Practice Test Geeks(EXAMFX) Exam FX Insurance Practice Test
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Health Insurance Flashcards

7 cards from real EXAMFX practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Health Insurance flashcards as text

  1. An insured is hospitalized for surgery. The plan pays 80% of covered expenses after the deductible and the insured pays 20%. This cost-sharing arrangement is called:

    Answer: Coinsurance

    Coinsurance is the percentage split of covered expenses between the insurer and insured after the deductible is satisfied.

  2. The 'birthday rule' is used to determine which parent's plan pays primary when a child is covered under both parents' group plans. Under this rule, primary coverage is provided by the parent:

    Answer: Whose birthday falls earliest in the calendar year

    The birthday rule designates the parent with the earlier birthday in the calendar year (month and day, not year) as the primary insurer.

  3. A provision that prevents an insured from collecting more than 100% of actual medical expenses from multiple health policies is called:

    Answer: Coordination of Benefits (COB)

    Coordination of Benefits rules determine which plan pays primary and which pays secondary to prevent over-insurance and duplicate recovery.

  4. Under the 'own occupation' definition of disability, a claimant qualifies for disability benefits if:

    Answer: They cannot perform the duties of their specific regular occupation

    The own-occupation definition is the broadest and most favorable to the insured, paying benefits if the insured cannot perform their specific job duties.

  5. A long-term care (LTC) insurance policy typically begins paying benefits when an insured requires assistance with how many Activities of Daily Living (ADLs)?

    Answer: 2

    Most LTC policies trigger benefits when an insured is unable to perform at least 2 of 6 standard ADLs (bathing, dressing, eating, toileting, transferring, continence).

  6. Under the incontestability clause in a health insurance policy, the insurer generally cannot contest a claim after the policy has been in force for:

    Answer: 2 years

    After two years, the incontestability clause typically prevents the insurer from voiding the policy or denying claims based on misrepresentations in the application.

  7. A 'gatekeeper' in a managed care plan refers to:

    Answer: The primary care physician who must authorize specialist referrals

    In HMO-style plans, the primary care physician acts as a gatekeeper, coordinating care and providing referrals before the member sees a specialist.