A. health maintenance ____ 1.

A list of the medical services covered by an insurance policy

organization (HMO) ____ 2. The amount of money paid to a health plan to buy an insurance
B. capitation policy
C. schedule of benefits ____ 3. A managed care network of providers under contract to provide
D. fee-for-service services at discounted fees
E. coinsurance ____ 4. An amount that an insured person pays at the time of a visit to a
F. deductible provider
G. co payment ____ 5. The percentage of each claim that an insured person must pay
H. premium ____ 6. A prospective payment to a provider made for each plan member
I. preferred provider ____ 7. A health plan that reimburses policyholders based on the fees
organization (PPO) charged
J. Indemnity ____ 8. An organization that contracts with a network of providers for the

Decide whether each statement is True or False (T) or (F).

____1. Employment opportunities for medical insurance specialists are increasing because providers
need trained, knowledgeable staff members to maximize revenue and ensure patient
satisfaction.

____ 2. The third party to a medical insurance contract is the policyholder.

____ 3. A discounted fee-for-service schedule provides for prospective payment.

____ 4. In order to receive prospective payments for enrollees in a capitated managed care plan, a
provider must have given medical services to each member at least once a month.

____ 5. Under an indemnity plan, the premium, deductible, and coinsurance are taken into account
before the insured is reimbursed.

____ 6. Members of a POS plan must use network providers to be covered.

____ 7. Both HMOs and PPOs use capitation as their main reimbursement method.

____ 8. PPOs are the most popular type of health plan.

____ 9. A consumer-directed health plan is a type of HMO.

____ 10. Everyone who works in a medical practice, whether a physician, a nonphysician
practitioner, or an administrative staff member, has ethical responsibilities.