#1
What is a deductible in health insurance?
The amount the insured must pay out-of-pocket before the insurance company pays for covered services.
The amount the insurance company must pay for covered services.
The maximum amount of money the insured will have to pay for covered services in a year.
The monthly premium paid to maintain health insurance coverage.
#2
Which of the following is not a type of managed care organization (MCO)?
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Point of Service Plan (POS)
Fee-for-Service Plan (FFS)
#3
Which federal law requires group health plans to provide a notice of privacy practices to individuals?
Health Insurance Portability and Accountability Act (HIPAA)
Affordable Care Act (ACA)
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Americans with Disabilities Act (ADA)
#4
Which of the following is not a factor typically considered when determining health insurance premiums?
Age
Gender
Marital status
Ethnicity
#5
Which of the following is not typically covered by health insurance?
Preventive care services
Emergency medical treatment
Cosmetic surgery
Prescription drugs
#6
Which of the following statements best describes a copayment (copay)?
A fixed amount paid by the insured for covered services at the time of service.
An annual fee paid to maintain health insurance coverage.
A percentage of covered expenses that the insured must pay after reaching the deductible.
A fee charged for services rendered outside the network.
#7
What is 'capitation' in the context of managed care?
A system where providers are paid a fixed amount per patient enrolled, regardless of the services provided.
A plan that offers coverage for catastrophic events only.
A type of co-payment for each service rendered.
A system where providers are paid based on the number of services they provide.
#8
Which federal program provides health insurance coverage for individuals aged 65 and older?
Medicaid
CHIP
Medicare
TRICARE
#9
What is the main purpose of utilization management in managed care?
To minimize unnecessary healthcare services and control costs.
To maximize profits for healthcare providers.
To provide unlimited access to healthcare services for all patients.
To increase administrative burdens on healthcare providers.
#10
Which of the following statements best describes a Health Savings Account (HSA)?
A tax-advantaged account that individuals can use to pay for qualified medical expenses.
A government-funded program that provides free healthcare to low-income individuals.
An insurance plan that covers only hospitalization costs.
A type of managed care organization (MCO) that emphasizes preventive care.
#11
Which of the following is a characteristic of a High Deductible Health Plan (HDHP)?
It typically has lower deductibles and out-of-pocket limits compared to other plans.
It is only available to individuals under the age of 18.
It does not require the insured to pay any out-of-pocket costs.
It allows individuals to contribute pre-tax dollars to a Health Savings Account (HSA).
#12
What is a health maintenance organization (HMO) gatekeeper?
A device used to restrict access to healthcare facilities.
A primary care physician responsible for coordinating and managing a patient's care.
A type of insurance policy that covers preventive care only.
An administrative role within insurance companies.
#13
What is 'co-insurance' in health insurance?
A fixed amount the insured must pay for covered services.
A percentage of covered expenses that the insured must pay after reaching the deductible.
An additional fee for services rendered outside the network.
The maximum amount the insured will have to pay for covered services in a year.
#14
What is 'prior authorization' in the context of health insurance?
A process where the insurance company pays for services after they are rendered.
A requirement for patients to seek approval from their insurance company before certain services are covered.
A system where patients pay a fixed fee at the time of service.
A type of managed care plan.
#15
What is 'medical underwriting' in the context of health insurance?
A process of evaluating an individual's health status to determine eligibility and premiums.
A type of emergency medical treatment covered by insurance.
A process of reviewing medical claims for accuracy and completeness.
A system where healthcare providers negotiate rates with insurance companies.
#16
What is a health reimbursement arrangement (HRA)?
A type of health insurance plan that covers only hospitalization costs.
A tax-advantaged account funded by an employer to reimburse employees for qualified medical expenses.
A government-funded program that provides healthcare services to low-income individuals.
An insurance plan that offers coverage for catastrophic events only.
#17
What is 'balance billing' in the context of health insurance?
A billing method used by healthcare providers to charge patients for the remaining balance after insurance reimbursement.
A system where patients pay a fixed amount at the time of service.
A requirement for patients to seek approval from their insurance company before certain services are covered.
A process of negotiating rates between healthcare providers and insurance companies.
#18
What is 'adverse selection' in the context of health insurance?
A situation where individuals with lower healthcare needs are more likely to enroll in insurance plans.
A process of evaluating an individual's health status to determine eligibility and premiums.
A system where insurance companies negotiate rates with healthcare providers.
A requirement for patients to obtain referrals before accessing specialized care.
#19
What is the purpose of coordination of benefits (COB) in health insurance?
To prevent individuals from receiving duplicate payments for the same medical expenses.
To regulate the prices of healthcare services.
To provide coverage for preventive care services only.
To establish a network of healthcare providers.