Free Medical Plans Practice Questions
South Carolina Accident & Health exam — 94 practice questions.
Subtopics: HMO, PPO, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Major medical, Health savings account, Coordination of benefits, Newborn coverage, Adopted children, Postpartum stay, Mastectomy stay, Mammography mandate, Mandated screenings, Breast reconstruction, Clean claim payment, Overpayment recovery, Prompt pay enforcement, Subrogation, Fee-for-service, Stop-loss, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, 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, 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 health maintenance organization (HMO) generally:
Uses a gatekeeper and prepaid care
HMOs use a defined provider network and often a primary care gatekeeper, emphasizing prepaid, managed care.
2. A preferred provider organization (PPO) typically:
Covers out-of-network care at more cost
A PPO lets members use out-of-network providers but at a higher cost share than in-network care.
3. In a major medical plan, the deductible is:
What the insured pays before the plan pays
The deductible is the amount the insured must pay out of pocket before the plan starts paying covered expenses.
4. Coinsurance in a health plan refers to:
The percentage split of costs after the deductible
Coinsurance is the percentage split of covered costs between the insurer and insured after the deductible is met.
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.
