CCHI - Insurance Exam Questions
Correct Solutions
Affordable Care Act (ACA)/ Health Care Reform; Obamacare - Answer -✔✔The
comprehensive federal health care reform law enacted in March 2010.
Health Insurance - Answer -✔✔A contract that requires an individual's health insurer to
pay some or all of their health care costs in exchange for a premium.
Health Insurance Marketplace/ Exchange - Answer -✔✔State- or federally run and
regulated market where an individual can shop, compare, and buy health care
coverage.
Eligibility requirements - Answer -✔✔Conditions that must be met in order for an
individual or group to be considered eligible for insurance coverage.
Open enrollment (period) - Answer -✔✔A period of time each year when an individual
can purchase or change health coverage.
Medicaid - Answer -✔✔Health insurance provided by the government to some low-
income people, families and children, pregnant women, the elderly, and people with
disabilities. In some states the program covers all adults below a certain income level.
Medicaid programs must follow federal guidelines, but coverage and costs may be
different from state to state.
Children's Health Insurance Program (CHIP) - Answer -✔✔Health insurance provided
by the government to children in families that earn too much money to qualify for
Medicaid. In some states, CHIP covers parents and pregnant women. Each state works
closely with its state Medicaid program. In many cases, if an individual qualifies for
Medicaid your children will qualify for either Medicaid or CHIP.
Medicare - Answer -✔✔A federal health insurance program, administered by the Social
Security Administration, that provides health care for most people over 65 and certain
other eligible individuals.
Health plan - Answer -✔✔A benefit an individual's employer, union or other group
sponsor provides to that individual to pay for their health care services.
Secondary coverage - Answer -✔✔When a person is covered under more than one
health insurance plan, this term describes the health insurance plan that provides
payment on claims after the primary coverage (i.e. main plan).
, Managed care - Answer -✔✔A general term used to describe a variety of health care
and health insurance systems that attempt to guide a patient's use of benefits, typically
by requiring that a patient coordinate his or her health care through a primary care
physician, or by encouraging the use of a specific network of healthcare providers. The
management of health care is intended to keep costs -and monthly premiums- as low as
possible. Examples of managed care plans include:
• Health maintenance organizations (HMOs),
• Preferred provider organizations (PPOs),
• Exclusive provider organizations (EPOs), and
• Point of service plans (POSs).
Premium - Answer -✔✔The amount that must be paid for an individual's health
insurance or plan. The individual and/or their employer usually pay it monthly, quarterly
or yearly.
Dependent - Answer -✔✔A spouse, child, or domestic partner who is covered under a
policyholder or subscriber's plan, depending on applicable law and the plan's terms and
conditions.
Covered services - Answer -✔✔Health care services that are included in and paid for by
an individual's health insurance or plan.
Excluded services - Answer -✔✔Health care services that an individual's health
insurance or plan doesn't pay for or cover.
Pre-existing condition - Answer -✔✔A medical condition that a person has before being
enrolled in a health plan.
Service area - Answer -✔✔The geographic area in which a health insurance plan's
benefits are made available. Some health insurance plans will not provide coverage
outside of a plan's service area.
Network - Answer -✔✔The facilities, providers and suppliers an individual's health
insurer or plan has contracted with to provide health care services.
Provider - Answer -✔✔A physician (M.D.- Medical Doctor or D.O.- Doctor of
Osteopathic Medicine), health care professional or health care facility licensed, certified
or accredited as required by state law.
Primary Care Provider/ Physician (PCP) - Answer -✔✔A physician (M.D. - Medical
Doctor or D.O.- Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse
specialist or physician assistant, as allowed under state law, who provides, coordinates
or helps a patient access a range of health care services.
Correct Solutions
Affordable Care Act (ACA)/ Health Care Reform; Obamacare - Answer -✔✔The
comprehensive federal health care reform law enacted in March 2010.
Health Insurance - Answer -✔✔A contract that requires an individual's health insurer to
pay some or all of their health care costs in exchange for a premium.
Health Insurance Marketplace/ Exchange - Answer -✔✔State- or federally run and
regulated market where an individual can shop, compare, and buy health care
coverage.
Eligibility requirements - Answer -✔✔Conditions that must be met in order for an
individual or group to be considered eligible for insurance coverage.
Open enrollment (period) - Answer -✔✔A period of time each year when an individual
can purchase or change health coverage.
Medicaid - Answer -✔✔Health insurance provided by the government to some low-
income people, families and children, pregnant women, the elderly, and people with
disabilities. In some states the program covers all adults below a certain income level.
Medicaid programs must follow federal guidelines, but coverage and costs may be
different from state to state.
Children's Health Insurance Program (CHIP) - Answer -✔✔Health insurance provided
by the government to children in families that earn too much money to qualify for
Medicaid. In some states, CHIP covers parents and pregnant women. Each state works
closely with its state Medicaid program. In many cases, if an individual qualifies for
Medicaid your children will qualify for either Medicaid or CHIP.
Medicare - Answer -✔✔A federal health insurance program, administered by the Social
Security Administration, that provides health care for most people over 65 and certain
other eligible individuals.
Health plan - Answer -✔✔A benefit an individual's employer, union or other group
sponsor provides to that individual to pay for their health care services.
Secondary coverage - Answer -✔✔When a person is covered under more than one
health insurance plan, this term describes the health insurance plan that provides
payment on claims after the primary coverage (i.e. main plan).
, Managed care - Answer -✔✔A general term used to describe a variety of health care
and health insurance systems that attempt to guide a patient's use of benefits, typically
by requiring that a patient coordinate his or her health care through a primary care
physician, or by encouraging the use of a specific network of healthcare providers. The
management of health care is intended to keep costs -and monthly premiums- as low as
possible. Examples of managed care plans include:
• Health maintenance organizations (HMOs),
• Preferred provider organizations (PPOs),
• Exclusive provider organizations (EPOs), and
• Point of service plans (POSs).
Premium - Answer -✔✔The amount that must be paid for an individual's health
insurance or plan. The individual and/or their employer usually pay it monthly, quarterly
or yearly.
Dependent - Answer -✔✔A spouse, child, or domestic partner who is covered under a
policyholder or subscriber's plan, depending on applicable law and the plan's terms and
conditions.
Covered services - Answer -✔✔Health care services that are included in and paid for by
an individual's health insurance or plan.
Excluded services - Answer -✔✔Health care services that an individual's health
insurance or plan doesn't pay for or cover.
Pre-existing condition - Answer -✔✔A medical condition that a person has before being
enrolled in a health plan.
Service area - Answer -✔✔The geographic area in which a health insurance plan's
benefits are made available. Some health insurance plans will not provide coverage
outside of a plan's service area.
Network - Answer -✔✔The facilities, providers and suppliers an individual's health
insurer or plan has contracted with to provide health care services.
Provider - Answer -✔✔A physician (M.D.- Medical Doctor or D.O.- Doctor of
Osteopathic Medicine), health care professional or health care facility licensed, certified
or accredited as required by state law.
Primary Care Provider/ Physician (PCP) - Answer -✔✔A physician (M.D. - Medical
Doctor or D.O.- Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse
specialist or physician assistant, as allowed under state law, who provides, coordinates
or helps a patient access a range of health care services.
