Free Medical Plans Practice Questions
Oregon Life, Accident & Health exam (series 12-03) — 51 practice questions.
Subtopics: Point of service, Exclusive provider organization, Usual customary reasonable, Basic surgical expense, Comprehensive major medical, Flexible spending account, Health reimbursement arrangement, Basic hospital expense, Benefit limits, Newborn coverage, Adopted children, Dependent age, Disabled dependents, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Capitation, Precertification, 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:
Allows out-of-network care at more cost
A POS plan blends HMO features with the option to use out-of-network providers at greater cost.
2. A health plan member enrolled in an Exclusive Provider Organization (EPO) sees an out-of-network doctor for a routine, non-emergency visit. Generally, the EPO will:
Pay nothing for the visit
An EPO generally covers care only from network providers, except emergencies, so a routine out-of-network visit is typically not covered.
3. The usual, customary, and reasonable (UCR) standard is used by health plans to:
Set the allowable charge for an area
UCR establishes the allowable amount for a service based on customary charges in the area.
4. A basic surgical expense plan typically pays for covered surgeries according to:
A schedule of procedure limits
Basic surgical expense coverage pays per a surgical schedule that lists maximum benefits for specific procedures.
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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.
