Free Medical Plans Practice Questions
New Mexico Accident & Health exam (series 18-26) — 88 practice questions.
Subtopics: Home health care option, Preexisting conditions, Claim payment time, External review, Deductible math, Out-of-pocket maximum, Copayment, HMO, PPO, Indemnity, Mammogram mandate, Early intervention benefit, Prompt payment, Manual clean claims, HMO producer license, Medicaid as payer, Fee-for-service, Deductible, Stop-loss, Major medical, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, Coordination of benefits, 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. New Mexico requires insurers issuing hospital or major medical expense policies to make available a home health care option covering at least how many home visits per insured per year?
100 visits
The required home health care option must cover at least 100 home visits per insured per year, each up to four hours of services.
2. Under current New Mexico and federal rules a comprehensive major medical plan generally may not:
Deny coverage based on a preexisting condition
Current rules generally prohibit denying or excluding comprehensive major medical coverage based on preexisting conditions.
3. New Mexico prompt-payment rules generally require a health insurer to pay or deny a clean claim within a set number of days to avoid:
Statutory interest on late payment
New Mexico requires a health plan to pay interest of 1.5 percent a month on clean claims not paid within 30 days (electronic) or 45 days (manual) of receipt.
4. A New Mexico insured who disagrees with a health insurer's denial of a covered service generally has the right to:
Request an independent external review
New Mexico provides an external review process so insureds may have adverse benefit determinations independently reviewed.
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.
