Free Medical Plans Practice Questions
Maryland Life, Accident & Health exam — 51 practice questions.
Subtopics: Point of service, Gatekeeper, Capitation, Major medical, Flexible spending account, Health reimbursement arrangement, Usual, customary, reasonable, Dental coverage, Grievance timeline, Emergency grievance, Health Advocacy Unit, Commissioner complaint decision, Clean claim payment, Provider claim deadline, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Precertification, 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
Read the Medical Plans study guide
Sample questions & answers
1. A point-of-service (POS) plan combines features of:
An HMO and a PPO
A POS plan blends HMO and PPO features, using a primary care physician but allowing out-of-network care at higher cost.
2. In a managed care 'gatekeeper' model, the primary care physician:
Coordinates care and refers to specialists
The gatekeeper (primary care physician) coordinates the member's care and must authorize referrals to specialists.
3. Under a capitation arrangement, a provider is paid:
A fixed amount per member per month
Capitation pays providers a set amount per enrolled member per month, shifting some utilization risk to the provider.
4. Major medical coverage is characterized by:
High limits with deductibles and coinsurance
Major medical provides broad coverage with high limits, typically subject to a deductible and coinsurance.
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.
