#1
What does the term 'premium' refer to in health insurance?
The monthly payment to the insurance company for coverage
ExplanationMonthly payment for coverage
#2
What is the primary purpose of a Health Maintenance Organization (HMO)?
To emphasize preventive care and coordinate healthcare services for its members
ExplanationEmphasizing preventive care and coordinating services
#3
What does the term 'network' refer to in health insurance?
The list of healthcare providers covered by the insurance plan
ExplanationCovered healthcare providers list
#4
What is the role of a Primary Care Physician (PCP) in managed care?
To coordinate and manage all aspects of an individual's healthcare needs
ExplanationCoordination and management of healthcare needs
#5
What is 'prior authorization' in health insurance?
The process of getting approval from the insurance company before receiving certain medical services or medications
ExplanationApproval process before certain medical services
#6
What is a deductible in health insurance?
The amount an individual pays out-of-pocket for healthcare services before the insurance coverage kicks in
ExplanationInitial out-of-pocket payment
#7
What is 'co-insurance' in health insurance?
The percentage of costs of a covered healthcare service that an individual pays (e.g., 20% of the allowed amount) after paying the deductible
ExplanationPercentage of covered costs paid after deductible
#8
What is the purpose of a Health Savings Account (HSA) in the United States?
To allow individuals to save for qualified medical expenses on a pre-tax basis
ExplanationPre-tax savings for medical expenses
#9
What is the 'out-of-pocket maximum' in health insurance?
The maximum amount of money the insured individual will have to pay out-of-pocket in a policy period
ExplanationMaximum out-of-pocket expenses
#10
What is 'medically necessary' in the context of health insurance coverage?
Healthcare services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine
ExplanationEssential healthcare meeting medical standards
#11
What is 'pre-existing condition' in the context of health insurance?
A condition that existed before the individual's health insurance coverage began
ExplanationExisting condition before coverage