EXAMFX Health Insurance 3 — Questions and Answers
Question 1: Which of the following best describes a Point-of-Service (POS) plan?
- A plan that only covers services from HMO network providers
- A managed care plan that allows members to use out-of-network providers at a higher cost (Correct answer)
- A high-deductible plan paired with a health savings account
- An indemnity plan with no network restrictions
Correct 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.
Question 2: The 'elimination period' in a disability income policy is most analogous to which feature in a health insurance policy?
- Coinsurance
- Deductible (Correct answer)
- Copayment
- Out-of-pocket maximum
Correct 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.
Question 3: A health savings account (HSA) can only be paired with which type of health plan?
- Any employer-sponsored group plan
- A High-Deductible Health Plan (HDHP) (Correct answer)
- A Medicare Supplement plan
- An HMO with a primary care gatekeeper
Correct answer: A High-Deductible Health Plan (HDHP)
HSAs are only available to individuals enrolled in an IRS-qualified High-Deductible Health Plan.
Question 4: Under the ACA, preventive care services must be covered by non-grandfathered plans:
- After the deductible is met
- Subject to a 20% coinsurance
- With no cost-sharing to the insured (Correct answer)
- Only for in-network primary care providers on weekdays
Correct 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.
Question 5: In health insurance, 'subrogation' means the insurer has the right to:
- Cancel the policy for nonpayment of premium
- Seek reimbursement from a liable third party after paying the insured's claim (Correct answer)
- Exclude a pre-existing condition from coverage
- Increase premiums after a large claim
Correct 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.
Question 6: A dependent child must be covered under a parent's group health plan until at least what age under the ACA?
- 19
- 21
- 23
- 26 (Correct answer)
Correct answer: 26
The ACA requires group and individual plans to offer dependent child coverage until age 26, regardless of student or marital status.
Question 7: Which of the following is a feature of a Medicare Supplement (Medigap) policy?
- It replaces Medicare Parts A and B entirely
- It covers long-term custodial care in nursing homes
- It helps pay Medicare cost-sharing amounts such as copays and deductibles (Correct answer)
- It is administered directly by Medicare and billed through Medicare claims
Correct 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.
EXAMFX Health Insurance 3
Which of the following best describes a Point-of-Service (POS) plan?