#1
Which of the following is a common provision in a health insurance policy?
Deductible
ExplanationAmount a policyholder pays out of pocket before insurance coverage kicks in.
#2
What does the term 'co-payment' refer to in health insurance?
A fixed amount paid by the insured for covered services
ExplanationSpecified amount paid by the insured for each medical service.
#3
Which federal program provides health insurance coverage for individuals aged 65 and older?
Medicare
ExplanationFederal health insurance program primarily for seniors.
#4
Which federal program provides health insurance coverage for low-income individuals and families?
Medicaid
ExplanationFederal and state program providing health coverage to low-income individuals.
#5
Which federal program provides health insurance coverage for military personnel and their families?
Tricare
ExplanationHealthcare program for military personnel, retirees, and their families.
#6
Which federal program provides health insurance coverage for children from low-income families?
CHIP
ExplanationProgram providing health coverage to children in low-income families.
#7
Which of the following is NOT typically covered in a health insurance policy?
Cosmetic surgery
ExplanationElective procedures not considered medically necessary.
#8
What is the purpose of a 'lifetime maximum benefit' in a health insurance policy?
To limit the total amount the insurance company will pay over the insured's lifetime
ExplanationCeiling on the total benefits paid by the insurer over the lifetime of the insured.
#9
What is the purpose of a 'grace period' in a health insurance policy?
To allow policyholders additional time to pay their premiums without coverage lapsing
ExplanationTime after premium due date where coverage remains active.
#10
Which of the following is NOT typically covered under a health insurance policy's preventive care benefits?
Hospitalization
ExplanationMedical services provided for illnesses or injuries, not preventive in nature.
#11
What is the purpose of a 'network' in a health insurance policy?
To determine which healthcare providers are covered by the policy
ExplanationGroup of medical professionals and facilities that contract with insurers.
#12
Which of the following is typically covered under a health insurance policy's emergency care benefits?
Urgent care visits
ExplanationImmediate medical care for acute conditions or injuries.
#13
What does 'in-network' mean in the context of health insurance?
Healthcare providers who have agreed to provide services at a discounted rate
ExplanationMedical providers who have a contract with the insurer, typically offer lower costs.
#14
In health insurance, what does 'pre-existing condition' usually refer to?
A health condition that existed before the policy's effective date
ExplanationMedical condition diagnosed before the insurance coverage begins.
#15
What is 'coinsurance' in a health insurance policy?
The percentage of covered expenses the insured must pay after meeting the deductible
ExplanationShare of costs paid by the policyholder after deductible, usually a percentage.
#16
What is the purpose of 'exclusions' in a health insurance policy?
To specify what services are not covered under the policy
ExplanationList of medical services or conditions not covered by the policy.
#17
What is the purpose of 'out-of-pocket maximum' in a health insurance policy?
To limit the total amount the insured has to pay for covered services in a policy period
ExplanationCap on the total amount the policyholder is required to pay for covered services.
#18
What is the purpose of 'endorsements' in a health insurance policy?
To modify or add coverage to the standard policy
ExplanationAdditional provisions added to a policy, adjusting or expanding coverage.
#19
What is the purpose of a 'guaranteed renewable' provision in a health insurance policy?
To ensure the policy can't be canceled by the insurer as long as premiums are paid
ExplanationAssurance that policyholders can renew their policy without being denied coverage.
#20
What is the purpose of 'coordination of benefits' in a health insurance policy?
To determine how multiple insurance policies pay for the same claim
ExplanationProcess of ensuring that medical claims are appropriately handled when multiple insurances are involved.