Free Medical Plans Practice Questions
Texas General Lines — Life, Accident, Health & HMO exam (series InsTX-LAH05) — 60 practice questions.
Subtopics: HMO definition, HMO out of network, Evidence of coverage, ACA essential health benefits, ACA premium tax credits, ACA cost-sharing reductions, ACA employer notice, ACA employer mandate, ACA exchanges, ACA reporting, HMO cancellation, HMO grace period, HMO copayments, HMO deductibles, HMO primary care, HMO out-of-network, HMO evidence of coverage, HMO statements, 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
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Sample questions & answers
1. Under Texas law, a health maintenance organization (HMO) provides health care primarily through:
A network of contracted providers
An HMO arranges for or provides a health care plan to enrollees on a prepaid basis, generally through a delivery network of contracted physicians and providers.
2. A Texas HMO enrollee who receives covered emergency care out of network is generally:
Covered for emergency services as required by law
HMOs must cover emergency care, including from non-network providers, and enrollees are protected from balance billing for such care.
3. The document a Texas HMO issues to an enrollee describing the covered benefits is the:
Evidence of coverage
An evidence of coverage is the certificate, agreement, or contract issued to an enrollee stating the coverage to which the enrollee is entitled.
4. Under the Affordable Care Act, the essential health benefits that non-grandfathered individual and small group plans must cover include:
Mental health and substance use disorder services
ACA Section 1302 lists ten EHB categories, including mental health and substance use disorder services, preventive and wellness services, and pediatric services.
All General Lines — Life, Accident, Health & HMO 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.
