Question 1

BCBS has a mandatory second surgical opinion (SSO)  requirement necessary when a patient is considering elective, nonemergency surgical care. The initial surgical recommendation must be made by a physician qualified to perform the anticipated surgery. If a second surgical opinion is not obtained prior to surgery, the patient's out-of-pocket expenses may be __________.

Accepted Answer

A)   eliminated
B)   increased
C)   reduced
D)   waivedE) None of the above
F) A) and C) B

Question 2

The forerunner of what is known today as the BlueCross plan began in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents, in exchange for a $6 annual premium. This was considered a __________ plan.

Accepted Answer

A)   postpaid
B)   prepaid
C)   retrospective
D)   traditionalE) A) and B)
F) C) and D)

Question 3

BCBS corporations offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by the word __________ on the patient's plan ID card.

Accepted Answer

A)   Medicaid
B)   Medicare
C)   Medigap
D)   MediSuppE) B) and D)
F) B) and C)

Question 4

BlueCross plans originally covered only hospital bills, and BlueShield plans covered fees for physician services, and there was close cooperation between the plans that resulted in joint ventures where the two corporations were housed in one building. In these joint ventures, BlueCross BlueShield (BCBS)  __________.

Accepted Answer

A)   contracted with providers to offer hospital and physician services, regardless of plan
B)   merged as a single corporate entity and was able to significantly reduce premium costs
C)   provided health care services and procedures to subscribed patients in the building
D)   shared one building and computer services but maintained separate corporate identitiesE) B) and C)
F) A) and D)

Question 5

The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or __________ for policyholder.

Accepted Answer

A)   member
B)   patient
C)   payer
D)   providerE) B) and D)
F) A) and D)

Question 6

BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.

Accepted Answer

A)   basic
B)   contractual
C)   major medical
D)   traditionalE) B) and C)
F) A) and C)

Question 7

The medical emergency care rider covers __________ treatment sought and received for sudden, severe, and unexpected conditions that if not treated would place the patient's health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or body part.

Accepted Answer

A)   continuous
B)   immediate
C)   protracted
D)   recurringE) B) and D)
F) A) and D) B

Question 8

Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.

Accepted Answer

A)   distributed to shareholders and officers
B)   paid to the federal government as taxes
C)   returned to the nonprofit corporation
D)   sent to beneficiaries who paid premiumsE) All of the above
F) None of the above

Question 9

Participating providers contract to participate in a BCBS plan's preferred provider network (PPN) , which is a program that requires providers to adhere to __________ care provisions.

Accepted Answer

A)   hospital
B)   managed
C)   prospective
D)   retrospectiveE) All of the above
F) B) and D)

Question 10

By 1932 some plans modified the prepaid plan concept and organized community-wide programs that allowed the subscriber to be hospitalized in one of several member hospitals in accordance with signed contracts to provide services __________.

Accepted Answer

A)   at no charge to the patient
B)   for negotiated special rates
C)   on an emergency basis only
D)   when the patient needed surgeryE) All of the above
F) B) and C)

Question 11

BCBS Healthcare Anywhere coverage allows members of the independently owned and operated BCBS plans to have access to health care benefits throughout the __________, depending on their home plan benefits.

Accepted Answer

A)   preferred provider network
B)   state in which they reside
C)   United States only
D)   United States and worldE) None of the above
F) C) and D)

Question 12

Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract.

Accepted Answer

A)   combined into
B)   instead of
C)   over and above
D)   that is part ofE) None of the above
F) A) and B)

Question 13

The BCBS coordinated home health and hospice care program allows patients with this option to elect an alternative to __________ or long-term care settings.

Accepted Answer

A)   acute
B)   emergency
C)   outpatient
D)   rehabilitationE) A) and D)
F) B) and C) A

Question 14

The BlueCard and BlueCard Worldwide programs enable members to obtain health care services while traveling or living in another BCBS plan's service area, which means they can receive __________.

Accepted Answer

A)   benefits of their home plan contract and access to local provider networks
B)   health care services from out-of-network providers where they are traveling
C)   optional services and procedures not in their contract, if they are traveling
D)   reimbursement if they have to receive services from nonparticipating providersE) B) and C)
F) None of the above

Question 15

FEP cards contain the phrase __________ under the BCBS trademark.

Accepted Answer

A)   BCBS Supplemental Plan
B)   Federal Employee Program
C)   Government-Wide Service Benefit Plan
D)   Healthcare AnywhereE) A) and B)
F) A) and C)

Question 16

For-profit corporations pay taxes on profits generated by the corporation's enterprises and pay dividends to __________ on after-tax profits.

Accepted Answer

A)   beneficiaries
B)   patients
C)   providers
D)   shareholdersE) A) and D)
F) B) and D)

Question 17

The BlueCross BlueShield Federal Employee Program (FEP)  is a(n)  __________ health benefits program established by an Act of Congress in 1959.

Accepted Answer

A)   employer-sponsored
B)   government-sponsored
C)   payer-sponsored
D)   state-sponsoredE) A) and B)
F) A) and C)

Question 18

The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments.

