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Exam 13: Bluecross Blueshield

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Question 1

Multiple Choice

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

A) 2
B) 6
C) 12
D) 18

E) All of the above
F) C) and D)

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Question 2

Multiple Choice

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

A) combined into
B) instead of
C) over and above
D) that is part of

E) B) and C)
F) A) and D)

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Question 3

Multiple Choice

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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.

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) __________.

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 __________.

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.

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

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.

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.

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

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 __________.

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.

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

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 __________.

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.

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

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.

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 __________.

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

FEP cards contain the phrase __________ under the BCBS trademark.