HSA4109 PRACTICE EXAM QUESTIONS WITH SOLUTIONS
2025 GRADED A+
✔✔Which of the following is the strictest form of health insurance? - ✔✔Health
Maintenance Organization (HMO)
✔✔True or False: The medical loss ratio for small group and individual health plans is
85%. - ✔✔False
✔✔True or False: Congress created the National Association of Insurance
Commissioners (NAIC) to develop medical loss ratios (MLRs). - ✔✔False
✔✔Choose the answer that best fills in the blank: If a health plan purchases reinsurance
then ______________? - ✔✔It has protection against extremely high costs.
✔✔Pair the regulator to the type of health insurance plans it regulates.
1. Medicare
2. Medicaid
3. State Departments of Insurance (DOIs) - ✔✔1. The Centers for Medicare and
Medicaid Services (CMS)
2. State Medicaid Agencies
3. Private Health Plans
✔✔Choose the answer that best fills in the blank: If a health plan charges consumers
different premium rates in the individual health plan market, it is violating
_____________________ provisions under the Affordable Care Act (ACA). -
✔✔community rating
✔✔Which of the following statements regarding market consolidation is true?
If providers or hospitals merge together and consolidate then market competition
increases
If providers or hospitals merge together and consolidate then premiums will likely
decrease
When providers and hospitals merge together and consolidate there is no impact on
market competition, nor premiums - ✔✔None
✔✔What do state departments of insurance regulate?
Solvency
Provider networks
, Medical loss ratio - ✔✔All are correct
✔✔Which of the following is an advantage to a health insurance company of contracting
with an independent practice association (IPA)? - ✔✔Many providers are included in a
single contract
✔✔When a health insurance plan or employer contracts with a Center of Excellence,
which of the following is a likely outcome?
Better employee morale and less employee turnover
Fewer post-surgical complications
Fewer medical errors
More costs to the health plan or employer in the short term, but savings over the long
term
Better long-term health outcomes - ✔✔All correct
✔✔True or False: Providers must be recredentialed every year. - ✔✔False
✔✔True or False: Individual healthcare providers have more contract negotiating power
than health insurance companies. - ✔✔False
✔✔Which of the following types of payment methods is based on volume? - ✔✔Fee-for-
service
✔✔Under which of the following payment methods would a provider earn more money
by serving more insured health plan members each month? - ✔✔Capitation
✔✔True or False: Under capitation, providers are paid regardless of whether they see
an insured health plan member or not. - ✔✔True
✔✔Which of the following types of payment models tend to be more predictable and
less expensive? - ✔✔Capitation
✔✔True or False: One of the concerns with fee-for-service is that it may incentivize
providers to prescribe non-medically necessary services. - ✔✔True
✔✔Which of the following payment types is used after a service has occurred? -
✔✔Retrospective
2025 GRADED A+
✔✔Which of the following is the strictest form of health insurance? - ✔✔Health
Maintenance Organization (HMO)
✔✔True or False: The medical loss ratio for small group and individual health plans is
85%. - ✔✔False
✔✔True or False: Congress created the National Association of Insurance
Commissioners (NAIC) to develop medical loss ratios (MLRs). - ✔✔False
✔✔Choose the answer that best fills in the blank: If a health plan purchases reinsurance
then ______________? - ✔✔It has protection against extremely high costs.
✔✔Pair the regulator to the type of health insurance plans it regulates.
1. Medicare
2. Medicaid
3. State Departments of Insurance (DOIs) - ✔✔1. The Centers for Medicare and
Medicaid Services (CMS)
2. State Medicaid Agencies
3. Private Health Plans
✔✔Choose the answer that best fills in the blank: If a health plan charges consumers
different premium rates in the individual health plan market, it is violating
_____________________ provisions under the Affordable Care Act (ACA). -
✔✔community rating
✔✔Which of the following statements regarding market consolidation is true?
If providers or hospitals merge together and consolidate then market competition
increases
If providers or hospitals merge together and consolidate then premiums will likely
decrease
When providers and hospitals merge together and consolidate there is no impact on
market competition, nor premiums - ✔✔None
✔✔What do state departments of insurance regulate?
Solvency
Provider networks
, Medical loss ratio - ✔✔All are correct
✔✔Which of the following is an advantage to a health insurance company of contracting
with an independent practice association (IPA)? - ✔✔Many providers are included in a
single contract
✔✔When a health insurance plan or employer contracts with a Center of Excellence,
which of the following is a likely outcome?
Better employee morale and less employee turnover
Fewer post-surgical complications
Fewer medical errors
More costs to the health plan or employer in the short term, but savings over the long
term
Better long-term health outcomes - ✔✔All correct
✔✔True or False: Providers must be recredentialed every year. - ✔✔False
✔✔True or False: Individual healthcare providers have more contract negotiating power
than health insurance companies. - ✔✔False
✔✔Which of the following types of payment methods is based on volume? - ✔✔Fee-for-
service
✔✔Under which of the following payment methods would a provider earn more money
by serving more insured health plan members each month? - ✔✔Capitation
✔✔True or False: Under capitation, providers are paid regardless of whether they see
an insured health plan member or not. - ✔✔True
✔✔Which of the following types of payment models tend to be more predictable and
less expensive? - ✔✔Capitation
✔✔True or False: One of the concerns with fee-for-service is that it may incentivize
providers to prescribe non-medically necessary services. - ✔✔True
✔✔Which of the following payment types is used after a service has occurred? -
✔✔Retrospective
