Free Medical Plans Practice Questions
New Mexico Life, Accident & Health exam (series 18-27) — 51 practice questions.
Subtopics: Pre-authorization, Essential benefits, Open enrollment, Network adequacy, Emergency services, Grievances, Premium rating, Claims appeal time, Mammogram mandate, Early intervention benefit, Prompt payment, Manual clean claims, HMO producer license, Medicaid as payer, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Health reimbursement arrangement, Flexible spending account, Capitation, Precertification, Basic hospital expense, Major medical, 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 New Mexico health plan requirement that certain non-emergency services be approved before they are provided is called:
Prior authorization
Prior authorization requires plan approval before certain non-emergency services to confirm medical necessity and coverage.
2. New Mexico individual major medical plans subject to current rules generally must cover:
A defined set of essential health benefits
Comprehensive individual major medical plans must cover the defined essential health benefit categories under current rules.
3. A New Mexico consumer generally may enroll in an individual major medical plan outside open enrollment only if the consumer:
Experiences a qualifying life event
A qualifying life event, such as marriage or loss of coverage, triggers a special enrollment period outside open enrollment.
4. New Mexico network adequacy rules require a managed care plan to:
Maintain a sufficient number and type of providers for enrollees
Network adequacy rules require plans to maintain enough providers of appropriate types so enrollees have reasonable access to care.
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.
