Health Insurance Flashcards

Which of the following best describes a Point-of-Service (POS) plan?

Answer: A managed care plan that allows members to use out-of-network providers at a higher cost

A POS plan blends HMO and PPO features, offering lower costs for in-network care but allowing out-of-network use with higher cost-sharing.

The 'elimination period' in a disability income policy is most analogous to which feature in a health insurance policy?

Answer: Deductible

Like a deductible requires the insured to absorb initial costs, an elimination period requires the insured to wait a specified time before benefits begin.

A health savings account (HSA) can only be paired with which type of health plan?

Answer: A High-Deductible Health Plan (HDHP)

HSAs are only available to individuals enrolled in an IRS-qualified High-Deductible Health Plan.

Under the ACA, preventive care services must be covered by non-grandfathered plans:

Answer: With no cost-sharing to the insured

The ACA requires non-grandfathered plans to cover USPSTF-recommended preventive services at no cost to the patient.

In health insurance, 'subrogation' means the insurer has the right to:

Answer: Seek reimbursement from a liable third party after paying the insured's claim

Subrogation allows the insurer to step into the insured's shoes and recover claim costs from a negligent third party.

A dependent child must be covered under a parent's group health plan until at least what age under the ACA?

Answer: 26

The ACA requires group and individual plans to offer dependent child coverage until age 26, regardless of student or marital status.

Which of the following is a feature of a Medicare Supplement (Medigap) policy?

Answer: It helps pay Medicare cost-sharing amounts such as copays and deductibles

Medigap policies are sold by private insurers to fill the gaps — such as copayments, coinsurance, and deductibles — left by original Medicare.