Free Medical Plans Practice Questions
Washington Accident & Health exam — 100 practice questions.
Subtopics: HMO, PPO, Copayment, Point of service, Preventive care, Network, Health replacement, Fixed payment disclosure, HCSC definition, HMO services, HMO rates, HMO forms, Newborn coverage, Dependent age, Child enrollment, HCSC discrimination, Plan nondiscrimination, Maternity, Independent review, ACA metal levels, ACA dependent coverage, Fee-for-service, Deductible, Stop-loss, Major medical, POS, Gatekeeper, Preauthorization, Utilization review, 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, Out-of-pocket maximum, 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 defining feature of a health maintenance organization (HMO) plan is that it:
Emphasizes a network and often a primary care gatekeeper
HMOs emphasize coordinated care within a network, frequently using a primary care physician as a gatekeeper for referrals.
2. Compared with an HMO, a preferred provider organization (PPO) generally:
Allows out-of-network care at higher cost sharing
A PPO lets members use out-of-network providers, usually at higher cost sharing than in-network care.
3. A fixed dollar amount an HMO member pays at the time of a covered office visit is a:
Copayment
A copayment is a set dollar charge the member pays for a covered service at the time of care.
4. A point-of-service (POS) plan is best described as one that:
Blends HMO and PPO features
A POS plan combines HMO-style gatekeeping with the option to go out of network like a PPO, at higher cost.
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.
