Health Insurance Test Study Guide Questions and Answers Latest Version Rated A+

Health Insurance Test Study Guide Questions and Answers Latest Version Rated A+ What is the main goal of health insurance? To help pay for medical expenses What is a premium in health insurance? The amount paid regularly to keep the policy active What does a deductible mean in a health insurance plan? The amount the insured must pay before the insurer starts to pay What is a copayment? A fixed fee paid by the insured for specific healthcare services What does coinsurance mean? The percentage of costs shared between the insured and insurer after the deductible is met 2 Who usually provides group health insurance? Employers What is a network in health insurance? A group of doctors and facilities that agree to provide services at reduced rates What is an out-of-pocket maximum? The most an insured person will pay in a year for covered services What is a primary care physician? A doctor who coordinates general healthcare and referrals What does HMO stand for? Health Maintenance Organization What is the main feature of an HMO plan? Requires referrals and offers lower out-of-pocket costs 3 What is a PPO in health insurance? Preferred Provider Organization What is the main benefit of a PPO plan? More flexibility in choosing doctors and specialists What is a health savings account (HSA)? A tax-advantaged account for medical expenses linked to high-deductible plans Who owns the funds in an HSA? The individual policyholder What is a flexible spending account (FSA)? An employer-owned account used for qualified medical expenses What is a pre-existing condition? A health problem that existed before the start of coverage 4 What does the term "in-network" mean? Providers and facilities that have agreements with the insurer What does "out-of-network" mean? Providers who do not have a contract with the insurer What is a benefit period? The time during which benefits are payable under the policy What is an explanation of benefits (EOB)? A statement from the insurer showing what was paid and what the patient owes What is the purpose of the Affordable Care Act? To expand access to health insurance and reduce costs What is a lifetime maximum benefit?