#1
What does the term 'deductible' refer to in health insurance?
The amount the insured person pays out of pocket before the insurance coverage begins.
ExplanationInitial out-of-pocket payment by the insured before insurance coverage starts.
#2
What is the purpose of a 'copayment' in health insurance?
A fixed amount paid by the insured for covered services, usually at each visit.
ExplanationSet amount paid by insured for covered services, often per visit.
#3
What does the term 'pre-existing condition' mean in health insurance?
A condition that is excluded from coverage due to being present before the policy's effective date.
ExplanationCondition excluded from coverage due to pre-existing status.
#4
What is the purpose of 'out-of-pocket maximum' in health insurance?
The maximum amount the insured has to pay for covered expenses in a policy period.
ExplanationMaximum amount insured pays for covered expenses in a policy period.
#5
What does 'subrogation' mean in health insurance?
The right of the insurance company to recover costs from a third party responsible for the injury or illness.
ExplanationInsurer's right to recover costs from a third party responsible for injury or illness.
#6
Which of the following is a common exclusion in health insurance policies?
Pre-existing conditions
ExplanationMedical conditions existing before the policy's effective date, typically excluded from coverage.
#7
What is the 'coinsurance' provision in a health insurance policy?
The percentage of covered medical expenses paid by the insured after meeting the deductible.
ExplanationThe portion of medical costs shared by the insured after meeting the deductible.
#8
What is the 'in-network' vs. 'out-of-network' distinction in health insurance?
Whether the healthcare provider is within the insurance company's approved list or not.
ExplanationProvider approval status with the insurance company.
#9
In health insurance, what does the term 'pre-authorization' mean?
Approval from the insurance company before certain medical services or procedures are performed.
ExplanationPrior approval required for specific medical services or procedures.
#10
What is the purpose of the 'grace period' in health insurance?
The time after the due date during which the premium can be paid without the policy lapsing.
ExplanationPeriod post-due date allowing premium payment without lapse.
#11
What does the term 'catastrophic coverage' refer to in health insurance?
Coverage for major medical expenses after a high deductible is met.
ExplanationCoverage for significant medical costs post-high deductible.
#12
What does the term 'underwriting' mean in the context of health insurance?
The process of assessing and classifying the risk of insuring an individual or group.
ExplanationEvaluation and classification of insurance risk for individuals or groups.
#13
In health insurance, what does the term 'grace period' refer to?
The time after the due date during which the premium can be paid without the policy lapsing.
ExplanationPost-due date period allowing premium payment without policy lapse.
#14
What does the term 'explanation of benefits (EOB)' mean in health insurance?
A document that provides details about covered medical expenses.
ExplanationDocument detailing information about covered medical expenses.
#15
What is the significance of the 'guaranteed renewable' provision in health insurance?
The policy cannot be canceled by the insurer as long as premiums are paid.
ExplanationInsurer inability to cancel policy as long as premiums are paid.
#16
What is the 'open enrollment period' in health insurance?
The time during which individuals can enroll in a health insurance plan without a qualifying event.
ExplanationPeriod for enrolling in health insurance without a qualifying event.
#17
In health insurance, what does 'COBRA' stand for?
Consolidated Omnibus Budget Reconciliation Act
ExplanationAbbreviation for Consolidated Omnibus Budget Reconciliation Act.