Free Medical Plans Practice Questions
Wisconsin Life, Accident & Health exam — 73 practice questions.
Subtopics: Managed care goal, Capitation, Gatekeeper, Utilization review, Preventive care, Stop-loss, Formulary, Coordination of benefits, Dependent coverage, Handicapped children, Newborn coverage, Grandchildren, Adopted children, Mandated benefits, Provider coverage, Emergency services, Grievance, Independent review, Out-of-state providers, Types, Cost sharing, Cost containment, Point-of-service plan, Health savings account, Health reimbursement arrangement, Flexible spending account, Precertification, Basic hospital expense, Major medical, ACA metal tiers, Essential health benefits, Lifetime limits, Special enrollment, HDHP and HSA, Managed care, Usual, reasonable and customary, Basic surgical, Short-term medical, Vision insurance
Read the Medical Plans study guide
Sample questions & answers
1. A central goal of managed care plans is to:
Control costs while coordinating quality care
Managed care seeks to control costs and coordinate care through networks, utilization review, and provider arrangements.
2. Under capitation, a provider is paid:
A set amount per member, whatever is used
Capitation pays providers a fixed amount per enrolled member per period to deliver covered services.
3. In an HMO, the primary care physician often acts as a gatekeeper, meaning they:
Coordinate care and approve specialist referrals
The gatekeeper PCP coordinates the member's care and typically must authorize referrals to specialists.
4. Utilization review in a health plan is used to:
Judge whether care is necessary and appropriate
Utilization review assesses whether services are medically necessary and delivered efficiently.
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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.
