#1
What does the term 'premium' refer to in medical insurance?
The amount paid by the insured to the insurance company for coverage
ExplanationInsurance payment by insured
#2
Which of the following best describes 'co-payment' in medical insurance?
A fixed amount the insured pays for covered services
ExplanationFixed patient payment
#3
What is 'deductible' in medical insurance?
The amount the insured must pay before the insurance company covers the rest
ExplanationInitial patient payment
#4
What does 'coinsurance' mean in medical insurance terminology?
The percentage of covered expenses the insured pays after meeting the deductible
ExplanationPercentage payment by insured
#5
What is the 'Explanation of Benefits (EOB)' statement in medical insurance?
A summary of medical expenses paid by the insured and the insurance company
ExplanationSummary of expenses
#6
What does 'in-network' mean in the context of medical insurance?
Healthcare providers who have a contract with the insurance company
ExplanationContracted providers
#7
What is a 'pre-existing condition' in medical insurance?
A condition that was diagnosed before the start of the insurance coverage
ExplanationPre-existing diagnosis
#8
In medical insurance, what does 'out-of-pocket maximum' signify?
The maximum amount the insured is required to pay during a policy period
ExplanationMaximum patient liability
#9
What is the purpose of 'prior authorization' in medical insurance?
To obtain approval from the insurance company for certain medical services
ExplanationApproval for services
#10
What does 'underwriting' involve in the context of medical insurance?
The process of assessing risk and determining premium rates
ExplanationRisk assessment process
#11
What is 'network adequacy' in medical insurance?
The extent to which healthcare providers accept insurance plans
ExplanationProvider acceptance
#12
What is 'utilization review' in medical insurance?
The process of reviewing the necessity and appropriateness of medical care
ExplanationReviewing medical necessity