Health Insurance (Exam FX) Questions
and Answers | Latest Version |
2025/2026 | Correct & Verified
What is a premium in health insurance?
✔✔The amount paid regularly to keep the policy active
What does a deductible represent?
✔✔The amount the insured must pay before coverage begins
What is a copayment?
✔✔A fixed amount paid by the insured for a covered service
What does coinsurance mean?
✔✔A percentage of costs shared between insurer and insured
Who is the policyholder?
✔✔The person who owns the insurance policy
What is a beneficiary in health insurance?
✔✔The person entitled to receive benefits
What does “in-network provider” mean?
1
,✔✔A provider contracted with the insurer
What is an out-of-pocket maximum?
✔✔The most the insured pays in a policy period
What is a pre-existing condition?
✔✔A health condition existing before coverage starts
What does underwriting involve?
✔✔Evaluating risk to determine coverage terms
What is an exclusion in a policy?
✔✔A service or condition not covered
What does a waiting period refer to?
✔✔The time before certain benefits become available
What is group health insurance?
✔✔Coverage provided to members of a group
What is individual health insurance?
✔✔Coverage purchased by one person
2
, What does guaranteed renewability mean?
✔✔The policy can be renewed regardless of health
What is adverse selection?
✔✔Higher-risk individuals buying more insurance
What does coordination of benefits address?
✔✔How multiple policies share payment
What is a claim?
✔✔A request for payment of covered services
What is a provider?
✔✔A healthcare professional or facility
What does “medical necessity” mean?
✔✔Care required for diagnosis or treatment
What is a health maintenance organization (HMO)?
✔✔A plan requiring use of network providers
3
and Answers | Latest Version |
2025/2026 | Correct & Verified
What is a premium in health insurance?
✔✔The amount paid regularly to keep the policy active
What does a deductible represent?
✔✔The amount the insured must pay before coverage begins
What is a copayment?
✔✔A fixed amount paid by the insured for a covered service
What does coinsurance mean?
✔✔A percentage of costs shared between insurer and insured
Who is the policyholder?
✔✔The person who owns the insurance policy
What is a beneficiary in health insurance?
✔✔The person entitled to receive benefits
What does “in-network provider” mean?
1
,✔✔A provider contracted with the insurer
What is an out-of-pocket maximum?
✔✔The most the insured pays in a policy period
What is a pre-existing condition?
✔✔A health condition existing before coverage starts
What does underwriting involve?
✔✔Evaluating risk to determine coverage terms
What is an exclusion in a policy?
✔✔A service or condition not covered
What does a waiting period refer to?
✔✔The time before certain benefits become available
What is group health insurance?
✔✔Coverage provided to members of a group
What is individual health insurance?
✔✔Coverage purchased by one person
2
, What does guaranteed renewability mean?
✔✔The policy can be renewed regardless of health
What is adverse selection?
✔✔Higher-risk individuals buying more insurance
What does coordination of benefits address?
✔✔How multiple policies share payment
What is a claim?
✔✔A request for payment of covered services
What is a provider?
✔✔A healthcare professional or facility
What does “medical necessity” mean?
✔✔Care required for diagnosis or treatment
What is a health maintenance organization (HMO)?
✔✔A plan requiring use of network providers
3
