Free Medical Plans Practice Questions
West Virginia Accident & Health exam — 96 practice questions.
Subtopics: Health maintenance organization, Preferred provider organization, Point of service, Exclusive provider organization, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Usual customary reasonable, Capitation, Health savings account, Major medical, Flexible spending account, HMO definition, HMO advertising approval, HMO names, HMO enrollee cancellation, HMO sales disclosure, HMO violation liability, Evidence of coverage, HMO deceptive coverage, Hospital service corporation, Service corporation boards, Service corporation taxes, Fee-for-service, Stop-loss, HMO, PPO, 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, 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, Newborn coverage, Prescription drugs
Read the Medical Plans study guide
Sample questions & answers
1. A health maintenance organization (HMO) typically requires members to:
Get care from network providers, usually through a primary care physician
West Virginia's HMO Act requires an organized delivery system in which a primary care provider is designated for each subscriber and coordinates care and referrals.
2. A preferred provider organization (PPO) generally allows members to:
Use out-of-network providers at a higher cost share
A PPO lets members use out-of-network providers at a higher out-of-pocket cost while offering lower cost sharing in-network.
3. A point-of-service (POS) plan is best described as one that:
Combines HMO features with an option to go out of network at higher cost
A POS plan blends HMO coordination with an out-of-network option available at a higher cost.
4. An exclusive provider organization (EPO) generally covers:
Care only within its network, except emergencies
An EPO generally covers only in-network services except in emergencies, with no out-of-network benefits.
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.
