Health Insurance Policies: Types, Coverage, and Costs

Question 1

Which type of health insurance is intended for a specific group of people, such as employees of a company or members of an organization?

Accepted Answer

Group health insurance

Answer

Private health insurance

Answer

Government health insurance

Answer

Supplemental health insurance

Question 2

Which of the following is NOT a standard component of an insurance policy?

Accepted Answer

Network of Providers

Answer

Monthly Premium

Answer

Deductible Amount

Answer

Coinsurance Percentage

Question 3

Which type of health insurance plan is most commonly provided by employers in the United States?

Accepted Answer

Managed care plans (HMOs, PPOs, POS plans)

Answer

Traditional plans

Answer

Fee-for-service plans

Answer

High-deductible health plans (HDHPs)

Question 4

Which of the following expenses is generally **NOT** covered by health insurance?

Accepted Answer

Cosmetic surgery

Answer

Routine physical exams

Answer

Prescription medication

Answer

Emergency room visits

Question 5

Which of the following is a pre-existing condition that may affect health insurance coverage?

Accepted Answer

A condition that was diagnosed and treated in the past but is still ongoing and requires active management

Answer

A newly diagnosed chronic disease that has not yet been treated

Answer

A condition that was diagnosed and treated in the past and is now fully resolved

Answer

A condition that is suspected to develop in the future based on family history or other risk factors

Question 6

Which of the following is NOT a type of health insurance plan offered by private insurance companies?

Accepted Answer

Medicare

Answer

HMO

Answer

PPO

Answer

EPO

Question 7

Which managed care plan typically requires you to choose a primary care physician (PCP) for referrals to specialists?

Accepted Answer

Health Maintenance Organization (HMO)

Answer

Preferred Provider Organization (PPO)

Answer

Point-of-Service (POS) Plan

Answer

Traditional Fee-for-Service Plan

Question 8

In a health insurance policy, what is the set amount that the insured must pay for covered medical expenses before the insurance company starts paying?

Accepted Answer

Deductible

Answer

Copayment

Answer

Coinsurance

Answer

Out-of-pocket maximum

Question 9

Which of the following is a type of health insurance plan designed to cover specific medical expenses, rather than comprehensive coverage?

Accepted Answer

Supplemental Insurance

Answer

Health Maintenance Organization (HMO)

Answer

Preferred Provider Organization (PPO)

Answer

Point-of-Service (POS) Plan

Question 10

Which of the following is not a component of a health insurance policy?

Accepted Answer

Credit score

Answer

Premium

Answer

Deductible

Answer

Copayment

Question 11

Which of the following is NOT a type of health insurance plan commonly available in the United States?

Accepted Answer

Individual Retirement Account (IRA)

Answer

Health Maintenance Organization (HMO)

Answer

Preferred Provider Organization (PPO)

Answer

Exclusive Provider Organization (EPO)

Question 12

Which of the following are government-sponsored health insurance programs in the United States?

Accepted Answer

Medicare

Accepted Answer

Medicaid

Answer

Private Health Insurance

Answer

Employer-Sponsored Health Insurance

Question 13

Which of the following is not a type of health insurance plan?

Accepted Answer

Long-term care insurance

Answer

HMO

Answer

PPO

Answer

EPO

Question 14

Which health insurance plan type typically covers basic services like doctor's visits and preventive care, and has lower premiums than other plans?

Accepted Answer

HMO

Answer

PPO

Answer

POS

Answer

EPO

Question 15

Which of the following is NOT a traditional type of health insurance plan?

Accepted Answer

Short-term Health Insurance

Answer

HMO

Answer

PPO

Answer

POS

Question 16

Which of the following is NOT included in the calculation of a policyholder's out-of-pocket expenses?

Accepted Answer

Premium

Answer

Deductible

Answer

Coinsurance

Answer

Copayment

Question 17

What part of an insurance policy specifies the coverage and restrictions of the plan?

