Free Medical Plans Practice Questions
South Dakota Accident & Health exam — 99 practice questions.
Subtopics: Health maintenance organization, Preferred provider organization, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Health savings account, Basic hospital expense, Comprehensive major medical, Dependent age, Disabled dependent, Newborn coverage, Alcoholism coverage, Diabetes coverage, Chiropractic, Maternity stay, Telehealth, Abuse of health insurance, Dependent enrollment, Unfair discrimination, Outline of coverage, ACA metal tiers, ACA special enrollment, ACA limits, Fee-for-service, Stop-loss, Major medical, HMO, PPO, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, Coordination of benefits, 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, Prescription drugs
Read the Medical Plans study guide
Sample questions & answers
1. A health maintenance organization (HMO) typically emphasizes:
Preventive care and use of network providers
HMOs emphasize preventive care and in-network providers, frequently coordinated through a primary care physician.
2. A preferred provider organization (PPO) generally allows a member to:
Go out of network at a higher cost share
A PPO lets members use out-of-network providers but with higher out-of-pocket costs than for in-network care.
3. In a major medical plan, the deductible is the amount the insured must:
Pay out of pocket before the plan begins paying
The deductible is the amount the insured pays out of pocket before the plan starts paying covered expenses.
4. Under an 80/20 coinsurance arrangement after the deductible, the insured generally pays:
20% of covered charges up to any out-of-pocket limit
With 80/20 coinsurance, the plan pays 80% and the insured pays 20% of covered charges until any out-of-pocket maximum is met.
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.
