Free Medical Plans Practice Questions
New Jersey Accident & Health exam — 90 practice questions.
Subtopics: HMO, PPO, Deductible, Coinsurance, Out-of-pocket maximum, HSA, Coordination of benefits, Copayment, Prompt pay electronic, Prompt pay paper, Provider claims, IHC guaranteed issue, IHC choice of plans, IHC renewability, Market exit notice, Community rating, IHCAP, IHCAP scope, 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, Newborn coverage, Prescription drugs
Read the Medical Plans study guide
Sample questions & answers
1. An HMO typically requires members to:
Use network providers and often a primary care physician
HMOs emphasize network providers and often require a primary care physician and referrals.
2. Compared with an HMO, a PPO generally offers:
Broader provider choice with lower cost in-network
A PPO lets members use out-of-network providers at higher cost while favoring in-network care.
3. The amount an insured pays before the health plan begins to pay is the:
Deductible
The deductible is the amount the insured pays out of pocket before the plan starts paying.
4. Under 80/20 coinsurance after the deductible, the insured generally pays:
20 percent of covered costs
With 80/20 coinsurance the plan pays 80 percent and the insured pays 20 percent of covered charges.
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.
