Benefits Plans and Coverage Flashcards
6 cards from real CES practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Benefits Plans and Coverage flashcards as text
Which health plan type requires members to choose a primary care physician (PCP) and get referrals to see specialists?
Answer: HMO
HMO (Health Maintenance Organization) plans require members to designate a PCP who coordinates care and provides referrals to in-network specialists.
What does PPO stand for in health insurance?
Answer: Preferred Provider Organization
PPO stands for Preferred Provider Organization, offering flexibility to see in-network or out-of-network providers without referrals.
An EPO plan differs from a PPO primarily because an EPO:
Answer: Does not cover out-of-network care except emergencies
An EPO (Exclusive Provider Organization) restricts coverage to in-network providers, with no out-of-network benefits except for true emergencies.
A High Deductible Health Plan (HDHP) is typically paired with which savings vehicle?
Answer: Health Savings Account (HSA)
HDHPs are designed to be paired with HSAs, allowing members to save pre-tax dollars for qualified medical expenses.
Under the ACA, which metal tier plan covers approximately 80% of expected healthcare costs on average?
Answer: Gold
Gold plans have an actuarial value of about 80%, meaning the plan pays 80% of covered costs on average, leaving the member to pay 20%.
A formulary in a health insurance plan refers to:
Answer: The list of covered prescription drugs
A formulary is the plan's list of covered prescription drugs, typically organized into tiers with different cost-sharing amounts.