapidly in 1970s and 1980s. By 1999, HMOs had 39% Market share, compared to PPOs at 28%.

Group of answer choices:

True

False

(6.) The development of utilization management was also seen in the growth of carve-out organizations that have specialized provider networks to provide specialized service paid on a capitation basis. Which of the following is NOT a carve-out?

Group of answer choices

vision benefits

mental and behavioral health benefits

dental benefits

pharmaceutical benefits

(7.) The Affordable Care Act limits the maximum out-of-pocket cost for individuals and families, after which no further cost sharing may be applied.

Group of answer choices:

True

False

(8.)

The accountable care organization (ACO) program was included in the Affordable Care Act as a pilot program only.

Group of answer choices:

True

False

(11.) In 1965, Congress passed two landmark entitlement programs: Medicaid for selected low-income populations (Title XVIII of the Social Security Act) and Medicare for old adults (Title XIX of the Social Security Act).

Group of answer choices:

True

False

(12.)The Indiana Blues converted to for-profit status, which they did under the corporate name of ______.

Group of answer choices:

Aetna

Anthem

Highmark

WellPoint