Page 1 of 68
HEALTH INSURANCE EXAMS STUDY PACK WITH
COMPLETE SOLUTIONS | QUESTIONS AND VERIFIED
ANSWERS | 100% CORRECT ( 2025 UPDATES)
health insurance .....ANSWER.....broadly covers many risks, such
as the loss of income because of disability; the costs of medical
care and treatment; and the costs of care not covered by
government plans
hazards .....ANSWER.....a condition that increases the number of
or the severity of losses
managed care providers .....ANSWER.....provide their insured
with health care directly through a network of health care
providers
government plans .....ANSWER.....in relation to health insurance,
government plans are a third health insurance option after
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commercial insurers and managed care plans, government plans
include Medicare, Medicaid, Social Security, and Worker's Comp
Medicare .....ANSWER.....a federal government program that
provides hospital and medical insurance to people age 65 and
older.
Medicaid .....ANSWER.....a state public assistance program (with
some federal support) that provides health care benefits for the
poor of any age.
Social Security (Disability) .....ANSWER.....provides disability
income to people under age 65 who become totally disabled.
State workers' compensation .....ANSWER.....provides benefits to
workers who become sick or injured because of a job-related
event.
group plan sponsor .....ANSWER.....the policy owner and premium
payor
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Patient Protection and Affordable Care Act (PPACA)
.....ANSWER.....Affordable Care Act (ACA)
EHBs .....ANSWER.....Essential health benefits
coinsurance .....ANSWER.....a provision in most major medial
policies that requires the insured to pay a certain percentage of
the covered costs in addition to the deductible, usually 20-30%
catastrophic plans .....ANSWER.....available to persons who are
younger than 30 years and cannot afford any other health
insurance, or who are willing to accept minimal coverage in
exchange for a high deductible and a low premium.
deductible .....ANSWER.....a stated sum of money that the insured
must pay before any major medical policy benefits are paid
Medical Los Ratio (MLR) .....ANSWER.....The PPACA compels
insurers to spend a minimum percentage of premium dollars on
providing health care coverage and improving the quality of
health care. The MLR ensures consumers that their premiums are
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spent primarily on health care coverage, and not on insurers'
administrative and overhead business costs.
Individual Coverage Mandate .....ANSWER.....Beginning in 2014,
all individuals are required to obtain health insurance coverage
or pay a penalty. The penalty will start at $95 per person for
2014 and increase each year. (It increases to $325 in 2015 and
to $695, or up to 2.5 percent of income, in 2016.) Families will
pay half the penalty amount for children, up to a cap of $2,250
per family. Individuals may be eligible for an exemption from
the penalty if they cannot obtain affordable coverage.q
Employer Coverage Mandate .....ANSWER.....Employers with 50
or more employees that do not offer a medical plan face a
penalty if any of those employees receives a government
subsidy, of any form, to buy individual coverage. The penalty
amount is up to $2,000 annually for each full-time employee.
Moreover, employers who do offer coverage, but whose
HEALTH INSURANCE EXAMS STUDY PACK WITH
COMPLETE SOLUTIONS | QUESTIONS AND VERIFIED
ANSWERS | 100% CORRECT ( 2025 UPDATES)
health insurance .....ANSWER.....broadly covers many risks, such
as the loss of income because of disability; the costs of medical
care and treatment; and the costs of care not covered by
government plans
hazards .....ANSWER.....a condition that increases the number of
or the severity of losses
managed care providers .....ANSWER.....provide their insured
with health care directly through a network of health care
providers
government plans .....ANSWER.....in relation to health insurance,
government plans are a third health insurance option after
,Page 2 of 68
commercial insurers and managed care plans, government plans
include Medicare, Medicaid, Social Security, and Worker's Comp
Medicare .....ANSWER.....a federal government program that
provides hospital and medical insurance to people age 65 and
older.
Medicaid .....ANSWER.....a state public assistance program (with
some federal support) that provides health care benefits for the
poor of any age.
Social Security (Disability) .....ANSWER.....provides disability
income to people under age 65 who become totally disabled.
State workers' compensation .....ANSWER.....provides benefits to
workers who become sick or injured because of a job-related
event.
group plan sponsor .....ANSWER.....the policy owner and premium
payor
,Page 3 of 68
Patient Protection and Affordable Care Act (PPACA)
.....ANSWER.....Affordable Care Act (ACA)
EHBs .....ANSWER.....Essential health benefits
coinsurance .....ANSWER.....a provision in most major medial
policies that requires the insured to pay a certain percentage of
the covered costs in addition to the deductible, usually 20-30%
catastrophic plans .....ANSWER.....available to persons who are
younger than 30 years and cannot afford any other health
insurance, or who are willing to accept minimal coverage in
exchange for a high deductible and a low premium.
deductible .....ANSWER.....a stated sum of money that the insured
must pay before any major medical policy benefits are paid
Medical Los Ratio (MLR) .....ANSWER.....The PPACA compels
insurers to spend a minimum percentage of premium dollars on
providing health care coverage and improving the quality of
health care. The MLR ensures consumers that their premiums are
, Page 4 of 68
spent primarily on health care coverage, and not on insurers'
administrative and overhead business costs.
Individual Coverage Mandate .....ANSWER.....Beginning in 2014,
all individuals are required to obtain health insurance coverage
or pay a penalty. The penalty will start at $95 per person for
2014 and increase each year. (It increases to $325 in 2015 and
to $695, or up to 2.5 percent of income, in 2016.) Families will
pay half the penalty amount for children, up to a cap of $2,250
per family. Individuals may be eligible for an exemption from
the penalty if they cannot obtain affordable coverage.q
Employer Coverage Mandate .....ANSWER.....Employers with 50
or more employees that do not offer a medical plan face a
penalty if any of those employees receives a government
subsidy, of any form, to buy individual coverage. The penalty
amount is up to $2,000 annually for each full-time employee.
Moreover, employers who do offer coverage, but whose
