Prepare for the Health Insurance license exam with this study guide and practice questions. This covers medical insurance, disability, long-term care, and group health plans.
Q: Health insurance:
Answer: Made up of third party payer assumes most health care costs.
Q: Medicare
Answer: Government funded for 65+, disabilities, and ESRD (end-stage renal disease)
Q: Medicare (Part A)
Answer: Inpatient care in hospitals, nursing facilities, and some home health.
Q: Medicare (Part B)
Answer: Optional coverage
Q: Medicare: DRG (Diagnosis-related grouping)
Answer: Reimbursement based on diagnosis
Q: Medicaid
Answer: Health coverage for people with low income or limited resources (programs between federal and state government)
Q: Plans
Answer: Cover most or all of the cost of health care
Q: Co-pay
Answer: shared cost…… set amount
Q: Co-insurance
Answer: Shared percent…… a percent of the total bill.
Q: Formulary
Answer: Official list of prescriptions given
Q: Premium
Answer: Amount paid regularly (monthly). High premiums have low deductibles.
Q: Deductible
Answer: Money you pay yourself for health services before insurance begins to pay for your costs.
Q: Out of pocket maximum
Answer: Max limit on how much you pay for services after 100% of fees are paid.
Q: Lifetime maximum benefit
Answer: Highest amount in which the insurance company will pay.
Q: Affordable Healthcare Act “Obamacare”
Answer: Lifetime maximum benefit can be overreached.Everyone can get health insurance.Enacted January 1, 2014Took effect March 31, 2014Found online at Healthcare exchange.Sliding scale…. how much you make decides how much you pay.Good for low income families.Some plans county specific(medicare, medicaid etc.)
Q: Affordable Healthcare Act Penalties
Answer: 2014: $95 or 1% of your income2015: $325 or 2% of income2016: $695 or 2.5% of income
Q: Pre-existing condition
Answer: Insurance companies used to deny coverage for previous health conditions a person had before they purchased the plan (Affordable Healthcare Act prohibits this)
Q: EOB (Explanation of Benefits)
Answer: Statement from the insurance company.What’s covered by insurance plan.How much you owe (coinsurance and deductible)
Q: Indemnity (fee for service)
Answer: Reimburses the patient and/or provider as expenses incurred.Types: Conventional indemnity, and traditional indemnity.
Q: Managed Health Insurance Plans
Answer: HMO, EPO, PPO, POS, HDHP, Catastrophic
Q: HMO (Health Maintained Organization)
Answer: Can’t go out of network.In network: limited doctors, hospitals, and other providers.Must choose Primary Care PhysicianMust be referred to other doctors by PCP.
Q: EPO (Exclusive Provider Organization)
Answer: Can’t go out o network.Larger network or providers.No PCP requiredNo referral
Q: PPO (Preferred Provider Organization)
Answer: Can go out of network (doesn’t cover a lot of the expenses)Larger network of providersNo PCP requiredNo referral
Q: POS (Point of Service/ Open ended HMO)
Answer: HMO/PPO hybridIn network service and out of network is covered
Q: HDHP (High Deductible Health Plan)
Answer: Higher deductible, and lower monthly premiums
Q: Catastrophic
Answer: Emergency coverage from unexpected medical costs.Limit on regular doctor visits.Lower premium and increased deductible
Q: Dental Insurance
Answer: Covers part or all of fees for dental services. (Annual checkups, orthodontics, and oral surgery.)
Q: Vision insurance
Answer: Covers part of all of fees for optician and optometrist services (check ups, glasses, contact lenses, and surgery)
Q: Life insurance
Answer: Financial payment to beneficiary in the event of death.Benefit can vary, depending on needs of family and individual.Employers offer life insurance to in the amount of employee’s annual salary.Policies can be purchased.
Q: Types of Life Insurance
Answer: Term Life Insurance, and Whole life insurance.
Q: Term Life insurance
Answer: Specific amount of money paid to beneficiary
Q: Whole Life insurance
Answer: Policy that allows holder of policy to draw on the insurance as a pension, and hove money go to beneficiary at the time of death.