Which of the following is not considered to be a type of defined health benefits

Question

Which of the following is not considered to be a type of defined health benefits plan:

A self-funded employer plan

A Health Savings Account

Medicare

Medicaid

Match the following types of member cost-sharing:

Copayment

      [ Choose ]            Not a type of cost-sharing            Money that a member must pay before the plan begins to pay            A percentage of the total of what the plan covers that the member is responsible for paying            A fixed amount of money that a member pays for each office visit or prescription      

Coinsurance

      [ Choose ]            Not a type of cost-sharing            Money that a member must pay before the plan begins to pay            A percentage of the total of what the plan covers that the member is responsible for paying            A fixed amount of money that a member pays for each office visit or prescription      

Deductible

      [ Choose ]            Not a type of cost-sharing            Money that a member must pay before the plan begins to pay            A percentage of the total of what the plan covers that the member is responsible for paying            A fixed amount of money that a member pays for each office visit or prescription      

Out-of-pocket maximum

      [ Choose ]            Not a type of cost-sharing            Money that a member must pay before the plan begins to pay            A percentage of the total of what the plan covers that the member is responsible for paying            A fixed amount of money that a member pays for each office visit or prescription      

State mandated benefits coverage applies to all types of health benefits plans that provide coverage in that state.

True

False

Reinsurance and health insurance are subject to the same laws and regulations.

True

False

HMOs are licensed as health insurance companies.

True

False

A self-funded employer plan

A Health Savings Account

Explanation / Answer

1. Which of the following is not considered to be a type of defined health benefits plan:

Ans. - b> A Health Savings Account

The reason - A Health Savings Account is a tax-exempt savings account which is linked to a qualified high-deductible health plan (QHDHP). It is used to pay medical expenses and these deposited payments are totally tax-free.

2. Copayment

Ans. - d>   A fixed amount of money that a member pays for each office visit or prescription

The reason - Copays are the due amount in the time of receiving services. Any customers/patients are asked to pay their copays when they come for their doctor's visit or any diagnostic test.

It is a fixed amount which has to be paid by patients for the healthcare service.  

3. Coinsurance

Ans. - c> A percentage of the total of what the plan covers that the member is responsible for paying  

The reason - It is a percentage of total payment for a healthcare service which has to be given by a patient.

Example - Suppose if the health insurance plan is paying $80 for any visit then the coinsurance payment is $16 means 20% of the payment by health insurance plan. The patient must have to pay this with the ductible charges.

4. Deductible

Ans. - b>   Money that a member must pay before the plan begins to pay     

The reason - This is an amount which has to paid by patients before their health insurance plan start.

Example - Suppose in an emergency case patient's deductible charge is $400, then that patient must have to pay $400 before his/her health insurance plan cover the rest amount for the service.

5. Out-of-pocket maximum

Ans. - a> Not a type of cost-sharing

The reason - It is the amount which any patient has to pay for health care services in a year. It is the total amount of copayment, coinsurance, and reducible. After this amount of payment, the health insurance plan pays the rest amount for any service.

6. State mandated benefits coverage applies to all types of health benefits plans that provide coverage in that state.

Ans. - False.

The reason - State mandated benefits coverage applies to some health service providers like acupuncturists or chiropractors and health benefits plans for persons like adopted children, handicapped dependents or adult dependents only.

7. Reinsurance and health insurance are subject to the same laws and regulations.

Ans. - False.

The reason - Reinsurance is a reimbursement system that helps any insurance companies to protect themselves from high claims. There will be a third party involvement for paying the total claims after some amount is passed by the insurance company.

But health insurance is a type of insurance plan which covers the total medical expenses of the patient. There is no third party involvement to pay the insurance claims.

So these two are not subject to the same laws and regulations.

8. HMOs are licensed as health insurance companies.

Ans. - False.

The reason - Many health insurance companies are licensed to do their business and operation in many states. But HMOs are licensed to do their business and operation in their state only.

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