#1
What does a deductible refer to in health insurance?
The amount the insured must pay out-of-pocket before the insurance company starts covering costs
ExplanationUpfront payment by insured before insurance coverage kicks in.
#2
Which of the following is NOT typically covered by health insurance?
Cosmetic surgery
ExplanationNon-medically necessary procedures not covered by insurance.
#3
What is the purpose of a Certificate of Coverage in health insurance?
To confirm the details and benefits of the health insurance plan
ExplanationConfirmation of details and benefits of health insurance plan.
#4
What is a copayment in health insurance?
A fixed amount paid by the insured for covered services at the time of service
ExplanationFixed payment by insured for covered services during each visit.
#5
What does the term 'in-network' mean in health insurance?
Healthcare providers who are contracted with the insurance company, offering lower costs to insured individuals
ExplanationLower-cost healthcare providers contracted with the insurance company.
#6
What is a Preferred Provider Organization (PPO)?
A network of healthcare providers that offer discounted rates to insured individuals
ExplanationProvider network with discounted rates for insured individuals.
#7
What is the purpose of a preauthorization requirement in health insurance?
To obtain approval from the insurance company before certain medical services or treatments are provided
ExplanationApproval needed from insurance before specific medical services.
#8
What is a Health Reimbursement Arrangement (HRA)?
A tax-advantaged employer-funded plan that reimburses employees for qualified medical expenses
ExplanationEmployer-funded plan reimbursing employees for medical expenses.
#9
What is a Health Maintenance Organization (HMO)?
A type of health insurance plan that offers a network of healthcare providers and requires referrals for specialist visits
ExplanationInsurance plan with provider network and specialist referrals.
#10
What is a Health Savings Account (HSA)?
A tax-advantaged savings account for medical expenses, paired with a high-deductible health plan
ExplanationTax-advantaged savings for medical expenses with high-deductible plan.
#11
What is the difference between coinsurance and copayment?
Coinsurance is the percentage of covered expenses the insured must pay, while copayment is a fixed amount paid by the insured
ExplanationCoinsurance is percentage, copayment is fixed amount paid by insured.
#12
What is the main difference between an EPO and a PPO?
EPOs do not cover out-of-network care, while PPOs may provide some coverage
ExplanationEPOs exclude out-of-network care; PPOs may provide some coverage.
#13
What is the difference between an HMO and a POS plan?
POS plans require referrals to see specialists, while HMO plans do not
ExplanationPOS plans need specialist referrals; HMO plans do not.