Oregon Health Insurance Exam Practice
Questions And Correct Answers
(Verified Answers) Plus Rationale 2027
Q&A| Instant Download Pdf.
1. Which of the following best describes the primary purpose of health
insurance?
A. To guarantee that an insured will never experience illness or injury
B. To eliminate all out-of-pocket medical expenses regardless of the
policy
C. To provide financial protection against covered medical expenses
and specified health-related losses
D. To replace the need for preventive medical care
Rationale: Health insurance is designed to transfer or share the financial
risk associated with covered medical expenses, subject to policy terms,
deductibles, exclusions, limitations, and cost-sharing provisions.
2. Which of the following is generally considered an important
characteristic of an insurance contract?
A. It must provide identical benefits to every insured
B. It is always negotiated equally by both parties
C. It is a contract in which the insurer agrees to provide specified
benefits in exchange for consideration such as premium
D. It guarantees that every submitted claim will be paid
Rationale: An insurance contract establishes the insurer's obligations and
the insured's rights and duties in exchange for the premium and
compliance with policy conditions.
, 3. Which provision requires the insured to pay a specified amount of
covered expenses before the insurer begins paying benefits under
many health plans?
A. Coinsurance
B. Copayment
C. Deductible
D. Premium
Rationale: A deductible is the amount the insured generally must pay
toward covered expenses before the insurer begins sharing covered costs
according to the policy.
4. An insured has a health plan with a $1,500 annual deductible. During
the year, the insured incurs $5,000 in covered expenses subject to the
deductible. What does the deductible generally require?
A. The insurer must pay the entire $5,000
B. The insured must pay the entire $5,000
C. The insured generally pays the first $1,500 of applicable covered
expenses before the plan begins paying according to its terms
D. The insured receives $1,500 from the insurer
Rationale: A deductible represents the initial portion of covered expenses
for which the insured is responsible before applicable insurance benefits
are triggered.
5. Which of the following best describes coinsurance in a health
insurance policy?
A. A fixed premium paid to maintain coverage
B. A fixed dollar amount paid for every medical service
C. A percentage of an eligible covered expense that the insured
shares with the insurer
D. An amount paid only when a policy is canceled
Rationale: Coinsurance is percentage-based cost sharing, such as an
arrangement under which the insurer pays 80% of an eligible expense and
the insured pays the remaining 20%, subject to the policy terms.
, 6. Which of the following best describes a copayment?
A. A percentage of the insurer's annual profit
B. A premium refund paid after a claim
C. A specified dollar amount the insured pays for a covered service
D. The policy's maximum lifetime benefit
Rationale: A copayment is generally a fixed dollar amount required from
the insured for a covered service, such as a physician visit or prescription,
according to the plan's terms.
7. What is the primary purpose of a health insurance policy's out-of-
pocket maximum?
A. To establish the insurer's annual profit
B. To determine the policy's premium
C. To limit the insured's responsibility for certain covered cost-
sharing expenses after the applicable threshold is reached
D. To eliminate all policy exclusions
Rationale: An out-of-pocket maximum limits specified cost-sharing
obligations for covered services, although premiums and certain
noncovered expenses may not count toward the limit.
8. Which of the following is generally considered a covered medical
expense?
A. Any expense the insured chooses to incur
B. A service expressly excluded by the policy
C. An eligible health care service that falls within the policy's covered
benefits and applicable conditions
D. An expense incurred solely because the insured failed to follow
policy requirements
Rationale: Coverage depends on the policy's definition of eligible services,
exclusions, limitations, medical necessity requirements, networks, and
other applicable conditions.
, 9. What is a health insurance premium?
A. The amount the insurer pays for every claim
B. The deductible paid after hospitalization
C. The amount paid to obtain and maintain insurance coverage
D. The amount credited to the insured's medical savings account
Rationale: A premium is the consideration paid to the insurer or applicable
plan for maintaining insurance coverage, subject to the terms of the policy
or plan.
10. Which of the following is an example of a health insurance
exclusion?
A. A covered physician examination
B. A covered hospitalization
C. A type of service or condition that the policy expressly states is not
covered
D. A deductible applied to covered services
Rationale: An exclusion identifies circumstances, services, conditions, or
expenses for which the policy does not provide coverage.
11. Which of the following best describes medical necessity in
health insurance?
A. Any treatment requested by the insured
B. Any service that costs less than the deductible
C. A determination that a service or treatment meets applicable
clinical and coverage criteria under the plan
D. Any procedure performed by a licensed person
Rationale: Medical necessity generally involves whether a service is
appropriate and meets the insurer's or plan's applicable clinical and
coverage standards; licensing alone does not guarantee coverage.
12. What is the principal function of a health insurance provider
network?
