Free Medical Plans Practice Questions
Colorado Life, Accident & Health exam — 75 practice questions.
Subtopics: EPO, Gatekeeper, Capitation, Basic vs major medical, Flexible spending account, Indemnity plan, Usual customary reasonable, Essential health benefits, Newborn coverage, Maternity length of stay, Maternity coverage, Complications of pregnancy, Adopted children, Dependent children, Prostate screening, Hospice and home health, Diabetes coverage, Insulin cost sharing, Guaranteed renewability, Market withdrawal, Utilization review, External review, Grace period - subsidized, Grace period - unsubsidized, Termination, Health-status rating, Special enrollment, Child-only plans, Health exchange, Plan description, Claim practices, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Health reimbursement arrangement, Precertification, Basic hospital expense, Major medical, ACA metal tiers, Lifetime limits, Preventive care, 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. An exclusive provider organization (EPO) generally:
Covers care only within its network except for emergencies
An EPO covers services only when received from its network providers, except for emergency care, with little or no out-of-network benefit.
2. In a managed care plan that uses a gatekeeper, the primary care physician:
Coordinates care and provides referrals to specialists
The gatekeeper primary care physician coordinates the member's care and authorizes referrals to specialists.
3. Capitation is a payment method in which a provider is paid:
A fixed amount per member per period regardless of services used
Under capitation, the provider receives a set amount per enrolled member per period, encouraging cost-effective care.
4. Compared with a basic hospital expense plan, a major medical plan typically offers:
Higher overall limits with deductibles and coinsurance for a broad range of expenses
Major medical plans provide broad coverage with higher limits, using deductibles and coinsurance, unlike limited basic expense plans.
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.
