#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
ExplanationContracted healthcare providers and facilities.
#2
In health insurance terminology, what does 'coinsurance' refer to?
The percentage of covered healthcare expenses that a policyholder must pay after meeting the deductible
ExplanationPercentage of expenses after deductible.
#3
What is the purpose of an Explanation of Benefits (EOB) statement in health insurance?
To explain the benefits and coverage details for a specific healthcare service or claim
ExplanationExplains benefits and coverage details.
#4
Which federal program provides health insurance coverage for individuals aged 65 and older?
Medicare
ExplanationProvides health insurance for individuals aged 65 and older.
#5
In health insurance, what does the term 'open enrollment period' refer to?
The time frame when policyholders can make changes to their coverage without a qualifying life event.
ExplanationTime frame for policyholders to make changes.
#6
What does the term 'cost-sharing' mean in health insurance?
The division of healthcare expenses between the policyholder and the insurance company.
ExplanationDivision of healthcare expenses between policyholder and insurance company.
#7
What is a common provision in a health insurance policy that limits coverage for certain pre-existing conditions?
Exclusionary rider
ExplanationLimits coverage for pre-existing conditions.
#8
Which regulatory body oversees health insurance companies in the United States?
Centers for Medicare & Medicaid Services (CMS)
ExplanationRegulates health insurance companies in the US.
#9
What is the purpose of a health insurance deductible?
To establish the minimum amount the policyholder must pay before the insurance company contributes
ExplanationMinimum amount before insurance contribution.
#10
What is the grace period in health insurance policies?
The waiting period before the insurance coverage becomes effective after the policy is issued
ExplanationWaiting period before coverage is effective.
#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.
ExplanationMandates coverage of specific healthcare services.
#12
What is a Health Savings Account (HSA) commonly used for in conjunction with a High Deductible Health Plan (HDHP)?
To accumulate funds for qualified medical expenses on a tax-advantaged basis.
ExplanationAccumulates funds for qualified medical expenses.
#13
What does COBRA stand for in the context of health insurance regulations?
Consolidated Omnibus Budget Reconciliation Act
ExplanationProvides continuation of health coverage.
#14
Which type of health insurance plan typically requires policyholders to choose a primary care physician and get referrals to see specialists?
Health Maintenance Organization (HMO)
ExplanationRequires primary care physician and referrals.
#15
Which of the following is a characteristic of a High Deductible Health Plan (HDHP)?
Eligibility for Health Savings Account (HSA)
ExplanationAllows eligibility for Health Savings Account.
#16
What is the purpose of the Consolidated Omnibus Budget Reconciliation Act (COBRA) in health insurance?
To provide continuation of health coverage for certain individuals and their dependents in specific situations.
ExplanationProvides continuation of health coverage in specific situations.
#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.
ExplanationMaximum amount for covered services in an individual's lifetime.
#18
What is the primary purpose of the Health Insurance Portability and Accountability Act (HIPAA) in the context of health insurance?
To ensure the privacy and security of individuals' health information.
ExplanationEnsures privacy and security of health information.