1
Accident and Health Insurance Final Exam Questions and Answers Latest Version Graded A+
What does a deductible represent in a health insurance policy?✔✔ The amount the insured must pay before the insurance company begins to pay benefits.
What is the purpose of coinsurance in health insurance?✔✔ To share medical costs between the insurer and the insured after the deductible is met.
Who is the beneficiary in a health insurance policy?✔✔ The person who receives benefits or reimbursement from the policy.
What is the grace period in most health insurance policies?✔✔ A set amount of time after a missed premium payment during which the policy remains active.
What type of insurance provides income if a person is unable to work due to illness or injury?✔✔ Disability income insurance. 1 / 3
2
What does the term “pre-existing condition” mean in health insurance?✔✔ A medical condition that existed before the policy began.
What is the elimination period in a disability policy?✔✔ The waiting period before disability benefits start after an illness or injury.
What is the main difference between an HMO and a PPO?✔✔ An HMO requires members to use network providers, while a PPO allows more flexibility in choosing providers.
What is the primary goal of managed care plans?✔✔ To control healthcare costs and improve quality of care.
What is a copayment in a health insurance plan?✔✔ A fixed fee the insured pays for covered services at the time of care.
What is the purpose of a coordination of benefits provision? 2 / 3
3
✔✔ To prevent overpayment when a person is covered by multiple insurance policies.
Who pays the premium in a group health insurance policy?✔✔ It is often shared between the employer and the employee.
What is the benefit of a major medical insurance policy?✔✔ It provides broad coverage for serious illness or injury with high benefit limits.
What is the role of the primary care physician in an HMO?✔✔ To coordinate the patient’s healthcare and provide referrals to specialists.
What is the free-look period in a health insurance policy?✔✔ A period (typically 10 days) when the policyholder can cancel the policy and receive a full refund.
What happens if an insured fails to pay a premium and the grace period expires?✔✔ The policy will lapse and coverage will be terminated.
- / 3