#1
What is the deductible in health insurance?
The amount paid by the insured before the insurance coverage kicks in
ExplanationInitial amount paid by insured before insurance benefits begin
#2
What does COBRA stand for in the context of health insurance?
Consolidated Omnibus Budget Reconciliation Act
ExplanationFederal law allowing continuation of group health insurance after employment loss
#3
What does EOB stand for in health insurance?
Explanation of Benefits
ExplanationDocument detailing benefits paid or denied for medical services
#4
What is a copayment (copay) in health insurance?
A fixed amount the insured pays for covered medical services
ExplanationFixed amount paid for each medical service
#5
What is a premium in health insurance?
A monthly or yearly fee paid to the insurance company to maintain coverage
ExplanationFee paid to maintain insurance coverage
#6
What is a Health Insurance Claim?
A request for payment submitted to the insurance company by a healthcare provider
ExplanationRequest for payment submitted by healthcare provider to insurance company
#7
Which of the following is NOT typically covered by a basic health insurance plan?
Cosmetic surgery
ExplanationOptional surgical procedures not usually covered by basic plans
#8
What is the purpose of a Health Savings Account (HSA)?
To save money for medical expenses on a tax-advantaged basis
ExplanationTax-advantaged savings account for medical expenses
#9
What is the purpose of a Health Maintenance Organization (HMO)?
To manage and coordinate healthcare services for its members
ExplanationOrganize and oversee healthcare services for members
#10
What does the term 'coinsurance' mean in health insurance?
A percentage of medical costs the insured pays after meeting the deductible
ExplanationPercentage of medical costs paid by insured after deductible
#11
What is a pre-existing condition in the context of health insurance?
A condition for which the insured received treatment before the insurance coverage started
ExplanationCondition treated before insurance coverage began
#12
What is the purpose of a Health Reimbursement Arrangement (HRA)?
To reimburse employees for qualified medical expenses
ExplanationReimburse employees for medical expenses
#13
What is the main difference between an HMO and a PPO?
HMOs require referrals to see specialists, while PPOs do not
ExplanationReferral requirements for specialist care differ between these insurance models
#14
What is the main difference between an EPO and a PPO?
EPOs typically require referrals to see specialists, while PPOs do not
ExplanationReferral requirements differ between these insurance plans
#15
What does the term 'out-of-pocket maximum' mean in health insurance?
The maximum amount the insured pays out of pocket each year, after which the insurance covers 100% of covered expenses
ExplanationMaximum annual amount insured pays before insurance covers 100%