Accepted Answer

Policy Provisions

Answer

Policyholder

Answer

Premium

Answer

Exclusions

Question 18

Which of the following is NOT a common type of health insurance plan offered in the United States?

Accepted Answer

Dental Insurance

Answer

Preferred Provider Organization (PPO)

Answer

Exclusive Provider Organization (EPO)

Answer

Health Maintenance Organization (HMO)

Question 19

Which part of a health insurance policy describes the medical services and treatments that are covered?

Accepted Answer

Benefit schedule

Answer

Deductible

Answer

Copayment

Answer

Lifetime maximum

Question 20

Which of the following is **NOT** a type of health insurance plan?

Accepted Answer

Flexible Spending Account (FSA)

Answer

Health Maintenance Organization (HMO)

Answer

Medicare

Answer

Preferred Provider Organization (PPO)

Question 21

Which feature distinguishes a Preferred Provider Organization (PPO) from other health insurance plans?

Accepted Answer

Offers a wider selection of providers, including out-of-network options at an additional cost

Answer

Limits access to providers outside the PPO network

Answer

Mandates referrals for specialist visits

Answer

Features lower premiums and deductibles with limited provider options and higher copayments

Question 22

Which of these is NOT a required part of a health insurance policy?

Accepted Answer

Expiration date

Answer

Deductible

Answer

Premium

Answer

Coinsurance

Question 23

Which of the following is **not** a type of health insurance policy that covers medical expenses?

Accepted Answer

Disability insurance

Answer

Managed care

Answer

Fee-for-service

Answer

Long-term care insurance

Question 24

Under the Affordable Care Act, which provision ensures that individuals with preexisting conditions cannot be denied health insurance coverage?

Accepted Answer

Guaranteed issue

Answer

Essential health benefits

Answer

Medicaid expansion

Answer

Pre-existing conditions exclusion

Question 25

What is the regular payment required to maintain coverage under an insurance policy?

Accepted Answer

Premium

Answer

Deductible

Answer

Coinsurance

Question 26

Which of these is a common feature of most insurance policies?

Accepted Answer

A policy term

Accepted Answer

Coverage limits

Accepted Answer

Deductibles

Answer

A low premium

Question 27

Within HMOs (Health Maintenance Organizations), which network type is a defining characteristic?

Accepted Answer

Closed panel network, limiting members to a specific group of contracted providers

Answer

Open access network, allowing members to visit any healthcare provider

Answer

Tiered network, categorizing providers into levels based on cost-sharing

Answer

Preferred provider network, offering financial incentives for using network providers

Question 28

What is the primary purpose of a health insurance policy?

Accepted Answer

To create a legal contract outlining the rules and terms of insurance coverage.

Answer

To document the history of health insurance.

Answer

To provide detailed instructions on submitting insurance claims.

Answer

To promote the benefits of different insurance plans.

Question 29

In a health insurance policy, what is the maximum amount of money an insured person is required to pay out-of-pocket for covered medical expenses within a plan year?

Accepted Answer

Out-of-Pocket Maximum

Answer

Deductible

Answer

Copayment

Answer

Coinsurance

Question 30

In health insurance, what is the term for the initial amount of medical expenses that the insured must pay before the insurance coverage starts to reimburse them?

Accepted Answer

Deductible

Answer

Premium

Answer

Copay

Question 31

What sets government-backed health insurance programs (like Medicare and Medicaid) apart from private health insurance plans in the United States?

Accepted Answer

Eligibility based on age, income, or disability

Answer

Lower monthly premiums than private insurance

Answer

Larger provider networks than private insurance

Question 32

Which of the following is not a type of health insurance plan offered by insurance companies?

Accepted Answer

Dental Insurance Plan

Answer

Managed Care Plan

Answer

Traditional Indemnity Plan

Question 33

Which of the following is NOT a type of managed care plan?

