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  4. Medical Plans

Free Medical Plans Practice Questions

South Dakota Accident & Health exam — 45 practice questions.

Subtopics: Health maintenance organization, Preferred provider organization, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Health savings account, Basic hospital expense, Comprehensive major medical, Fee-for-service, Stop-loss, Major medical, HMO, PPO, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, Coordination of benefits, 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) typically emphasizes:

Preventive care and use of network providers, often with a primary care physician

HMOs emphasize preventive care and in-network providers, frequently coordinated through a primary care physician.

2. A preferred provider organization (PPO) generally allows a member to:

Use out-of-network providers, usually at a higher cost share

A PPO lets members use out-of-network providers but with higher out-of-pocket costs than for in-network care.

3. In a major medical plan, the deductible is the amount the insured must:

Pay out of pocket before the plan begins paying

The deductible is the amount the insured pays out of pocket before the plan starts paying covered expenses.

4. Under an 80/20 coinsurance arrangement after the deductible, the insured generally pays:

20% of covered charges up to any out-of-pocket limit

With 80/20 coinsurance, the plan pays 80% and the insured pays 20% of covered charges until any out-of-pocket maximum 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 Insurance Department and the exam administrator before relying on it.