Free Medical Plans Practice Questions
Oklahoma Life, Accident & Health exam — 69 practice questions.
Subtopics: Point of service, Exclusive provider organization, Usual customary reasonable, Capitation, Basic surgical expense, Comprehensive major medical, Flexible spending account, Health reimbursement arrangement, Continuity of coverage, Clean claims, Defective claims, Claim refunds, Preauthorization, Verification of eligibility, Medical necessity denials, Newborn coverage, Adopted children, Mammography, Insulin cost sharing, Diabetes coverage, Maternity stays, Child immunizations, Health benefit plan defined, Prostate screening, Autism coverage, High deductible plans, Military reinstatement, Premium refund at death, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, 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
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Sample questions & answers
1. A point-of-service (POS) managed care plan is best described as one that:
Combines in-network care with the option to go out of network at higher cost
A POS plan blends HMO features with the option to use out-of-network providers at greater cost.
2. Which managed care plan generally pays only for in-network care, except in emergencies?
Exclusive provider organization
An exclusive provider organization generally covers only in-network care except emergencies; PPO and POS plans pay some out-of-network benefits at higher cost.
3. The usual, customary, and reasonable (UCR) standard is used by health plans to:
Determine the allowable charge for a service in a geographic area
UCR establishes the allowable amount for a service based on customary charges in the area.
4. Under a capitation arrangement, a provider is paid:
A set amount per member per period regardless of services used
Capitation pays the provider a fixed amount per enrolled member per period regardless of the services actually rendered.
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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.
