Cigna Healthspring – 2026 2027 Certifications
Exam latest update Practice Questions (Original)
EXAM 2026–2027 Latest Update Original
Questions & Answers with Detailed Rationales
Graded A+
1. What is the primary purpose of a health insurance plan?
A. To eliminate all healthcare costs
B. To provide financial protection against covered healthcare expenses
C. To guarantee a specific physician
D. To replace emergency services
Correct Answer: B. To provide financial protection against covered healthcare expenses
Rationale: Health insurance helps members manage the financial risk associated with covered
medical services. It generally does not eliminate all out-of-pocket costs.
2. What is a premium?
A. The amount a member pays for covered services at the point of care
B. A periodic amount paid to maintain insurance coverage
C. The amount paid after a claim is denied
D. The provider's negotiated rate
Correct Answer: B. A periodic amount paid to maintain insurance coverage
Rationale: A premium is the amount paid to maintain insurance coverage, typically monthly,
although payment arrangements vary by plan.
3. What is a deductible?
A. The amount the insurer always pays first
B. The amount a member generally pays for covered services before the plan begins paying
according to its deductible terms
,C. A provider's billed charge
D. A monthly premium
Correct Answer: B. The amount a member generally pays for covered services before the plan
begins paying according to its deductible terms
Rationale: A deductible is the amount a member may need to pay for covered services before
the plan begins cost-sharing for applicable services.
4. What is coinsurance?
A. A fixed dollar amount paid for a service
B. A percentage of the allowed amount that a member may owe
C. The monthly premium
D. A claim-processing fee
Correct Answer: B. A percentage of the allowed amount that a member may owe
Rationale: Coinsurance is generally expressed as a percentage, such as 20%, after applicable
plan requirements are met.
5. What is a copayment?
A. A fixed amount a member pays for a covered service
B. The annual premium
C. A provider's full billed charge
D. A deductible balance
Correct Answer: A. A fixed amount a member pays for a covered service
Rationale: A copayment is usually a specified dollar amount associated with a covered service,
although exact terms vary by plan.
6. What is an out-of-pocket maximum?
A. The maximum amount a provider can bill
B. A limit on certain covered cost-sharing expenses a member pays during a plan period
C. The maximum premium a member can pay
D. The total cost of healthcare services
,Correct Answer: B. A limit on certain covered cost-sharing expenses a member pays during a
plan period
Rationale: Once applicable member cost-sharing reaches the plan's out-of-pocket limit, the plan
generally pays 100% of covered services for the remainder of the applicable period, subject to
plan terms.
7. What is an in-network provider?
A. A provider with no relationship to the health plan
B. A provider that has contracted with the plan or network under applicable terms
C. A provider who never accepts insurance
D. A provider located outside the country
Correct Answer: B. A provider that has contracted with the plan or network under applicable
terms
Rationale: Network providers generally agree to specific contractual terms and negotiated
reimbursement arrangements.
8. Why is network status important to members?
A. It can affect access and out-of-pocket costs
B. It determines the member's age
C. It changes the member's diagnosis
D. It eliminates all deductibles
Correct Answer: A. It can affect access and out-of-pocket costs
Rationale: Using participating providers may provide members with lower cost-sharing and
access to services under network terms.
9. What is an out-of-network provider?
A. A provider that does not participate in the applicable plan network
B. A provider who has no medical license
C. A provider employed by the insurer
D. A provider who provides only emergency care
Correct Answer: A. A provider that does not participate in the applicable plan network
, Rationale: Out-of-network status means the provider does not have the applicable network
participation agreement.
10. What is a health plan's Evidence of Coverage or similar coverage document used for?
A. Describing important benefits, limitations, exclusions, and member responsibilities
B. Replacing the member ID card
C. Recording laboratory results
D. Prescribing medication
Correct Answer: A. Describing important benefits, limitations, exclusions, and member
responsibilities
Rationale: Coverage documents explain the plan's benefits and applicable rules so members
can understand how coverage works.
11. What is Medicare?
A. A federal health insurance program primarily serving eligible older adults and certain other
eligible individuals
B. A private pharmacy
C. A state driver's license program
D. A hospital billing system
Correct Answer: A. A federal health insurance program primarily serving eligible older adults
and certain other eligible individuals
Rationale: Medicare is a federal health insurance program with different parts covering
different categories of healthcare services.
