Health Insurance Today: Chapter 11
Social Security disability benefits do not cover the first ________ of the disability.
The examining body that determines whether an applicant qualifies for SSDI is the:
Social Security administration
After eliminating all items not considered income and applying all appropriate exclusions to the items that are income, what’s left is referred to as:
The income limit for the SSI program is based on:
Federal Benefit Rate
The type of insurance that replaces a portion of earned income when an individual is unable to perform the requirements of his or her job because of non-job related injury or illness is called:
A patients inability to perform normal job duties at the previous level of expertise as a result of being absent from work is called:
The time limit for filing a workers compensation claim is established by the:
Individual state statutes
The federal program that establishes workers compensation for railroad workers engaged in interstate commerce is known by the acronym:
In workers compensation insurance, the premiums are paid by:
The _____ initiates an SSI or SSDI claim by going to the nearest social security office in person or by telephoning and arranging for a telephone interview to file the claim.
All employers must purchase workers compensation policies from the state in which their business operates.
If an employee is injured on the job, the employer can be penalized if the cause of injury or illness was conspicuous negligence on the part of the employer.
If a workers compensation claim is denied, the worker may file a claim with his or her health insurance carrier only after all workers compensation appeals have been exhausted
Workers compensation claims must be submitted on the universal CMS 1500 claim form.
Workers compensation patients are not required to sign a release of information for a claim to be filed.
The SSI program provides monthly cash payments to low income aged, blind, and disabled individuals.
The SSDI and SSI programs share various concepts and terms. However there are many important differences in the rules affecting eligibility and benefit payments.
The premium costs of managed care option can not be less than a FFS option that states offer for WC insurance.
The ADA considers disability present if an individual meets the following three standards: physical or mental impairment, en existing record of impairments and the individual is regarded as having an impairment.
The social security insurance claim form can be completed online
The health insurance professional typically does not get involved in the SSDI or SSI claim process.
The HIPPA privacy rule does not permit covered entities to disclose PHI to WC insurance without patients signing a release of information
WC insurance is a no fault insurance
In the United States, any employee who is injured on the job or develops and employment related illness that prevents the individual from working is likely to be eligible to collect workers' compensation benefits
Short term disability replaces income for 5 years or more, or until the disabled patient turns 65 years of age.
The CDC Control and Prevention support 18 state-based disability and health programs. The programs' goals focus is promoting safe workplace procedures.
In the 1800's Workers' Compensation got its start in:
The maximum amount of benefits that can be received in a specific time period is called:
A benefit cap
After the initial attending physician report has been filed, periodic updates must be provided to the employer/insurer, called:
Progress and supplemental reports.
The method of determining whether or not an individual is eligible for SSI benefits is through a(n):
Financial Means Test
The following multiple copies of Workers' Compensation reports are essential for proper distribution:
Original form to the insurance company
One copy to the appropriate state agency
One copy to the patients' employer
One copy to be retained in the healthcare provider's file
Select the work related incidents in which injury occurs that would be exclusions to the employee drawing Workers' Compensation benefits:
- Drunken stumbling
- Illegal drug are involved
- Self inflicted injuries
- Violating company policy
- Committing a crime
- Injuries while off work