COLORADO HEALTH INSURANCE EXAM
LATEST 2025-2026 UPDATE QUESTIONS AND
ANSWERS
Basic Hospital, Medical, and Surgical Policies - Answer-Low coverage
limits, no deductibles
Major Medical Insurance - Answer-Broader coverage, higher maximum
limits, more expensive
- Supplemental major medical - back up to basic policy, insured pays
corridor deductible to begin this plan
- Comprehensive major medical - stand alone plan, benefits available
after deductible is paid
Major Medical Covered Expenses - Answer-Hospital stays, equipment,
services, ambulance service to and from hospital, emergency room care,
x-rays/radiology, prescription drugs administered in hospital,
blood/plasma, oxygen, dental services from injury, rehab, home health,
prosthetics when originally purchased, casts/splints/crutches/etc, hospice
care
, Deductibles - Answer-Insured pays up to certain amount of medical
expenses per year before coverage begins
- Family deductible - entire family pays certain amount as opposed to
each individual in the family
Coinsurance - Answer-Insured pays certain percentage of medical
expenses after deductible has been paid
Usual/Reasonable/Customary Charges - Answer-Based on geographical
area, policy will pay if the provider's charges are in line with the amount
other providers in the area charge for that service
- if provider's charge is more than the usual, reasonable, and customary
amount, the insured may be billed for difference
Individual Insurance - Answer--Anyone can apply for coverage
-Each person has a policy
-Individual can choose coverage from what's available in the market
-Individuals health is evaluated, medical exam may be required
-Coverage renewable at option of insured, sometimes insurer
-All accidents are covered regardless of when/where they occur
Group Insurance - Answer--Only group members covered, group must
meet size/purpose definitions
-One master contract, individuals given certificates as evidence of
coverage
, -Benefits essentially same for all members, choice of limited number of
packages
-Group as a whole is evaluated, no evidence of insurability required by
individual
-Group sponsor may change coverage, coverage stops when insured
leaves group
-Only off the job accidents generally covered
Dental Insurance - Answer-Helps pay dental bills, covers routine dental
care (cleanings, fillings, crowns, root canals, braces)
Accident Only Insurance - Answer-Covers accidents but not sickness or
disease
Specified Disease/Critical Illness Insurance - Answer-Covers
catastrophic/life threatening illnesses such as stroke, coma, cancer, liver
and kidney failure, paralysis, and organ or bone marrow transplants
Hospital Income (Indemnity) Insurance - Answer-Pays flat dollar
amount directly to insured as daily benefit for each day insured is
hospitalized an inpatient, insured can use payments any way they want,
may be used to pay deductible or other bills while hospitalized
Vision Insurance - Answer-Covers routine eye care exams and vision
correction, cost of glasses or contacts, usually provider needs to be in-
network
LATEST 2025-2026 UPDATE QUESTIONS AND
ANSWERS
Basic Hospital, Medical, and Surgical Policies - Answer-Low coverage
limits, no deductibles
Major Medical Insurance - Answer-Broader coverage, higher maximum
limits, more expensive
- Supplemental major medical - back up to basic policy, insured pays
corridor deductible to begin this plan
- Comprehensive major medical - stand alone plan, benefits available
after deductible is paid
Major Medical Covered Expenses - Answer-Hospital stays, equipment,
services, ambulance service to and from hospital, emergency room care,
x-rays/radiology, prescription drugs administered in hospital,
blood/plasma, oxygen, dental services from injury, rehab, home health,
prosthetics when originally purchased, casts/splints/crutches/etc, hospice
care
, Deductibles - Answer-Insured pays up to certain amount of medical
expenses per year before coverage begins
- Family deductible - entire family pays certain amount as opposed to
each individual in the family
Coinsurance - Answer-Insured pays certain percentage of medical
expenses after deductible has been paid
Usual/Reasonable/Customary Charges - Answer-Based on geographical
area, policy will pay if the provider's charges are in line with the amount
other providers in the area charge for that service
- if provider's charge is more than the usual, reasonable, and customary
amount, the insured may be billed for difference
Individual Insurance - Answer--Anyone can apply for coverage
-Each person has a policy
-Individual can choose coverage from what's available in the market
-Individuals health is evaluated, medical exam may be required
-Coverage renewable at option of insured, sometimes insurer
-All accidents are covered regardless of when/where they occur
Group Insurance - Answer--Only group members covered, group must
meet size/purpose definitions
-One master contract, individuals given certificates as evidence of
coverage
, -Benefits essentially same for all members, choice of limited number of
packages
-Group as a whole is evaluated, no evidence of insurability required by
individual
-Group sponsor may change coverage, coverage stops when insured
leaves group
-Only off the job accidents generally covered
Dental Insurance - Answer-Helps pay dental bills, covers routine dental
care (cleanings, fillings, crowns, root canals, braces)
Accident Only Insurance - Answer-Covers accidents but not sickness or
disease
Specified Disease/Critical Illness Insurance - Answer-Covers
catastrophic/life threatening illnesses such as stroke, coma, cancer, liver
and kidney failure, paralysis, and organ or bone marrow transplants
Hospital Income (Indemnity) Insurance - Answer-Pays flat dollar
amount directly to insured as daily benefit for each day insured is
hospitalized an inpatient, insured can use payments any way they want,
may be used to pay deductible or other bills while hospitalized
Vision Insurance - Answer-Covers routine eye care exams and vision
correction, cost of glasses or contacts, usually provider needs to be in-
network
