Louisiana Insurance Life, Health, and Accident Exam Questions and Verified Answers
Graded A+ 2026/27
Prepaid Medical Plans - Payments are made continuously regardless of services provided
(Services are PrePaid regardless if the "insured" utilizes the service or not)
Specified Coverages Medical Plan - Limits services to one illness or group of coverage
(Specifies what is covered)
Comprehensive Care Medical Plan - Provides coverage for most types of medical
expenses
Benefit Schedule Medical Plan - States exact coverages under a plan and given costs
What are the 4 providers available under a Medical Plan? - 1. Major Medical Insurance
2. Health Care Services Organization (HMO)
3. Preferred Provider Organization (PPOs)
4. Point-of-Service Plans (POS)
What are the Benefits of a Major Medical Insurance medical plan? - - High maximum
limits
- blanket coverage
- deductibles paid up front
- cost is shared after meeting deductibles
,What kind of medical plan is an HMO and what are the benefits of an HMO medical plan? -
HMO - Health Care Service Organization
- preventive care
- prepaid basis
- limited to service area
- basic benefit services: hospital inpatient, physician, outpatient medical, preventive, urgent care,
emergency, diagnostic laboratory, out of area coverage
- optional benefits: long term care, nursing services, home healthcare, prescription drugs,
dental/vision care, mental health care, substance abuse service
Wha kind of medical plan is a PPO and what are the benefits of a PPO medical plan? -
PPO - Preferred Provider Organization
- Physicians are paid on a fee of service basis
- No PCP referrals
- Members can use any physician they choose, but are encouraged to use approved physicians
who have previously agreed upon fees
What is a POS medical plan and what are the benefits of a POS medical plan? - POS -
Point-of-Service Plan
- Combination of HMO and PPO plans
,- Employees not locked into one plan; allowed to choose depending on the need for medical
services
- Non-member physicians are paid service fee; patient pays higher co-insurance
What does a Cost Saving Service cost containment plan offer? - - Preventative Care
- Hospitalization alternatives
- Second opinions
- Pre admission testing
- Catastrophic case management
- Risk Sharing
- High Quality of care
What are the benefits of the Affordable Care Act (ACA)? - - Mandates preventative,
educational, and community based health care
- Premium rates may be based on geographic rating area, family composition, age, and tobacco
use
- Premium may be based on geographic rating area, family composition, age, and tobacco use
- Children covered until age 26
- Each state sets up affordable insurance exchanges (market place)
What are the four metal levels/plan coverages in a ACA plan and what percentage would the
"insurer" cover under each metal? - 1. bronze : 60%
2. Silver : 70%
, 3. Gold : 80%
4. Platinum : 90%
What are the options of a Utilization management cost containment plain and their benefits? -
- Prospective Review : Claim information submitted before treatment
- Retrospective Review : Claim information submitted after treatment
- Concurrent Review : Insured's hospital stay monitored and planned for release
What does a managed care cost containment option offer? - - Financial incentives for
using approved providers and procedures
- Primary focus on preventive care
- Improved case management through utilization review
- Controlled length of hospital stay
What are the requirements for a Mental Health Parity and Addiction Equity Act? - -
Required coverage parity for mental health benefits
- For larger groups (50 ee or more)
- Deductibles, copayments, and treatment limitations cannot be more restrictive than medical
benefits.
- Cannot require separate cost sharing requirements
What is the difference between an insured and a subscriber? - Insured - people covered by
insurance
Subscriber - (participants/members) people signed up for pre-paid health plans such as HMOs
Graded A+ 2026/27
Prepaid Medical Plans - Payments are made continuously regardless of services provided
(Services are PrePaid regardless if the "insured" utilizes the service or not)
Specified Coverages Medical Plan - Limits services to one illness or group of coverage
(Specifies what is covered)
Comprehensive Care Medical Plan - Provides coverage for most types of medical
expenses
Benefit Schedule Medical Plan - States exact coverages under a plan and given costs
What are the 4 providers available under a Medical Plan? - 1. Major Medical Insurance
2. Health Care Services Organization (HMO)
3. Preferred Provider Organization (PPOs)
4. Point-of-Service Plans (POS)
What are the Benefits of a Major Medical Insurance medical plan? - - High maximum
limits
- blanket coverage
- deductibles paid up front
- cost is shared after meeting deductibles
,What kind of medical plan is an HMO and what are the benefits of an HMO medical plan? -
HMO - Health Care Service Organization
- preventive care
- prepaid basis
- limited to service area
- basic benefit services: hospital inpatient, physician, outpatient medical, preventive, urgent care,
emergency, diagnostic laboratory, out of area coverage
- optional benefits: long term care, nursing services, home healthcare, prescription drugs,
dental/vision care, mental health care, substance abuse service
Wha kind of medical plan is a PPO and what are the benefits of a PPO medical plan? -
PPO - Preferred Provider Organization
- Physicians are paid on a fee of service basis
- No PCP referrals
- Members can use any physician they choose, but are encouraged to use approved physicians
who have previously agreed upon fees
What is a POS medical plan and what are the benefits of a POS medical plan? - POS -
Point-of-Service Plan
- Combination of HMO and PPO plans
,- Employees not locked into one plan; allowed to choose depending on the need for medical
services
- Non-member physicians are paid service fee; patient pays higher co-insurance
What does a Cost Saving Service cost containment plan offer? - - Preventative Care
- Hospitalization alternatives
- Second opinions
- Pre admission testing
- Catastrophic case management
- Risk Sharing
- High Quality of care
What are the benefits of the Affordable Care Act (ACA)? - - Mandates preventative,
educational, and community based health care
- Premium rates may be based on geographic rating area, family composition, age, and tobacco
use
- Premium may be based on geographic rating area, family composition, age, and tobacco use
- Children covered until age 26
- Each state sets up affordable insurance exchanges (market place)
What are the four metal levels/plan coverages in a ACA plan and what percentage would the
"insurer" cover under each metal? - 1. bronze : 60%
2. Silver : 70%
, 3. Gold : 80%
4. Platinum : 90%
What are the options of a Utilization management cost containment plain and their benefits? -
- Prospective Review : Claim information submitted before treatment
- Retrospective Review : Claim information submitted after treatment
- Concurrent Review : Insured's hospital stay monitored and planned for release
What does a managed care cost containment option offer? - - Financial incentives for
using approved providers and procedures
- Primary focus on preventive care
- Improved case management through utilization review
- Controlled length of hospital stay
What are the requirements for a Mental Health Parity and Addiction Equity Act? - -
Required coverage parity for mental health benefits
- For larger groups (50 ee or more)
- Deductibles, copayments, and treatment limitations cannot be more restrictive than medical
benefits.
- Cannot require separate cost sharing requirements
What is the difference between an insured and a subscriber? - Insured - people covered by
insurance
Subscriber - (participants/members) people signed up for pre-paid health plans such as HMOs
