#1
In health insurance, what does the term 'network' refer to?
A group of healthcare providers and facilities that have contracted with an insurance company
The amount a policyholder pays for covered healthcare services before the insurance company starts to pay
The maximum amount an insurance company will pay for covered services
The percentage of covered healthcare expenses that a policyholder must pay after the deductible
#2
In health insurance terminology, what does 'coinsurance' refer to?
The fixed amount a policyholder pays for covered healthcare services before the insurance company starts to pay
The percentage of covered healthcare expenses that a policyholder must pay after meeting the deductible
A type of health plan that covers only specific services or treatments
The maximum amount an insurance company will pay for covered services
#3
What is the purpose of an Explanation of Benefits (EOB) statement in health insurance?
To inform the policyholder about the upcoming premium payment
To explain the benefits and coverage details for a specific healthcare service or claim
To provide information on the policyholder's credit score
To offer discounts on future insurance premiums
#4
Which federal program provides health insurance coverage for individuals aged 65 and older?
Medicaid
CHIP (Children's Health Insurance Program)
Medicare
Affordable Care Act (ACA) Exchange Plans
#5
In health insurance, what does the term 'open enrollment period' refer to?
The period during which individuals can enroll in a health insurance plan for the first time.
The time frame when policyholders can make changes to their coverage without a qualifying life event.
The duration when insurance companies review and update their policy offerings.
The period for filing claims for reimbursement.
#6
What does the term 'cost-sharing' mean in health insurance?
The total cost of health insurance coverage for an individual or family.
The division of healthcare expenses between the policyholder and the insurance company.
The amount paid by the policyholder to purchase prescription medications.
The process of comparing costs between different health insurance plans.
#7
What is a common provision in a health insurance policy that limits coverage for certain pre-existing conditions?
Deductible
Copayment
Exclusionary rider
Premium
#8
Which regulatory body oversees health insurance companies in the United States?
Federal Trade Commission (FTC)
Centers for Medicare & Medicaid Services (CMS)
Food and Drug Administration (FDA)
Occupational Safety and Health Administration (OSHA)
#9
What is the purpose of a health insurance deductible?
To limit the total annual out-of-pocket expenses for the policyholder
To determine the percentage of covered expenses paid by the insurance company
To establish the minimum amount the policyholder must pay before the insurance company contributes
To regulate the premium amount based on the policyholder's health
#10
What is the grace period in health insurance policies?
The period during which the policyholder can enroll in a health insurance plan after a life-changing event
The time frame in which the policyholder can renew the insurance policy without a lapse in coverage
The waiting period before the insurance coverage becomes effective after the policy is issued
The period during which the policyholder can file a claim for reimbursement
#11
What is the 'essential health benefits' requirement in health insurance under the Affordable Care Act (ACA)?
It mandates coverage of a specific set of healthcare services, such as preventive services and maternity care.
It allows insurance companies to exclude certain essential services from coverage.
It pertains only to optional health coverage like vision and dental care.
It applies only to employer-sponsored health plans.
#12
What is a Health Savings Account (HSA) commonly used for in conjunction with a High Deductible Health Plan (HDHP)?
To pay premiums for the health insurance plan.
To cover routine preventive care services.
To accumulate funds for qualified medical expenses on a tax-advantaged basis.
To purchase over-the-counter medications.
#13
What does COBRA stand for in the context of health insurance regulations?
Consolidated Omnibus Budget Reconciliation Act
Consumer Operations and Business Regulations Act
Comprehensive Options for Benefits and Retirement Act
Coverage of Biomedical Research and Analysis
#14
Which type of health insurance plan typically requires policyholders to choose a primary care physician and get referrals to see specialists?
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Exclusive Provider Organization (EPO)
Point of Service (POS)
#15
Which of the following is a characteristic of a High Deductible Health Plan (HDHP)?
Low annual out-of-pocket limit
No deductible requirement
Eligibility for Health Savings Account (HSA)
No copayment for prescription drugs
#16
What is the purpose of the Consolidated Omnibus Budget Reconciliation Act (COBRA) in health insurance?
To establish standards for the security of electronic health information.
To provide continuation of health coverage for certain individuals and their dependents in specific situations.
To regulate the pricing of prescription drugs.
To set guidelines for the accreditation of healthcare facilities.
#17
What is the 'lifetime maximum' in health insurance coverage?
The maximum amount an insurance company will pay for covered services during an individual's lifetime.
The total premium payments made by a policyholder over their lifetime.
The annual limit on out-of-pocket expenses for the policyholder.
The maximum deductible allowed in a policyholder's lifetime.
#18
What is the primary purpose of the Health Insurance Portability and Accountability Act (HIPAA) in the context of health insurance?
To regulate the pricing of health insurance premiums.
To ensure the privacy and security of individuals' health information.
To establish guidelines for the marketing of health insurance plans.
To mandate coverage for specific preventive services.