Free Medical Plans Practice Questions
Ohio Accident & Health exam (series 11-45) — 100 practice questions.
Subtopics: External review, Health insuring corporations, HMO, PPO, Deductible, Coinsurance, Out-of-pocket maximum, HSA, Dependent to age 26, Disabled dependent, Newborn coverage, Newborn notice, Adopted children, Mammography, Supplemental breast screening, Prior authorization, External review effect, HIC basic services, Closed panel plan, HIC nonrenewal, Unfair discrimination, Child health supervision, HIC identification card, HIC evidence of coverage, Fee-for-service, Stop-loss, Major medical, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, Copayment, Coordination of benefits, Comprehensive major medical, HIPAA portability, HIPAA privacy, 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, 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. An Ohio consumer who disagrees with a health plan's final denial of a covered service may request:
An external review of the decision
Ohio provides external review rights for adverse benefit determinations.
2. In Ohio, a health insuring corporation (HIC) is regulated as an entity that:
Arranges health care for enrollees, like an HMO
HICs (HMO-type entities) arrange health services and are regulated by the Department.
3. A plan that provides care through a network and typically requires a primary care physician referral is a(n):
HMO
HMOs use networks and often gatekeeper primary care physicians.
4. A plan that allows out-of-network care at higher cost without a referral is a:
PPO
PPOs let members use out-of-network providers at higher cost-sharing.
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.
