Free Medical Plans Practice Questions
Iowa Life, Accident & Health exam — 56 practice questions.
Subtopics: Exclusive provider organization, Capitation, Usual customary and reasonable, Precertification, Drug formulary, Flexible spending account, Health reimbursement arrangement, Major medical, Newborn coverage, Adopted children, Mammography, Diabetes training, Maternity stays, Clean claim, Hawki, ACA essential benefits, ACA mental health, No Surprises Act, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Basic hospital expense, ACA metal tiers, Essential health benefits, Lifetime limits, Preventive care, Special enrollment, HDHP and HSA, Managed care, Usual, reasonable and customary, Basic surgical, Short-term medical, Vision insurance
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Sample questions & answers
1. An exclusive provider organization (EPO) is best described as a plan that:
Covers only network care, except emergencies
An EPO covers services only when received from network providers, except in emergencies.
2. Under a capitation arrangement in managed care a provider is paid:
A fixed amount per member, regardless of use
Capitation pays the provider a set amount per member per period, regardless of how much care each member uses.
3. A usual, customary, and reasonable (UCR) charge is used by insurers to:
Set a fair payment level for an area
UCR reflects the prevailing charge for a service in an area and helps set the allowable payment.
4. Precertification (prior authorization) in a managed care plan requires the insured to:
Get approval before some nonemergency care
Precertification requires advance approval for specified nonemergency procedures to confirm medical necessity.
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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.
