#1
Which of the following is a type of health insurance plan that typically has lower premiums but higher out-of-pocket costs?
HDHP
ExplanationHigh Deductible Health Plan with higher out-of-pocket costs and lower premiums.
#2
What does the acronym 'HMO' stand for in the context of health insurance?
Health Management Organization
ExplanationHealth Management Organization, emphasizing care coordination and prevention.
#3
Which of the following is NOT a type of health insurance plan?
General Savings Plan (GSP)
ExplanationGeneral Savings Plan is not a recognized type of health insurance plan.
#4
What is a copayment (copay) in health insurance?
The amount the insured person must pay for each healthcare service or prescription
ExplanationCopayment is the fixed amount an insured person pays for each healthcare service or prescription.
#5
What is the purpose of a health insurance premium?
To cover the cost of medical services
ExplanationPremiums cover the cost of medical services within the insurance plan.
#6
In the United States, which government program provides health insurance coverage to individuals aged 65 and older?
Medicare
ExplanationMedicare covers healthcare for seniors aged 65 and older.
#7
What type of healthcare provider typically serves as the 'gatekeeper' in a managed care system, requiring referrals for specialized care?
Primary Care Physician
ExplanationPrimary Care Physicians coordinate and manage healthcare needs, providing referrals for specialized services.
#8
What does COBRA stand for in the context of health insurance?
Consolidated Omnibus Budget Reconciliation Act
ExplanationCOBRA provides temporary continuation of health coverage in specific situations.
#9
Which of the following is NOT typically covered by basic health insurance plans?
Cosmetic surgery
ExplanationBasic health insurance plans usually exclude cosmetic surgeries.
#10
What is the main function of a health insurance provider network?
To manage and coordinate healthcare services
ExplanationProvider networks manage and coordinate healthcare delivery.
#11
Which of the following is not typically covered by standard health insurance plans?
Cosmetic surgery
ExplanationCosmetic surgery is often considered elective and not covered by standard plans.
#12
What is a 'deductible' in the context of health insurance?
The total amount the insured person pays before the insurance company starts to pay
ExplanationDeductible is the initial amount an insured person pays before insurance coverage begins.
#13
What is an 'explanation of benefits' (EOB) statement in health insurance?
A document detailing the costs and payments related to a medical claim
ExplanationEOB statement outlines costs and payments regarding a medical claim.
#14
What is the purpose of a health insurance claim?
To request reimbursement for medical services
ExplanationClaims are requests for reimbursement of medical expenses.
#15
What is a 'network adequacy' requirement in health insurance?
The requirement for insurance companies to have enough in-network providers to serve their members
ExplanationNetwork adequacy ensures insurance companies have sufficient in-network providers.