Employee covered health plans

Page 1 Question 1.1. (TCO 7) Employee covered health plans are most likely to be? (Points : 5) High deductible health plans with a savings option. HMOs. PPOs. Traditional indemnity plans Question 2.2. (TCO 7) Capitation plans are more common for physician payment because: (Points : 5) they can better control utilization. physicians want more risk in their payment plans. they are concerned about adverse selection. physicians have larger reserves and can assume more risk. Question 3.3. (TCO 7) The James Clinic is an organization of 100 physicians in a variety of specialties. They recently contracted with Prudential Health Plan on a capitated basis to provide all medical services to Prudential’s members for the next three years. This HMO model would be defined as a: (Points : 5) Staff Model Group Model Individual Practice Association Model Network Model Question 4.4. (TCO 7) Suppose that AT&T had made an offer to acquire Merck Pharmaceuticals. Ignoring potential antitrust problems, this merger would be classified as a: (Points : 5) Cross-border merger Horizontal merger Conglomerate merger Vertical merger Question 5. 5. (TCO 7) An HMO has a Point of Service (POS) option for its members, but will pay only 80 percent of approved charges. If a member goes out of network for a medical procedure with a charge of $2,000, of which $1,200 is approved, how much must the member pay? (Points : 10) Question 6. 6. (TCO 7) A hospital incurs $10 million of cost to treat Medicaid patients and receives $7 million in payment. Actual charges for these Medicaid patients were $20 million. The net community benefit expense that would be reported in Schedule H of IRS Form 990 would be? (Points : 10) Question 7. 7. (TCO 7) How is charity care usually defined? (Points : 10)