#1
Which of the following is not a type of health insurance plan structure?
ICO
ExplanationICO is not a recognized health insurance plan structure.
#2
What does HMO stand for in the context of health insurance?
Health Maintenance Organization
ExplanationHMO stands for Health Maintenance Organization.
#3
What does the term 'network' refer to in the context of health insurance?
A group of healthcare providers and facilities that have agreed to provide services to insured individuals at pre-negotiated rates
ExplanationNetwork refers to a group of providers offering services at agreed rates.
#4
Which federal agency oversees the implementation of the Affordable Care Act (ACA) in the United States?
Department of Health and Human Services (HHS)
ExplanationHHS oversees ACA implementation.
#5
Which of the following best describes a deductible in health insurance?
The amount the insured must pay before the insurance company begins to pay
ExplanationDeductible is the amount the insured pays before insurance coverage starts.
#6
What is a copayment (copay) in health insurance?
A fixed amount paid by the insured for covered services
ExplanationCopayment is a fixed amount paid by the insured for covered services.
#7
What is the primary difference between an HMO and a PPO?
HMOs typically have lower premiums but require referrals for specialists, while PPOs offer more flexibility in choosing healthcare providers.
ExplanationHMOs have lower premiums but require referrals, while PPOs offer more provider flexibility.
#8
What is a Health Savings Account (HSA) commonly used for in the context of health insurance?
To accumulate pre-tax funds for qualified medical expenses
ExplanationHSAs are used to save pre-tax funds for medical expenses.
#9
In the context of health insurance, what does the term 'out-of-pocket maximum' refer to?
The most an insured individual has to pay during a policy period
ExplanationOut-of-pocket maximum is the maximum amount the insured has to pay during a policy period.
#10
What is a common feature of a high-deductible health plan (HDHP)?
Low monthly premiums and high deductibles
ExplanationHDHPs have low premiums and high deductibles.
#11
What is the purpose of a Health Reimbursement Arrangement (HRA) in health insurance?
To provide tax-free funds for eligible medical expenses
ExplanationHRAs provide tax-free funds for medical expenses.
#12
What does a co-insurance clause in a health insurance policy determine?
The percentage of covered medical expenses paid by the insured after the deductible is met
ExplanationCoinsurance determines the percentage of medical expenses paid after the deductible.