Free Medical Plans Practice Questions
Alabama Life, Accident & Health exam — 57 practice questions.
Subtopics: HMO prepaid care, Network discounts, Referral requirement, Capitation, HDHP, Preventive care, Utilization review, Out-of-pocket maximum, Newborn coverage, Prostate screening, HMO producers, HMO complaint system, HMO enrollment, HMO regulation, Prompt pay, Auto injury claims, Claim denials, Precertification penalties, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Health reimbursement arrangement, Flexible spending account, Precertification, Basic hospital expense, Major medical, ACA metal tiers, Essential health benefits, Lifetime limits, Special enrollment, HDHP and HSA, Managed care, Usual, reasonable and customary, Basic surgical, Short-term medical, Vision insurance
Read the Medical Plans study guide
Sample questions & answers
1. HMOs are distinguished from indemnity plans primarily by their emphasis on:
Prepaid, coordinated care delivered through a network
HMOs provide prepaid, coordinated care through a defined network, unlike open indemnity reimbursement.
2. PPO members generally pay less when they:
Use in-network preferred providers
PPOs negotiate discounts with preferred providers, so in-network care costs the member less.
3. Compared with a PPO, an HMO is more likely to require:
A primary care physician referral to see specialists
HMOs commonly require a PCP referral for specialist care, while PPOs usually do not.
4. Under capitation, an HMO pays a provider:
A fixed amount per member per period regardless of services used
Capitation pays providers a set amount per enrolled member per period, shifting some utilization risk to providers.
All Life, Accident & Health topics
Practice: Medical Plans
Answer choices are shuffled every time, and every question comes with an explanation.
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
