Free Medical Plans Practice Questions
Kentucky Accident & Health exam — 92 practice questions.
Subtopics: HMO, PPO, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Primary care physician, HSA, Coordination of benefits, Newborn coverage, Newborn notification, Maternity stay, Dependent coverage options, Guaranteed renewability, Market withdrawal notice, Grace period 17A, Cancellation notice, Second opinion, Direct access OB/GYN, Prompt pay, 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:
Receive most care through the plan's network and a primary care physician
HMOs emphasize network care coordinated through a primary care physician, with limited out-of-network coverage.
2. Compared with an HMO, a preferred provider organization (PPO) generally offers:
Greater freedom to use out-of-network providers at a higher cost
A PPO lets members use out-of-network providers at higher out-of-pocket cost while offering lower costs in-network.
3. The deductible in a medical plan is the amount the insured must:
Pay out of pocket before the plan begins to pay
The deductible is the amount the insured pays out of pocket before the plan starts paying covered expenses.
4. In a medical plan with 80/20 coinsurance, after the deductible the insured generally pays:
20 percent of covered charges up to the out-of-pocket limit
With 80/20 coinsurance, the plan pays 80 percent and the insured pays 20 percent of covered charges until the out-of-pocket limit 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.
