Free Medical Plans Practice Questions
New Jersey Life, Accident & Health exam — 55 practice questions.
Subtopics: Indemnity plan, Gatekeeper, Capitation, Formulary, Preventive care, POS plan, Utilization review, Network discount, 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, 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, Special enrollment, HDHP and HSA, Managed care, Usual, reasonable and customary, Basic surgical, Short-term medical, Vision insurance
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Sample questions & answers
1. A traditional indemnity (fee-for-service) health plan generally:
Lets the insured choose any provider and pays a share of charges
Indemnity plans let the insured choose providers and reimburse a share of covered charges.
2. In an HMO, the primary care physician often acts as a gatekeeper to:
Coordinate care and authorize specialist referrals
The PCP gatekeeper coordinates care and controls access to specialists through referrals.
3. Capitation reimburses a provider by paying:
A fixed amount per member regardless of services used
Under capitation a provider receives a set payment per member per period regardless of utilization.
4. A prescription drug formulary is:
A list of covered drugs by tier
A formulary is the plan's list of covered medications, often arranged in cost-sharing tiers.
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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.
