Free Medical Plans Practice Questions
Utah Life, Accident & Health exam (series 17-03) — 72 practice questions.
Subtopics: Point of service, Maternity preauthorization, Usual customary reasonable, Capitation, Basic surgical expense, Comprehensive major medical, Flexible spending account, Responsibility for payment, Claims handling, Emergency services, Maternity stay, Newborn coverage, Adopted children, Dependent age, Disabled dependents, Child support orders, Former spouse, Uniform application, Health information card, Individual renewability, Open enrollment, HMO name, Medicaid, Cancellation refunds, Coordination of benefits, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Health reimbursement arrangement, 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. A Utah insured received preauthorization for prenatal care under a policy with maternity benefits. The policy may NOT then require:
Additional preauthorization for the delivery
After initial preauthorization for prenatal care, a policy may not require additional preauthorization for customary maternity care or delivery; admission notice is not preauthorization.
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.
All Life, Accident & Health 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.
