Free Medical Plans Practice Questions
Tennessee Accident & Health exam — 91 practice questions.
Subtopics: HMO, PPO, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Health savings account, ACA requirements, Major medical, Newborn coverage, Prompt pay, External review, Mental health parity, Telehealth, Fee-for-service, Stop-loss, 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, Children's coverage, Prescription drugs
Read the Medical Plans study guide
Sample questions & answers
1. An HMO that requires members to use network providers and select a primary care physician emphasizes:
Gatekeeper PCP and network care
HMOs use managed care, typically requiring a primary care gatekeeper and in-network providers.
2. Compared with an HMO, a PPO generally:
Allows out-of-network care at a higher cost share
A PPO allows members to use out-of-network providers, usually at higher cost sharing, with more flexibility than an HMO.
3. The amount an insured must pay before the health plan begins to pay is the:
Deductible
The deductible is the amount the insured pays out of pocket before the plan starts paying covered expenses.
4. After the deductible, the percentage of covered costs an insured shares with the insurer, such as 20 percent, is:
Coinsurance
Coinsurance is the percentage of covered costs the insured pays after the deductible 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.