12. Which Medicare part generally covers inpatient hospital services?
A. Part A
B. Part B
C. Part C only
D. Part D
Correct Answer: A. Part A
Exam latest update Practice Questions (Original)
EXAM 2026–2027 Latest Update Original
Questions & Answers with Detailed Rationales
Graded A+
1. What is the primary purpose of a health insurance plan?
A. To eliminate all healthcare costs
B. To provide financial protection against covered healthcare expenses
C. To guarantee a specific physician
D. To replace emergency services
Correct Answer: B. To provide financial protection against covered healthcare expenses
Rationale: Health insurance helps members manage the financial risk associated with covered
medical services. It generally does not eliminate all out-of-pocket costs.
2. What is a premium?
A. The amount a member pays for covered services at the point of care
B. A periodic amount paid to maintain insurance coverage
C. The amount paid after a claim is denied
D. The provider's negotiated rate
Correct Answer: B. A periodic amount paid to maintain insurance coverage
Rationale: A premium is the amount paid to maintain insurance coverage, typically monthly,
although payment arrangements vary by plan.
3. What is a deductible?
A. The amount the insurer always pays first
B. The amount a member generally pays for covered services before the plan begins paying
according to its deductible terms
,C. A provider's billed charge
D. A monthly premium
Correct Answer: B. The amount a member generally pays for covered services before the plan
begins paying according to its deductible terms
Rationale: A deductible is the amount a member may need to pay for covered services before
the plan begins cost-sharing for applicable services.
4. What is coinsurance?
A. A fixed dollar amount paid for a service
B. A percentage of the allowed amount that a member may owe
C. The monthly premium
D. A claim-processing fee
Correct Answer: B. A percentage of the allowed amount that a member may owe
Rationale: Coinsurance is generally expressed as a percentage, such as 20%, after applicable
plan requirements are met.
5. What is a copayment?
A. A fixed amount a member pays for a covered service
B. The annual premium
C. A provider's full billed charge
D. A deductible balance
Correct Answer: A. A fixed amount a member pays for a covered service
Rationale: A copayment is usually a specified dollar amount associated with a covered service,
although exact terms vary by plan.
6. What is an out-of-pocket maximum?
A. The maximum amount a provider can bill
B. A limit on certain covered cost-sharing expenses a member pays during a plan period
C. The maximum premium a member can pay
D. The total cost of healthcare services
,Correct Answer: B. A limit on certain covered cost-sharing expenses a member pays during a
plan period
Rationale: Once applicable member cost-sharing reaches the plan's out-of-pocket limit, the plan
generally pays 100% of covered services for the remainder of the applicable period, subject to
plan terms.
7. What is an in-network provider?
A. A provider with no relationship to the health plan
B. A provider that has contracted with the plan or network under applicable terms
C. A provider who never accepts insurance
D. A provider located outside the country
Correct Answer: B. A provider that has contracted with the plan or network under applicable
terms
Rationale: Network providers generally agree to specific contractual terms and negotiated
reimbursement arrangements.
8. Why is network status important to members?
A. It can affect access and out-of-pocket costs
B. It determines the member's age
C. It changes the member's diagnosis
D. It eliminates all deductibles
Correct Answer: A. It can affect access and out-of-pocket costs
Rationale: Using participating providers may provide members with lower cost-sharing and
access to services under network terms.
9. What is an out-of-network provider?
A. A provider that does not participate in the applicable plan network
B. A provider who has no medical license
C. A provider employed by the insurer
D. A provider who provides only emergency care
Correct Answer: A. A provider that does not participate in the applicable plan network
, Rationale: Out-of-network status means the provider does not have the applicable network
participation agreement.
10. What is a health plan's Evidence of Coverage or similar coverage document used for?
A. Describing important benefits, limitations, exclusions, and member responsibilities
B. Replacing the member ID card
C. Recording laboratory results
D. Prescribing medication
Correct Answer: A. Describing important benefits, limitations, exclusions, and member
responsibilities
Rationale: Coverage documents explain the plan's benefits and applicable rules so members
can understand how coverage works.
11. What is Medicare?
A. A federal health insurance program primarily serving eligible older adults and certain other
eligible individuals
B. A private pharmacy
C. A state driver's license program
D. A hospital billing system
Correct Answer: A. A federal health insurance program primarily serving eligible older adults
and certain other eligible individuals
Rationale: Medicare is a federal health insurance program with different parts covering
different categories of healthcare services.
12. Which Medicare part generally covers inpatient hospital services?
A. Part A
B. Part B
C. Part C only
D. Part D
Correct Answer: A. Part A
