#1
Which of the following is a common feature of Health Insurance Policy Administration?
Processing claims
ExplanationManaging and handling requests for medical expenses reimbursement.
#2
What does the term 'deductible' mean in the context of health insurance?
The amount the insured pays for covered healthcare services before the insurance plan starts to pay
ExplanationInitial amount an individual must pay out of pocket before the insurance plan begins to cover costs.
#3
In health insurance, what is the 'grace period' referring to?
The time allowed for premium payment after the due date
ExplanationPeriod granted after the premium due date, during which coverage remains active.
#4
What is 'coinsurance' in health insurance?
The percentage of costs shared between the insured and the insurer
ExplanationSharing of healthcare costs between the insured individual and the insurance provider, typically after meeting the deductible.
#5
What is the 'grace period' in health insurance referring to?
The time allowed for premium payment after the due date
ExplanationInterval following the premium deadline wherein coverage remains in effect despite delayed payment.
#6
What is the primary purpose of underwriting in health insurance?
To evaluate risks and set premiums
ExplanationAssessing risks associated with insuring individuals and determining appropriate premiums.
#7
Which government agency in the United States oversees health insurance regulations?
Centers for Medicare & Medicaid Services (CMS)
ExplanationResponsible for administering Medicare, Medicaid, and overseeing private health insurance regulations.
#8
Which type of health insurance plan typically allows policyholders to see any healthcare provider, with or without a referral?
Preferred Provider Organization (PPO)
ExplanationOffering flexibility to choose healthcare providers without referrals, albeit at a higher cost.
#9
What is the role of a Health Insurance Broker?
To connect individuals with insurance plans and help them navigate options
ExplanationAssisting individuals in selecting suitable insurance coverage and understanding available options.
#10
What is 'COBRA' in the context of health insurance?
A federal law allowing continuation of health coverage after job loss
ExplanationLegislation permitting individuals to retain their health insurance temporarily following job termination.
#11
What does 'adverse selection' mean in health insurance?
The tendency for unhealthy individuals to seek insurance more than healthy individuals
ExplanationUnfavorable situation where individuals with higher risk levels are more likely to purchase insurance.
#12
What is the purpose of a copayment in health insurance?
To share the cost of medical expenses between the insured and the insurer
ExplanationRequiring the insured to contribute a fixed amount towards the cost of covered services.
#13
In health insurance, what does the term 'exclusion' refer to?
A medical condition not covered by the policy
ExplanationConditions or treatments not included in the coverage.
#14
Which of the following is NOT typically covered in a basic health insurance plan?
Cosmetic surgery
ExplanationProcedures primarily done for aesthetic purposes are often excluded from basic coverage.
#15
What is the purpose of a Health Savings Account (HSA) in the context of health insurance?
To accumulate tax-free funds for medical expenses
ExplanationAllowing individuals to save money specifically for medical costs, often with tax advantages.
#16
What is the purpose of the 'Explanation of Benefits' (EOB) in health insurance?
To outline the cost of medical services
ExplanationProviding a summary of healthcare services rendered and associated costs for insured individuals.
#17
Which government program provides health insurance for individuals aged 65 and older in the United States?
Medicare
ExplanationFederal program offering healthcare coverage primarily for individuals aged 65 and above.