Insurance & Risk Managment

1. _____ type managed care plan requires primary care physician preapproval of specialist.

2. _____ type managed care plan covers only network-provided services.

3. _____ type managed care plan does not require primary care physician preapproval of specialist.

4. In ________________, only the employer contributes; in ____________, both the employer and employee contribute.

5. Under the ___________________, group medical expense plans are prohibited from excluding or limiting coverage for preexisting conditions or imposing lifetime limits or annual limits on benefits.

6. ___________________ generally can remain the same and are subject only to certain provisions of the Affordable Care Act.

7. ___________is the dollar amount patient pays for each service.

8. ____________is the annual amount patient must pay before receiving plan benefits.

9. ________is the percentage of eligible expenses that plan pays in excess of deductible.

10. ____________is the maximum amount patient will pay before the plan pays 100 percent.

11. An HMO physician who determines if medical care from a specialist is necessary is called ___________

12. Group life and group health insurances are costly. Why do companies still offer these benefits?

13. Monthly income $3,000

Qualified monthly deductions:

Medical $200

Dental $16

HSA $40

Dependent care $400

Retirement plan $150

Using the information above, calculate the annual tax savings. Tax rate is 36%.

14. Charlie has broken his finger. He is covered under his employers preferred provider organization (PPO) plan. The plan has a $1,000 calendar-year deductible, 80/20 percent coinsurance, and an annual out-of-pocket maximum limit of $5,000. Charlie incurred $3,000 expenses. He had no medical expenses for the year.

Based on this information, how much will Charlie pay for his injury if he receives medical care from healthcare providers who are part of the PPO network?