NHA CCMA Exam Questions and
Answers | Latest Version | 2025/2026 |
Correct & Verified
Which of the following is the primary purpose of health insurance?
✔✔To help cover the cost of medical care and protect patients from high expenses.
What does a premium represent in an insurance policy?
✔✔The amount a patient or employer pays regularly to maintain coverage.
Which part of insurance determines the percentage the patient must pay after deductible is met?
✔✔Coinsurance.
What is a deductible in health insurance terms?
✔✔The amount a patient must pay out-of-pocket before the insurance begins to pay.
Which type of insurance plan allows patients to see any provider without a referral?
✔✔PPO (Preferred Provider Organization).
1
,What is the purpose of a copayment?
✔✔A fixed amount a patient pays at the time of service.
Which type of insurance plan usually requires a primary care physician and referrals for
specialists?
✔✔HMO (Health Maintenance Organization).
What is the Explanation of Benefits (EOB)?
✔✔A statement sent by the insurance company showing what was paid, denied, or patient
responsibility.
What is considered a pre-existing condition in insurance?
✔✔A medical condition diagnosed before obtaining the insurance policy.
Which federal program provides health insurance for individuals over 65 or with certain
disabilities?
✔✔Medicare.
2
,Which federal program provides insurance for low-income individuals and families?
✔✔Medicaid.
What is prior authorization in medical insurance?
✔✔Approval from the insurance company before a procedure or service is performed.
Which document is required to verify a patient’s insurance coverage at a visit?
✔✔Insurance card.
What is the difference between in-network and out-of-network providers?
✔✔In-network providers have contracted rates with the insurance company, while out-of-
network may cost more.
What is a premium grace period?
✔✔The time allowed to pay a late premium without losing coverage.
Which of the following is considered patient responsibility?
✔✔Deductibles, copayments, and coinsurance.
3
, What is a lifetime maximum in an insurance policy?
✔✔The total amount an insurance company will pay for a patient’s covered services over their
lifetime.
Which form documents a patient’s assignment of benefits to the provider?
✔✔Assignment of Benefits (AOB) form.
What is the purpose of a formulary in insurance coverage?
✔✔A list of medications covered by the insurance plan.
Which of the following is an example of a primary insurance carrier?
✔✔The insurance that pays first when a patient has more than one plan.
Which insurance program covers active-duty military personnel and their families?
✔✔TRICARE.
Which form is used for Medicare billing in the outpatient setting?
4
Answers | Latest Version | 2025/2026 |
Correct & Verified
Which of the following is the primary purpose of health insurance?
✔✔To help cover the cost of medical care and protect patients from high expenses.
What does a premium represent in an insurance policy?
✔✔The amount a patient or employer pays regularly to maintain coverage.
Which part of insurance determines the percentage the patient must pay after deductible is met?
✔✔Coinsurance.
What is a deductible in health insurance terms?
✔✔The amount a patient must pay out-of-pocket before the insurance begins to pay.
Which type of insurance plan allows patients to see any provider without a referral?
✔✔PPO (Preferred Provider Organization).
1
,What is the purpose of a copayment?
✔✔A fixed amount a patient pays at the time of service.
Which type of insurance plan usually requires a primary care physician and referrals for
specialists?
✔✔HMO (Health Maintenance Organization).
What is the Explanation of Benefits (EOB)?
✔✔A statement sent by the insurance company showing what was paid, denied, or patient
responsibility.
What is considered a pre-existing condition in insurance?
✔✔A medical condition diagnosed before obtaining the insurance policy.
Which federal program provides health insurance for individuals over 65 or with certain
disabilities?
✔✔Medicare.
2
,Which federal program provides insurance for low-income individuals and families?
✔✔Medicaid.
What is prior authorization in medical insurance?
✔✔Approval from the insurance company before a procedure or service is performed.
Which document is required to verify a patient’s insurance coverage at a visit?
✔✔Insurance card.
What is the difference between in-network and out-of-network providers?
✔✔In-network providers have contracted rates with the insurance company, while out-of-
network may cost more.
What is a premium grace period?
✔✔The time allowed to pay a late premium without losing coverage.
Which of the following is considered patient responsibility?
✔✔Deductibles, copayments, and coinsurance.
3
, What is a lifetime maximum in an insurance policy?
✔✔The total amount an insurance company will pay for a patient’s covered services over their
lifetime.
Which form documents a patient’s assignment of benefits to the provider?
✔✔Assignment of Benefits (AOB) form.
What is the purpose of a formulary in insurance coverage?
✔✔A list of medications covered by the insurance plan.
Which of the following is an example of a primary insurance carrier?
✔✔The insurance that pays first when a patient has more than one plan.
Which insurance program covers active-duty military personnel and their families?
✔✔TRICARE.
Which form is used for Medicare billing in the outpatient setting?
4
