Health Insurance Flashcards
6 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Health Insurance flashcards as text
What is a 'birthday rule' in insurance coordination of benefits?
Answer: The rule that determines which parent's plan is primary for a dependent child, based on whose birthday falls earlier in the calendar year
The birthday rule is used when a dependent child is covered under both parents' plans. The plan of the parent whose birthday falls earliest in the calendar year (month and day, not year) is primary.
What is a Health Savings Account (HSA)?
Answer: A tax-advantaged savings account paired with a High-Deductible Health Plan (HDHP) to pay qualified medical expenses
An HSA is a tax-advantaged account available to individuals enrolled in a qualifying High-Deductible Health Plan (HDHP). Contributions, earnings, and withdrawals for qualified medical expenses are all tax-free.
What is the Consolidated Omnibus Budget Reconciliation Act (COBRA) best known for in healthcare?
Answer: Allowing individuals who lose employer-sponsored health coverage to continue that coverage temporarily by paying the full premium
COBRA allows workers and their dependents to continue group health plan coverage for a limited time (typically 18–36 months) after losing employer-sponsored coverage, at the individual's own expense.
What is the difference between Medicare Advantage (Part C) and Original Medicare?
Answer: Medicare Advantage is a private plan alternative to Original Medicare that includes Part A and Part B benefits, often with additional coverage; Original Medicare is administered directly by the federal government
Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare. They include all Part A and Part B benefits and often add dental, vision, hearing, and prescription drug coverage. Original Medicare is the traditional fee-for-service program run by CMS.
What is an Explanation of Benefits (EOB)?
Answer: A statement from an insurance company to the patient explaining how a claim was processed, including amounts paid and patient responsibility
An EOB is a statement from the insurance company sent to the policyholder explaining how a claim was adjudicated, including the amount billed, the allowed amount, what the plan paid, and what the patient owes.
What is a formulary in health insurance?
Answer: A list of prescription drugs covered by a health plan, organized by cost-sharing tiers
A formulary is a list of prescription drugs covered by a health plan, typically organized into tiers based on cost-sharing requirements (generic, preferred brand, non-preferred brand, specialty).