Free Medical Plans Practice Questions
Kansas Accident & Health exam (series 12-KS-02) — 90 practice questions.
Subtopics: HMO, PPO, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Health savings account, Stop-loss, Preexisting conditions, Mental illness coverage, Substance use coverage, Outpatient mental health, Maternity stays, ACA navigators, Essential health benefits, Fee-for-service, Major medical, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, Coordination of benefits, 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, 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, Newborn coverage, Prescription drugs
Read the Medical Plans study guide
Sample questions & answers
1. Which description best fits a health maintenance organization (HMO)?
A network plan that typically uses a primary care gatekeeper
HMOs emphasize network providers and often use a primary care physician as a gatekeeper to specialist care.
2. A preferred provider organization (PPO) generally:
Offers lower cost for network providers while still allowing out-of-network care
A PPO gives the best benefits for using network providers but still pays, at a lower level, for out-of-network care.
3. In a major medical plan, the deductible is:
The amount the insured pays before the plan begins to pay
The deductible is the amount the insured must pay out of pocket before the plan starts paying covered expenses.
4. An 80/20 coinsurance provision means that, after the deductible, the plan pays:
80 percent and the insured pays 20 percent
Under 80/20 coinsurance, the plan pays 80 percent and the insured pays 20 percent until the out-of-pocket maximum is reached.
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.
