Quantum Health Core Training Modules
Questions with Complete Solutions
(Latest 2025)
The money that the employee (and typically your employer)
pays for access to insurance coverage. If purchased through
the employer, this money is typically taken directly out of the
employee's paycheck per the frequency determined by the
employer (monthly, bi-weekly, weekly, etc.) - Correct
Answers ✅Premium
A fixed dollar amount a covered member is responsible for
paying out of pocket during the plan year before the
insurance begins to pay for covered services. Plans may have
both a separate individual and family deductible and may
differ for services provided by an INN physician or OON
physician. - Correct Answers ✅Deductible
A fixed dollar amount a covered member is responsible for
paying to the provider at the time of service. Copays are
mostly used for office visits to the PCP, specialist, Urgent
Care, and ER, but only if the plan is designed with a copay
option. - Correct Answers ✅Copay
The percentage of costs shared by the patient and the
insurance plan typically after the member's deductible is met.
These amounts can vary based on utilizing an INN provider
vs. OON provider. Providers can ask for the members portion
to be paid at the time of service, but sometimes is deferred
by the provider's office until the claim has been processed
and the exact amount identified. - Correct Answers
✅Coinsurance
, Quantum Health Core Training Modules
Questions with Complete Solutions
(Latest 2025)
The total maximum amount that a covered member of family
member is responsible for paying out-of-pocket towards
medical services within a calendar or plan year. The out-of-
pocket (OOP) expense usually includes the plan deductible,
what the member pays for co-insurance, and (if applicable)
copays. Once the OOP Maximum has been met, the plan will
cover 100% of allowable medical expenses by an INN
provider for the rest of the calendar or plan year. - Correct
Answers ✅OOP MAX (Out-of-Pocket Maximum)
Healthcare services that are not covered by the plan. -
Correct Answers ✅Exclusions
When limitations are applied to a plan, the plan will not pay
benefits once the limitations is reached, or the criteria is not
met. (Example: "Covers 60 visits per plan year for physical,
occupational, and speech therapy combined.") - Correct
Answers ✅Benefit Limitations/Maximums
The maximum amount a provider will be paid for a service.
The rate is based on their contract with the network. Benefits
are paid against the "allowed amount" not the actual
"charged amount." INN providers cannot balance bill
members for the difference between the provider's charged
amount and the maximum allowed amount for covered
services.
Questions with Complete Solutions
(Latest 2025)
The money that the employee (and typically your employer)
pays for access to insurance coverage. If purchased through
the employer, this money is typically taken directly out of the
employee's paycheck per the frequency determined by the
employer (monthly, bi-weekly, weekly, etc.) - Correct
Answers ✅Premium
A fixed dollar amount a covered member is responsible for
paying out of pocket during the plan year before the
insurance begins to pay for covered services. Plans may have
both a separate individual and family deductible and may
differ for services provided by an INN physician or OON
physician. - Correct Answers ✅Deductible
A fixed dollar amount a covered member is responsible for
paying to the provider at the time of service. Copays are
mostly used for office visits to the PCP, specialist, Urgent
Care, and ER, but only if the plan is designed with a copay
option. - Correct Answers ✅Copay
The percentage of costs shared by the patient and the
insurance plan typically after the member's deductible is met.
These amounts can vary based on utilizing an INN provider
vs. OON provider. Providers can ask for the members portion
to be paid at the time of service, but sometimes is deferred
by the provider's office until the claim has been processed
and the exact amount identified. - Correct Answers
✅Coinsurance
, Quantum Health Core Training Modules
Questions with Complete Solutions
(Latest 2025)
The total maximum amount that a covered member of family
member is responsible for paying out-of-pocket towards
medical services within a calendar or plan year. The out-of-
pocket (OOP) expense usually includes the plan deductible,
what the member pays for co-insurance, and (if applicable)
copays. Once the OOP Maximum has been met, the plan will
cover 100% of allowable medical expenses by an INN
provider for the rest of the calendar or plan year. - Correct
Answers ✅OOP MAX (Out-of-Pocket Maximum)
Healthcare services that are not covered by the plan. -
Correct Answers ✅Exclusions
When limitations are applied to a plan, the plan will not pay
benefits once the limitations is reached, or the criteria is not
met. (Example: "Covers 60 visits per plan year for physical,
occupational, and speech therapy combined.") - Correct
Answers ✅Benefit Limitations/Maximums
The maximum amount a provider will be paid for a service.
The rate is based on their contract with the network. Benefits
are paid against the "allowed amount" not the actual
"charged amount." INN providers cannot balance bill
members for the difference between the provider's charged
amount and the maximum allowed amount for covered
services.
