Free Medical Plans Practice Questions
Delaware Accident & Health exam — 87 practice questions.
Subtopics: HMO, PPO, Deductible, Coinsurance, Out-of-pocket maximum, Health savings account, Point of service plan, Coordination of benefits, Copayment, Hospitalized at termination, Newborn coverage, Adding a newborn, Dependent children to 26, Disabled dependent children, Clean claim processing, Fee-for-service, Stop-loss, Major medical, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, Comprehensive major medical, HIPAA portability, HIPAA privacy, Dependent to age 26, Exclusive Provider Organization, High-deductible health plan, Capitation, Closed-panel HMO, Open-panel HMO, Concurrent review, Second surgical opinion, Case management, Out-of-network cost sharing, Essential health benefits, Metal tier levels, Guaranteed issue, Medical loss ratio, Annual and lifetime limit prohibition, Health insurance marketplace, Premium tax credit, Prescription drug formulary, Major medical cost-sharing, Plan concepts, Consumer-driven plans, HDHP and HSA, Cost containment, Grievances and appeals, ACA, Emergency services, Mental health parity, Children's coverage, Prescription drugs
Read the Medical Plans study guide
Sample questions & answers
1. A health maintenance organization (HMO) typically requires members to:
Use network providers and get PCP referrals
An HMO generally requires members to use network providers and obtain referrals through a primary care physician.
2. A preferred provider organization (PPO) differs from an HMO mainly because it:
Pays for out-of-network care at higher cost sharing
A PPO lets members use out-of-network providers at greater cost while offering savings for using preferred providers.
3. In a major medical plan, the amount the insured must pay each year before the plan begins to pay is the:
Deductible
The deductible is the amount the insured pays out of pocket before the plan starts paying covered charges.
4. After the deductible is satisfied, an 80/20 coinsurance arrangement means the plan generally pays:
80% of covered charges, with the insured paying 20%
Under 80/20 coinsurance the plan pays 80 percent of covered charges and the insured pays the remaining 20 percent, up to any out-of-pocket limit.
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.
