Free Medical Plans Practice Questions
Kentucky Life, Accident & Health exam — 56 practice questions.
Subtopics: Fee-for-service, Point of service, Capitation, UCR charges, Preauthorization, Formulary, Stop-loss feature, Dependent coverage, 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, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Health reimbursement arrangement, Flexible spending account, Precertification, Basic hospital expense, Major medical, 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
Read the Medical Plans study guide
Sample questions & answers
1. A traditional fee-for-service (indemnity) health plan generally:
Reimburses covered services without requiring a provider network
A fee-for-service indemnity plan reimburses covered charges without requiring the insured to use a network, unlike managed care.
2. A point-of-service (POS) plan combines features of an HMO and a PPO by letting members:
Choose in-network or out-of-network care at the time service is needed
A POS plan blends HMO and PPO features, allowing members to decide whether to use network or out-of-network care when they seek treatment.
3. Capitation is a payment method in which a provider receives:
A fixed amount per enrolled member per period regardless of services used
Under capitation, the provider is paid a set amount per member per period regardless of how many services that member uses.
4. Usual, customary, and reasonable (UCR) charges are used by a health plan to:
Determine the allowable amount the plan will pay for a service
UCR charges establish the allowable amount a plan will recognize for a given service based on prevailing charges in the area.
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.
