Free Medical Plans Practice Questions
North Carolina Accident & Health exam — 90 practice questions.
Subtopics: HMO, PPO, Capitation, Preventive care, HSA, Coordination of benefits, Network gatekeeper, Disabled dependent children, Newborn coverage, Adopted children, Child enrollment, Direct OB-GYN access, Mammogram coverage, PSA coverage, Diabetes coverage, Preferred provider plans, Utilization review, External review, Fee-for-service, Deductible, Stop-loss, Major medical, POS, Gatekeeper, Preauthorization, Copayment, Comprehensive major medical, HIPAA portability, HIPAA privacy, Dependent to age 26, Exclusive Provider Organization, High-deductible health plan, 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, Out-of-pocket maximum, 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:
Use network providers and often select a primary care physician
HMOs emphasize coordinated care through a network and often require a primary care physician and referrals, generally offering little or no out-of-network coverage except emergencies.
2. Compared with an HMO, a PPO generally:
Covers out-of-network care at a higher member cost
PPOs offer more flexibility, covering both in-network and out-of-network care, with the insured paying more for using non-preferred providers.
3. In an HMO, capitation refers to:
A fixed per-member payment to the provider
Capitation is a payment arrangement in which providers receive a set amount per enrolled member per period, regardless of how many services that member uses.
4. Most managed care plans encourage preventive care because:
Early care can reduce more costly treatment later
Managed care plans emphasize preventive services such as screenings and immunizations to detect problems early and reduce more expensive treatment later.
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.
