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Free Medical Plans Practice Questions

South Carolina Accident & Health exam — 45 practice questions.

Subtopics: HMO, PPO, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Major medical, Health savings account, Coordination of benefits, 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

Read the Medical Plans study guide

Sample questions & answers

1. A health maintenance organization (HMO) generally:

Emphasizes a network with a primary care 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:

Allows out-of-network care at a higher cost to the insured

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:

The amount the insured pays before the plan begins paying

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 of covered costs shared by insurer and insured after the deductible

Coinsurance is the percentage split of covered costs between the insurer and insured after the deductible is met.

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Practice: Medical Plans

Take a randomized, timed-style practice test. Answer choices are shuffled and your results are scored instantly with an explanation for every question.

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 Pennsylvania Insurance Department and the exam administrator before relying on it.