#1
What is a deductible in health insurance?
The amount you pay for covered healthcare services before your insurance plan starts to pay
ExplanationUpfront cost paid by the insured before insurance coverage kicks in.
#2
Which of the following is not typically covered by health insurance?
Cosmetic surgery
ExplanationNon-essential, elective procedures often not covered by insurance.
#3
What is the purpose of a health insurance premium?
To transfer risk from an individual to the insurance company
ExplanationPayment made to the insurance company to manage and assume the individual's health risk.
#4
Which federal program provides health insurance for people age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease?
Medicare
ExplanationGovernment program offering health coverage for specified demographics and medical conditions.
#5
What is a health insurance network?
A group of healthcare providers who have agreed to provide services to insured individuals at reduced rates
ExplanationCollaboration of healthcare providers offering discounted services to insured individuals.
#6
What is a copayment (copay) in health insurance?
A fixed amount you pay for a covered healthcare service, usually when you receive the service
ExplanationSet fee paid by the insured at the time of receiving covered medical services.
#7
What does COBRA stand for in health insurance?
Consolidated Omnibus Budget Reconciliation Act
ExplanationLegislation providing temporary continuation of health coverage after job loss.
#8
What is a Health Savings Account (HSA) in relation to health insurance?
A tax-advantaged savings account available to individuals enrolled in high-deductible health plans
ExplanationTax-advantaged account for individuals with high-deductible health plans to save for medical expenses.
#9
What is the purpose of a pre-existing condition clause in health insurance policies?
To limit the amount of coverage provided for certain medical conditions
ExplanationProvision restricting coverage for existing medical conditions to manage risk for the insurer.
#10
What is the role of a health insurance broker?
To help individuals and businesses find suitable health insurance plans
ExplanationFacilitates the selection of appropriate health insurance plans for individuals and businesses.
#11
What is a Health Maintenance Organization (HMO) in health insurance?
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO
ExplanationCoverage restricted to in-network healthcare providers under an HMO.
#12
What is the difference between an HMO and a PPO in health insurance?
HMOs typically require referrals to see specialists, while PPOs allow patients to see specialists without referrals
ExplanationHMOs mandate specialist referrals, while PPOs offer direct access to specialists.
#13
What is a health insurance formulary?
A list of prescription drugs covered by a health insurance plan
ExplanationCatalog of prescription medications covered by a given health insurance plan.
#14
What is a Health Flexible Spending Account (FSA) in relation to health insurance?
An account that allows employees to set aside pre-tax dollars to pay for eligible healthcare expenses
ExplanationPre-tax account for employees to fund eligible healthcare expenses.
#15
What is a COBRA continuation coverage?
Temporary continuation of health coverage for certain people after employment ends
ExplanationTemporary extension of health coverage post-employment termination.