Accepted Answer

A)   basic
B)   major medicalC) A) and B)
D) undefined

Question 19

The Away From Home Care Program allows participating BCBS plan members who are temporarily residing outside of their home HMO service area for at least 90 days to temporarily enroll with a local __________.

Accepted Answer

A)   health maintenance organization
B)   managed care company
C)   nonparticipating provider
D)   out-of-network providerE) A) and B)
F) A) and C)

Question 20

BlueGeo provides global medical coverage for active employees and their dependents who spend more than __________ months outside the United States.

Accepted Answer

A)   2
B)   6
C)   12
D)   18E) B) and C)
F) B) and D)

Exam 13: Bluecross Blueshield

Correct Answer
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B

Correct Answer
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BCBS corporations offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by the word __________ on the patient's plan ID card.

Correct Answer
verified

Correct Answer
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The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or __________ for policyholder.

Correct Answer
verified

BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.

Correct Answer
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The medical emergency care rider covers __________ treatment sought and received for sudden, severe, and unexpected conditions that if not treated would place the patient's health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or body part.

Correct Answer
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B

Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.

Correct Answer
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Participating providers contract to participate in a BCBS plan's preferred provider network (PPN) , which is a program that requires providers to adhere to __________ care provisions.

Correct Answer
verified

By 1932 some plans modified the prepaid plan concept and organized community-wide programs that allowed the subscriber to be hospitalized in one of several member hospitals in accordance with signed contracts to provide services __________.

Correct Answer
verified

BCBS Healthcare Anywhere coverage allows members of the independently owned and operated BCBS plans to have access to health care benefits throughout the __________, depending on their home plan benefits.

Correct Answer
verified

Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract.

Correct Answer
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The BCBS coordinated home health and hospice care program allows patients with this option to elect an alternative to __________ or long-term care settings.

Correct Answer
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A

The BlueCard and BlueCard Worldwide programs enable members to obtain health care services while traveling or living in another BCBS plan's service area, which means they can receive __________.

Correct Answer
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FEP cards contain the phrase __________ under the BCBS trademark.

Correct Answer
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For-profit corporations pay taxes on profits generated by the corporation's enterprises and pay dividends to __________ on after-tax profits.

Correct Answer
verified

The BlueCross BlueShield Federal Employee Program (FEP) is a(n) __________ health benefits program established by an Act of Congress in 1959.

Correct Answer
verified

The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments.

Correct Answer
verified

The Away From Home Care Program allows participating BCBS plan members who are temporarily residing outside of their home HMO service area for at least 90 days to temporarily enroll with a local __________.

Correct Answer
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BlueGeo provides global medical coverage for active employees and their dependents who spend more than __________ months outside the United States.

Correct Answer
verified

Exam 13: Bluecross Blueshield

Correct AnswerverifiedB

Correct AnswerverifiedShow Answer

BCBS corporations offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by the word __________ on the patient's plan ID card.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or __________ for policyholder.

Correct AnswerverifiedShow Answer

BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.

Correct AnswerverifiedShow Answer

The medical emergency care rider covers __________ treatment sought and received for sudden, severe, and unexpected conditions that if not treated would place the patient's health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or body part.

Correct AnswerverifiedB

Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.

Correct AnswerverifiedShow Answer

Participating providers contract to participate in a BCBS plan's preferred provider network (PPN) , which is a program that requires providers to adhere to __________ care provisions.

Correct AnswerverifiedShow Answer

By 1932 some plans modified the prepaid plan concept and organized community-wide programs that allowed the subscriber to be hospitalized in one of several member hospitals in accordance with signed contracts to provide services __________.

Correct AnswerverifiedShow Answer

BCBS Healthcare Anywhere coverage allows members of the independently owned and operated BCBS plans to have access to health care benefits throughout the __________, depending on their home plan benefits.

Correct AnswerverifiedShow Answer

Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract.

Correct AnswerverifiedShow Answer

The BCBS coordinated home health and hospice care program allows patients with this option to elect an alternative to __________ or long-term care settings.

Correct AnswerverifiedA

The BlueCard and BlueCard Worldwide programs enable members to obtain health care services while traveling or living in another BCBS plan's service area, which means they can receive __________.

Correct AnswerverifiedShow Answer

FEP cards contain the phrase __________ under the BCBS trademark.

Correct AnswerverifiedShow Answer

For-profit corporations pay taxes on profits generated by the corporation's enterprises and pay dividends to __________ on after-tax profits.

Correct AnswerverifiedShow Answer

The BlueCross BlueShield Federal Employee Program (FEP) is a(n) __________ health benefits program established by an Act of Congress in 1959.

Correct AnswerverifiedShow Answer

The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments.

Correct AnswerverifiedShow Answer

The Away From Home Care Program allows participating BCBS plan members who are temporarily residing outside of their home HMO service area for at least 90 days to temporarily enroll with a local __________.

Correct AnswerverifiedShow Answer

BlueGeo provides global medical coverage for active employees and their dependents who spend more than __________ months outside the United States.

Correct AnswerverifiedShow Answer

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B

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B

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A

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