#1
Which of the following is NOT typically covered by a basic health insurance policy?
Cosmetic surgery
ExplanationCosmetic procedures are often considered elective and not covered by basic health insurance.
#2
What does the term 'co-pay' refer to in health insurance?
A fixed amount you pay for a covered health care service, usually when you receive the service
ExplanationCo-pay is a predetermined amount you pay for a particular service, typically due at the time of service.
#3
In the context of health insurance, what does 'network' refer to?
A group of doctors and hospitals that have agreed to provide services at negotiated rates
ExplanationNetwork refers to healthcare providers who have agreements with the insurer to provide services at discounted rates.
#4
Which government program provides health insurance for individuals aged 65 and older in the United States?
Medicare
ExplanationMedicare is a federal program providing health coverage for seniors.
#5
What is 'premium' in the context of health insurance?
The amount you must pay each month for your insurance coverage
ExplanationPremium is the monthly cost of your insurance plan.
#6
Which of the following statements about 'dependent coverage' in health insurance is true?
Dependent coverage allows individuals to add family members to their health insurance plan
ExplanationDependent coverage permits adding family members to an insurance plan.
#7
What does the term 'deductible' mean in health insurance?
The total amount you pay out-of-pocket for covered services
ExplanationDeductible is the amount you must pay before your insurance kicks in and starts covering costs.
#8
Which of the following is an example of a 'pre-existing condition' that might affect your health insurance coverage?
High cholesterol diagnosed last month
ExplanationPre-existing conditions are medical issues diagnosed before obtaining insurance, such as high cholesterol.
#9
What is the 'out-of-pocket maximum' in health insurance?
The maximum amount you will pay in a policy period before your insurance starts to pay 100% of the allowed amount
ExplanationOut-of-pocket maximum is the limit on how much you have to spend for covered services in a policy period.
#10
Which type of health insurance plan typically offers the most flexibility in choosing healthcare providers?
Preferred Provider Organization (PPO)
ExplanationPPO plans usually provide more choice in healthcare providers without requiring referrals.
#11
What is the purpose of a 'health savings account' (HSA)?
To save money for medical expenses on a tax-advantaged basis
ExplanationHSAs allow individuals to save for medical expenses with pre-tax dollars.
#12
Which of the following is a potential advantage of having a high-deductible health plan (HDHP)?
Lower premiums
ExplanationHDHPs typically have lower premiums but higher deductibles.
#13
What is the purpose of 'coinsurance' in health insurance?
To share the cost of covered services between you and your insurance provider
ExplanationCoinsurance involves you and your insurer splitting the costs of covered services.
#14
What is the purpose of 'prior authorization' in health insurance?
To obtain permission from your insurance company before receiving certain services or medications
ExplanationPrior authorization is necessary for specific services or medications to ensure coverage.
#15
What is the purpose of 'catastrophic health insurance'?
To protect against high medical costs from severe accidents or illnesses
ExplanationCatastrophic insurance provides coverage for major medical expenses.
#16
What is the purpose of 'renewability' in health insurance policies?
To determine whether the policy can be continued after its expiration date
ExplanationRenewability determines if the policy can be extended after it expires.
#17
What is the purpose of 'lifetime maximum' in health insurance?
To specify the maximum amount the insurance company will pay over the insured's lifetime
ExplanationLifetime maximum defines the cap on total benefits paid over the insured's lifetime.