#1
Which of the following is typically not covered by a basic health insurance policy?
Routine dental check-ups
ExplanationOften considered separate from basic health coverage.
#2
In health insurance, what does the term 'network provider' refer to?
A health care provider that accepts the insurance company's negotiated rates
ExplanationMedical provider contracted with the insurer for reduced rates.
#3
What is a 'copayment' in health insurance?
A fixed amount paid by the insured for covered services at the time of service
ExplanationFixed fee paid for each medical service or prescription.
#4
What does 'premium' mean in the context of health insurance?
The amount the insured pays to the insurance company for coverage
ExplanationCost of insurance coverage paid by the insured.
#5
What does 'in-network' mean in health insurance?
Health care providers that accept the insurance company's negotiated rates
ExplanationProviders with agreed-upon rates with the insurer.
#6
What is a deductible in health insurance?
The total amount the insured has to pay before the insurance starts covering costs
ExplanationInitial out-of-pocket expense before insurance coverage kicks in.
#7
Which of the following is true about pre-existing conditions and health insurance?
Insurance companies can deny coverage for pre-existing conditions
ExplanationCertain conditions may not be covered due to their pre-existence.
#8
What is the purpose of a health insurance claim form?
To request reimbursement for medical expenses covered by the policy
ExplanationDocument used to claim coverage for medical expenses.
#9
What does the term 'coinsurance' mean in health insurance?
The percentage of medical expenses the insured must pay after meeting the deductible
ExplanationPercentage of costs the insured shares with the insurer.
#10
In health insurance terminology, what does the 'explanation of benefits' (EOB) document provide?
A detailed breakdown of the costs covered by the insurance company for a medical claim
ExplanationSummary of costs covered by the insurance company.
#11
What is 'lifetime maximum' in health insurance?
The maximum amount of money the insurance company will pay for the insured's medical expenses over their lifetime
ExplanationCap on total coverage benefits over the insured's lifetime.
#12
What is the 'grace period' in health insurance?
A period of time after the due date for premium payment during which coverage is still active
ExplanationTime after premium due date where coverage remains intact.
#13
What is the 'coordination of benefits' provision in health insurance?
It determines the order in which insurance companies will pay claims
ExplanationSystem to manage multiple insurance coverage for a single claim.
#14
What is 'prior authorization' in health insurance?
A process where the insured must obtain approval from the insurance company before receiving certain medical services or treatments
ExplanationRequirement to get approval for specific medical procedures.
#15
What is 'catastrophic coverage' in health insurance?
A type of coverage with high deductibles and low premiums, designed to protect against major medical expenses
ExplanationCoverage for severe, costly medical events.
#16
What is 'subrogation' in health insurance?
A provision that allows the insurance company to recover costs from a third party responsible for the insured's injuries
ExplanationInsurer's right to recover costs from liable third parties.
#17
What is 'ERISA' in health insurance?
A federal law that regulates employee retirement plans
ExplanationLegislation governing employee benefits including health insurance.