#1
What does the term 'co-payment' refer to in health insurance?
A fixed amount paid by the insured for a covered service, at the time of receiving the service
ExplanationFixed upfront payment for a service.
#2
What is a pre-existing condition in health insurance?
Any medical condition that existed prior to the effective date of the insurance coverage
ExplanationMedical condition predating insurance coverage.
#3
What is the purpose of a health insurance premium?
To pay for the cost of insurance coverage
ExplanationPayment for insurance coverage.
#4
What is the purpose of a health insurance claim?
To request reimbursement for healthcare services provided to the insured individual
ExplanationRequest for reimbursement of healthcare costs.
#5
Which of the following factors typically determines the premium cost of health insurance?
The policyholder's age and location
ExplanationAge and location determine premium cost.
#6
What is 'coinsurance' in health insurance?
The percentage of costs of a covered healthcare service that an insured person must pay
ExplanationPercentage of healthcare service costs paid by the insured.
#7
In health insurance, what does the term 'out-of-pocket maximum' refer to?
The maximum amount an insured individual has to pay for covered services in a year
ExplanationMaximum annual payment for covered services.
#8
What is the purpose of a health insurance deductible?
To establish the amount the insured individual must pay out of pocket before the insurance plan begins to pay
ExplanationInitial payment amount before insurance coverage kicks in.
#9
What does the term 'network' mean in the context of health insurance?
A group of doctors, hospitals, and other healthcare providers contracted with a health insurance company
ExplanationGroup of contracted healthcare providers.
#10
What does the term 'exclusion' mean in health insurance?
A medical condition that is not covered by the insurance policy
ExplanationCondition not covered by insurance.
#11
What is the main purpose of a health savings account (HSA)?
To allow individuals to save money for qualified medical expenses
ExplanationSavings for medical expenses.
#12
What is the difference between a health maintenance organization (HMO) and a preferred provider organization (PPO)?
HMOs typically require referrals for specialist visits, while PPOs usually do not
ExplanationReferral requirement for HMO vs. PPO.
#13
What is the purpose of coordination of benefits (COB) in health insurance?
To ensure that multiple insurance policies do not pay more than 100% of the total covered expenses
ExplanationPrevent overpayment by multiple policies.
#14
What is the difference between a copayment and coinsurance in health insurance?
Copayment is a fixed amount paid by the insured for a covered service, while coinsurance is a percentage of costs of a covered service paid by the insured.
ExplanationFixed vs. percentage payment for services.