Free Medical Plans Practice Questions
West Virginia Life, Accident & Health exam — 55 practice questions.
Subtopics: Primary care physician, Precertification, Health reimbursement arrangement, Stop-loss, Basic hospital expense, Surgical schedule, Drug formulary, 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, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Flexible spending account, Capitation, 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
Read the Medical Plans study guide
Sample questions & answers
1. In a traditional HMO, the primary care physician often acts as a 'gatekeeper,' meaning the PCP:
Coordinates care and provides referrals to specialists
In a gatekeeper HMO model, the primary care physician coordinates care and must refer members to specialists.
2. Precertification (prior authorization) in a managed care plan requires that:
Certain services be approved in advance as medically necessary
Precertification requires advance approval of certain services to confirm medical necessity before they are provided.
3. An employer-funded account that reimburses employees for qualified medical expenses, with no employee contributions, is a:
Health reimbursement arrangement (HRA)
An HRA is funded by the employer to reimburse employees for qualified medical expenses under the plan's terms.
4. A stop-loss feature in a major medical plan is designed to:
Cap out-of-pocket costs, after which the plan pays 100%
A stop-loss provision caps the insured's out-of-pocket expense, after which the plan pays 100% of covered charges.
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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.