A. To eliminate all deductibles
Questions And Correct Answers
(Verified Answers) Plus Rationale 2027
Q&A| Instant Download Pdf.
1. Which of the following best describes the primary purpose of health
insurance?
A. To guarantee that an insured will never experience illness or injury
B. To eliminate all out-of-pocket medical expenses regardless of the
policy
C. To provide financial protection against covered medical expenses
and specified health-related losses
D. To replace the need for preventive medical care
Rationale: Health insurance is designed to transfer or share the financial
risk associated with covered medical expenses, subject to policy terms,
deductibles, exclusions, limitations, and cost-sharing provisions.
2. Which of the following is generally considered an important
characteristic of an insurance contract?
A. It must provide identical benefits to every insured
B. It is always negotiated equally by both parties
C. It is a contract in which the insurer agrees to provide specified
benefits in exchange for consideration such as premium
D. It guarantees that every submitted claim will be paid
Rationale: An insurance contract establishes the insurer's obligations and
the insured's rights and duties in exchange for the premium and
compliance with policy conditions.
, 3. Which provision requires the insured to pay a specified amount of
covered expenses before the insurer begins paying benefits under
many health plans?
A. Coinsurance
B. Copayment
C. Deductible
D. Premium
Rationale: A deductible is the amount the insured generally must pay
toward covered expenses before the insurer begins sharing covered costs
according to the policy.
4. An insured has a health plan with a $1,500 annual deductible. During
the year, the insured incurs $5,000 in covered expenses subject to the
deductible. What does the deductible generally require?
A. The insurer must pay the entire $5,000
B. The insured must pay the entire $5,000
C. The insured generally pays the first $1,500 of applicable covered
expenses before the plan begins paying according to its terms
D. The insured receives $1,500 from the insurer
Rationale: A deductible represents the initial portion of covered expenses
for which the insured is responsible before applicable insurance benefits
are triggered.
5. Which of the following best describes coinsurance in a health
insurance policy?
A. A fixed premium paid to maintain coverage
B. A fixed dollar amount paid for every medical service
C. A percentage of an eligible covered expense that the insured
shares with the insurer
D. An amount paid only when a policy is canceled
Rationale: Coinsurance is percentage-based cost sharing, such as an
arrangement under which the insurer pays 80% of an eligible expense and
the insured pays the remaining 20%, subject to the policy terms.
, 6. Which of the following best describes a copayment?
A. A percentage of the insurer's annual profit
B. A premium refund paid after a claim
C. A specified dollar amount the insured pays for a covered service
D. The policy's maximum lifetime benefit
Rationale: A copayment is generally a fixed dollar amount required from
the insured for a covered service, such as a physician visit or prescription,
according to the plan's terms.
7. What is the primary purpose of a health insurance policy's out-of-
pocket maximum?
A. To establish the insurer's annual profit
B. To determine the policy's premium
C. To limit the insured's responsibility for certain covered cost-
sharing expenses after the applicable threshold is reached
D. To eliminate all policy exclusions
Rationale: An out-of-pocket maximum limits specified cost-sharing
obligations for covered services, although premiums and certain
noncovered expenses may not count toward the limit.
8. Which of the following is generally considered a covered medical
expense?
A. Any expense the insured chooses to incur
B. A service expressly excluded by the policy
C. An eligible health care service that falls within the policy's covered
benefits and applicable conditions
D. An expense incurred solely because the insured failed to follow
policy requirements
Rationale: Coverage depends on the policy's definition of eligible services,
exclusions, limitations, medical necessity requirements, networks, and
other applicable conditions.
, 9. What is a health insurance premium?
A. The amount the insurer pays for every claim
B. The deductible paid after hospitalization
C. The amount paid to obtain and maintain insurance coverage
D. The amount credited to the insured's medical savings account
Rationale: A premium is the consideration paid to the insurer or applicable
plan for maintaining insurance coverage, subject to the terms of the policy
or plan.
10. Which of the following is an example of a health insurance
exclusion?
A. A covered physician examination
B. A covered hospitalization
C. A type of service or condition that the policy expressly states is not
covered
D. A deductible applied to covered services
Rationale: An exclusion identifies circumstances, services, conditions, or
expenses for which the policy does not provide coverage.
11. Which of the following best describes medical necessity in
health insurance?
A. Any treatment requested by the insured
B. Any service that costs less than the deductible
C. A determination that a service or treatment meets applicable
clinical and coverage criteria under the plan
D. Any procedure performed by a licensed person
Rationale: Medical necessity generally involves whether a service is
appropriate and meets the insurer's or plan's applicable clinical and
coverage standards; licensing alone does not guarantee coverage.
12. What is the principal function of a health insurance provider
network?
A. To eliminate all deductibles
