#1
What does 'co-payment' refer to in a health insurance policy?
The initial amount paid by the insured for covered services
ExplanationInitial payment by insured for covered services
#2
What is 'coinsurance' in the context of health insurance?
The percentage of covered expenses paid by the insured
ExplanationPercentage of expenses paid by insured
#3
What is a 'deductible' in a health insurance policy?
The amount the insured must pay out-of-pocket before the insurer begins to cover expenses
ExplanationOut-of-pocket payment before coverage
#4
What is 'pre-existing condition' in the context of health insurance?
A condition that existed before the insurance coverage started
ExplanationExisting condition before coverage
#5
What does 'premium' refer to in a health insurance policy?
The monthly or yearly payment for insurance coverage
ExplanationMonthly/yearly insurance payment
#6
What is 'open enrollment' in the context of health insurance?
The period during which individuals can enroll in or change their health insurance coverage
ExplanationPeriod for enrollment/change in coverage
#7
What is 'in-network' coverage in a health insurance policy?
Coverage for medical services received within the network of approved providers
ExplanationCoverage within approved providers network
#8
Which of the following is typically NOT covered in a basic health insurance policy?
Cosmetic surgery
ExplanationCosmetic surgery not covered
#9
What does 'out-of-pocket maximum' mean in a health insurance policy?
The maximum amount the insured must pay annually before the insurer covers expenses
ExplanationMaximum annual payment by insured
#10
What is the purpose of 'coordination of benefits' in health insurance?
To determine the primary insurer when an individual is covered by more than one health insurance plan
ExplanationDetermining primary insurer in multiple plans
#11
What does 'network' refer to in a health insurance policy?
A group of hospitals and healthcare providers that have contracted with the insurer
ExplanationGroup of contracted hospitals/providers
#12
What is 'lifetime maximum' in a health insurance policy?
The maximum amount the insurer pays over the insured's lifetime
ExplanationMaximum amount paid over lifetime
#13
What is 'medically necessary' in the context of health insurance?
Medical treatment that is appropriate and consistent with the diagnosis
ExplanationAppropriate treatment as per diagnosis
#14
What is 'prior authorization' in health insurance?
A requirement for the insured to obtain approval from the insurer before certain medical services are provided
ExplanationApproval needed before certain services
#15
What is 'medical underwriting' in the context of health insurance?
The process of determining the premium based on individual health status
ExplanationDetermining premium based on health status
#16
What is 'explanation of benefits (EOB)' in health insurance?
A statement that outlines what medical treatments and services were paid for on the insured's behalf
ExplanationStatement of paid medical services
#17
What is 'annual out-of-pocket maximum' in a health insurance policy?
The maximum amount the insured must pay annually before the insurer begins to cover expenses
ExplanationMaximum annual payment by insured
#18
What is 'co-insurance' in a health insurance policy?
The percentage of covered expenses paid by the insured
ExplanationPercentage of expenses paid by insured
#19
What is a 'guaranteed issue' in health insurance?
A provision in the policy that guarantees coverage regardless of health status
ExplanationCoverage guaranteed regardless of health