Accepted Answer

Traditional fee-for-service plan

Answer

Health Maintenance Organization (HMO)

Answer

Preferred Provider Organization (PPO)

Answer

Point-of-Service (POS) Plan

Question 34

Which health insurance policy provides extensive coverage for various healthcare services, including hospital stays, doctor visits, and medications?

Accepted Answer

Comprehensive plan

Answer

Catastrophic plan

Answer

Preferred provider organization (PPO)

Answer

Health maintenance organization (HMO)

Question 35

What is a primary benefit of private health insurance compared to government-sponsored health insurance?

Accepted Answer

Wider selection of healthcare providers and medical services

Answer

Guaranteed coverage for pre-existing conditions

Answer

Reduced out-of-pocket medical costs

Answer

Fewer government regulations and oversight

Question 36

When comparing a health insurance plan with a higher deductible to one with a lower deductible, which of the following is likely to be lower?

Accepted Answer

Monthly premiums

Answer

Copays

Answer

Coinsurance

Question 37

Which of the following is an example of a situation where you would pay a coinsurance payment?

Accepted Answer

Covering the remaining balance after meeting your deductible

Answer

Visiting a doctor for an annual checkup

Answer

Paying the first $1,000 of your medical expenses

Answer

Paying a set fee for a prescription drug

Question 38

Which type of health insurance plan allows you to see any doctor you want without requiring a referral?

Accepted Answer

PPO

Answer

HMO

Answer

EPO

Answer

HDHP

Question 39

Which type of health insurance plan typically has lower monthly premiums but higher out-of-pocket expenses?

Accepted Answer

HDHP

Answer

HMO

Answer

PPO

Answer

EPO

Question 40

Government regulations exist to protect consumers in the health insurance industry. Which of the following is NOT a benefit of government regulation in this industry?

Accepted Answer

Guarantees coverage for all medical expenses.

Answer

Ensures access to affordable healthcare.

Answer

Prevents insurance companies from denying coverage for pre-existing conditions.

Question 41

Which type of health insurance plan requires you to pay all costs until you reach the deductible?

Accepted Answer

High Deductible Health Plan (HDHP)

Answer

Preferred Provider Organization (PPO)

Answer

Health Maintenance Organization (HMO)

Answer

Exclusive Provider Organization (EPO)

Question 42

What is the set amount you must pay out-of-pocket before your health insurance starts covering costs?

Accepted Answer

Deductible

Answer

Copayment

Answer

Coinsurance

Answer

Out-of-pocket maximum

Question 43

After meeting your deductible, what percentage of covered medical expenses are you responsible for paying?

Accepted Answer

Coinsurance

Answer

Copayment

Answer

Deductible

Answer

Out-of-pocket maximum

Question 44

Which of the following is NOT considered a form of cost-sharing in health insurance?

Accepted Answer

Monthly premium

Answer

Deductible

Answer

Copayment

Answer

Coinsurance

Question 45

What is the maximum amount you will have to pay for covered medical expenses in a calendar year, including deductibles, copays, and coinsurance?

Accepted Answer

Out-of-pocket maximum

Answer

Deductible

Answer

Copayment

Answer

Coinsurance

Question 46

What is the term for comparing different health insurance plans to find the best one for your needs?

Accepted Answer

Health insurance shopping

Answer

Health insurance negotiation

Answer

Health insurance billing

Answer

Health insurance management

Question 47

Which type of health insurance plan requires you to receive care from providers within a specific network?

Accepted Answer

Health Maintenance Organization (HMO)

Answer

Preferred Provider Organization (PPO)

Answer

Exclusive Provider Organization (EPO)

Answer

Point-of-Service (POS)

Question 48

Which government program provides health insurance coverage to low-income individuals and families?

Accepted Answer

Medicaid

Answer

Medicare

Answer

Social Security

Answer

CHIP

Question 49

When selecting a health insurance policy, which of the following is NOT a key factor to consider?

