Insurance MCQ

Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace? A. A US citizen who is incarcerated B. A US citizen living abroad C. A permanent resident lawfully present in the US D. Someone who has Medicare coverage Answer: C. A permanent resident lawfully present in the US

According to the provisions of the Patient Protection and Affordable Care Act, all of the following are required preventive care services EXCEPT A. Cervical cancer exams for all women starting at age 40 B. Diet counseling for adults C. Well-woman visits and counseling D. Screenings for autism and behavioral disorders for children Answer: A. Cervical cancer exams for all women starting at age 40

Which of the following are responsible for making premium payments in an HMO plan? A. Payors B. Subscribers C. Producers D. Insureds Answer: B. Subscribers

Maximum benefits for a major medical plan are usually lifetime A. Closed panel B. Minimums C. Maximums D. Open panel Answer: C. Maximumsd

On a major medical insurance policy, the amount that an insured must pay on a claim before the insurer will pay is known as A. Inside limit B. Coinsurance C. Deductible D. Copayment Answer: C. Deductibel

How are HMO territories typically divided? A. By where the HMO can find the least expensive physicians B. Geographic areas C. Type of physician services available D. Community rating system Answer: B. Geographic areas

An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement? A. Selective Coverage B. Limited Coverage C. Claims Saving D. Cost-containment Answer: D. Cost-containment

A man's physician submits claim information to his insurer before she actually performs a medical procedure on him. She is doing this to see if the procedure is covered under the patient's insurance plan and for how much. This is an example of A. Concurrent review B. Claims-delayed treatment C. Suspended treatment D. Prospective review Answer: D. Prospective review

A man bought an individual health insurance policy for himself. Which of the following roles does he now legally have? A. Broker B. Subscriber only C. Insured only D. Both subscriber and insured Answer: D. Both subscriber and insured

In a defined contribution plan, A. The benefit is known and the contribution is unknown B. The contribution and the benefit are unknown C. The contribution and the benefit are known D. The contribution is known and the benefit is unknown Answer: D. The contribution is known and the benefit is unknown

Which of the following is NOT the purpose of HIPAA? A. To prohibit discrimination against employees based on their health status B. To limit exclusions for pre-existing conditions C. To provide immediate coverage to new employees who had been previously covered for 18 months D. To guarantee the right to buy individual policies to eligible individuals Answer: C. To provide immediate coverage to new employees who had been previously covered for 18 months

Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy? A. An individual who was previously covered by group health insurance for 6 months is eligible B. An individual who has used up COBRA continuation coverage is eligible C. An individual who doesn't qualify for Medicare may be eligible D. The gap of coverage for eligibility is a period of 63 or less day Answer: A. An individual who was previously covered by group health insurance for 6 months is eligible

An insured's health claim internal appeal was denied. The insurer must do all of the following EXCEPT A. Notify the insured how to obtain an outside review B. Offer a payment plan C. Notify the insured about the decision in writing D. Complete the appeal in 60 days after service was received Answer: B. Offer a payment plan

A health insurance plan which involves financing, managing, and delivery of health care services and involves a group of providers who share in the financial risk of the plan or who have an incentive to deliver cost effective service, is called A. Managed care plan B. Preferred care plan C. Limited care plan D. Self-insurer Answer: A. Managed care plan

What term is used to describe when a medical caregiver contracts with a health organization to provide services to its members or subscribers, but retains the right to treat patients who are not members or subscribers? A. Indemnity contract B. Open panel C. Closed panel D. Restrictive rights Answer: B. Open panel

Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage? A. Basic medical expense plan B. Health Maintenance Organization plan C. Group dental insurance plan D. Medical-surgical expense plan Answer: B. Health Maintenance Organization plan

Which of the following is true of a PPO? A. Claim forms are completed by members on each claim B. No copayment fees are involved C. Its goal is to channel patients to providers that discount services D. The most common type of PPO is the staff model Answer: C. Its goal is to channel patients to providers that discount services

Which of the following is NOT a cost-saving service in a medical plan? A. Denial of coverage B. Preventative care C. Second surgical opinions D. Risk sharing Answer: A. Denial of coverage

Under which of the following organizations are the practicing providers compensated on a fee-for-service basis? A. Open panel B. PPO C. HMO D. Blue Cross/Blue Shield Answer: D. PPO

According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10%, what type of plan is that? A. Platinum B. Bronze C. Silver D. Gold Answer: A. Platinum