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NJ HEALTH AND ACCIDENT FINAL EXAM LATEST 2026-2027 ACTUAL
EXAM WITH COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (100% VERIFIED ANSWERS) |ALREADY GRADED A+|
||PROFESSOR VERIFIED|| ||BRANDNEW!!!||
David has a PPO that does not limit him to use only providers that
have contracts with the PPO. David's PPO is
a. choice panel
b. guarded panel
c. closed panel
d. open panel - ANSWER-open panel
All of the following are examples of managed care plans EXCEPT
a. indemnity arrangements
b. health maintenance organizations
c. preferred provider organizations
d. point-of-service plans - ANSWER-indemnity arrangements
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All of the following are characteristics of a PPO EXCEPT
a. the relationship between a PPO and its providers is contractual
b. PPO's are typically open panel entities
c. PPO's operate on a prepaid basis
d. PPO's operate on a fee-for-service - ANSWER-PPO's operate
on a prepaid basis
If treatment requiring hospitalization is recommended, the
physician of the insured may have to get the expense approved
prior to obtaining the treatment. This is known as
a. limits on lengths of stay
b. outpatient benefits
c. preauthorization
d. referral service - ANSWER-preauthorization
All of the following are points in the process of utilization
management EXCEPT
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a. prospective review
b. retrospective review
c. concurrent review
d. alternative review - ANSWER-alternative review
Which utilization management review is done after the treatment
is complete?
a. complete review
b. prospective review
c. concurrent review
d. retrospective review - ANSWER-retrospective review
Which of the following alternatives to hospital care provides
nursing care for patients who need 24-hour supervision?
a. home health care
b. rehabilitative facility
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c. skilled nursing facility
d. intermediate nursing facility - ANSWER-skilled nursing facility
All of the following statements about an HMO are correct
EXCEPT
a. HMO's control over-utilization of their services by subscribers
with the gatekeeper concept
b. HMO's operate on a fee for service plan
c. HMO's are managed care entities
d. HMO subscribers are not free to choose any provider that they
wish - ANSWER-HMO's operate on a fee for service plan
All of the following are characteristics of group health insurance
EXCEPT
a. it insures more people under one contract
b. it is less expensive than individual insurance
c. participants receive a certificate of insurance
NJ HEALTH AND ACCIDENT FINAL EXAM LATEST 2026-2027 ACTUAL
EXAM WITH COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (100% VERIFIED ANSWERS) |ALREADY GRADED A+|
||PROFESSOR VERIFIED|| ||BRANDNEW!!!||
David has a PPO that does not limit him to use only providers that
have contracts with the PPO. David's PPO is
a. choice panel
b. guarded panel
c. closed panel
d. open panel - ANSWER-open panel
All of the following are examples of managed care plans EXCEPT
a. indemnity arrangements
b. health maintenance organizations
c. preferred provider organizations
d. point-of-service plans - ANSWER-indemnity arrangements
,2|Page
All of the following are characteristics of a PPO EXCEPT
a. the relationship between a PPO and its providers is contractual
b. PPO's are typically open panel entities
c. PPO's operate on a prepaid basis
d. PPO's operate on a fee-for-service - ANSWER-PPO's operate
on a prepaid basis
If treatment requiring hospitalization is recommended, the
physician of the insured may have to get the expense approved
prior to obtaining the treatment. This is known as
a. limits on lengths of stay
b. outpatient benefits
c. preauthorization
d. referral service - ANSWER-preauthorization
All of the following are points in the process of utilization
management EXCEPT
,3|Page
a. prospective review
b. retrospective review
c. concurrent review
d. alternative review - ANSWER-alternative review
Which utilization management review is done after the treatment
is complete?
a. complete review
b. prospective review
c. concurrent review
d. retrospective review - ANSWER-retrospective review
Which of the following alternatives to hospital care provides
nursing care for patients who need 24-hour supervision?
a. home health care
b. rehabilitative facility
, 4|Page
c. skilled nursing facility
d. intermediate nursing facility - ANSWER-skilled nursing facility
All of the following statements about an HMO are correct
EXCEPT
a. HMO's control over-utilization of their services by subscribers
with the gatekeeper concept
b. HMO's operate on a fee for service plan
c. HMO's are managed care entities
d. HMO subscribers are not free to choose any provider that they
wish - ANSWER-HMO's operate on a fee for service plan
All of the following are characteristics of group health insurance
EXCEPT
a. it insures more people under one contract
b. it is less expensive than individual insurance
c. participants receive a certificate of insurance