Accepted Answer

Your personal beliefs

Answer

Coverage

Answer

Cost

Answer

Provider network

Question 50

What is the definition of coinsurance?

Accepted Answer

A percentage of the cost of covered services that the policyholder pays after meeting the deductible

Answer

A fixed amount that the policyholder pays for each covered service

Answer

The maximum amount that the insurance company will pay for a covered service

Answer

The amount that the policyholder pays for preventive care services

Question 51

Which of the following is an advantage of an HMO compared to other types of health insurance policies?

Accepted Answer

Lower monthly premiums

Answer

More comprehensive coverage

Answer

Greater flexibility in choosing providers

Answer

No deductibles or copays

Question 52

What is the primary purpose of obtaining a pre-authorization before receiving certain medical services?

Accepted Answer

To obtain approval from the insurance company prior to receiving specific medical services

Answer

To guarantee that the insurance company will cover the cost of medical services

Answer

To reduce the cost of medical services

Answer

To speed up the claim processing time

Question 53

Which of the following is **NOT** a type of health insurance policy?

Accepted Answer

Disability

Answer

Managed Care

Answer

Indemnity

Answer

Preferred Provider Organization (PPO)

Question 54

What is a deductible?

Accepted Answer

The amount you pay out-of-pocket before your insurance coverage begins

Answer

The percentage of medical expenses you pay after meeting your deductible

Answer

The maximum amount you pay for covered medical expenses each year

Answer

The amount you pay for each doctor's visit or prescription

Question 55

Which of the following is typically a lower cost option: Health Maintenance Organization (HMO) or PPO?

Accepted Answer

HMO

Answer

PPO

Question 56

What is the primary purpose of a Health Savings Account (HSA)?

Accepted Answer

To save money for future medical expenses

Answer

To pay for current medical expenses

Answer

To invest in stocks and bonds

Answer

To cover the cost of long-term care

Question 57

Which of the following is an example of a preventive care service?

Accepted Answer

Annual physical exam

Answer

Surgery for a broken leg

Answer

Treatment for a cold

Answer

MRI scan for a suspected brain tumor

Question 58

What is subrogation in health insurance?

Accepted Answer

The insurance company's right to seek reimbursement from another party responsible for an injury or illness

Answer

The policyholder's right to recover damages from the insurance company

Answer

The process of changing health insurance plans

Answer

The right of a medical provider to bill the patient directly

Question 59

What is the primary role of a medical assistant in health insurance billing?

Accepted Answer

Coding and submitting claims

Answer

Processing payments from insurance companies

Answer

Determining patient eligibility for coverage

Answer

Providing customer service to patients

Question 60

How can health insurance affect the relationship between patients and their doctors?

Accepted Answer

Health insurance can create conflicts of interest.

Answer

Health insurance has no impact on the relationship.

Answer

Health insurance always improves communication.

Answer

Health insurance always speeds up diagnosis.

Question 61

What is a key benefit for patients choosing a Preferred Provider Organization (PPO) over a Health Maintenance Organization (HMO)?

Accepted Answer

Access to a wider network of healthcare providers

Answer

Lower monthly premiums

Answer

No need for referrals to see specialists

Answer

Lower deductibles and out-of-pocket costs

Question 62

How does health insurance coverage affect individuals' decisions to use preventive care services?

Accepted Answer

Health insurance generally increases the use of preventive care services.

Answer

Health insurance generally decreases the use of preventive care services.

Answer

Health insurance generally has no significant impact on the use of preventive care services.

Question 63

Which type of health insurance plan offers lower monthly premiums but higher out-of-pocket costs?

Accepted Answer

High-deductible health plan (HDHP)

Answer

Point-of-service (POS) plan

Answer

Preferred provider organization (PPO)

Answer

Health maintenance organization (HMO)

Question 64

What is the out-of-pocket expense you must pay before your insurance coverage begins?

Accepted Answer

Deductible

Answer

Coinsurance

Answer

Out-of-pocket maximum

Answer

Copay