EPIC INSURANCE EXAM: HEALTH
SECTION QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS 100%
CORRECT!!!
What are the primary categories of health insurance coverage?
Answer: ✔️✔️
1. Disability Income: Replaces lost wages if you can't work.
2. Medical Expense: Covers hospital and doctor visits.
3. Accidental Death & Dismemberment: Pays out for specific severe injuries
or death.
4. Medicare: Federal coverage for seniors and certain disabilities.
5. Long-Term Care (LTC): Covers extended nursing or home care.
6. Limited Benefit (Voluntary): Specialized policies for specific illnesses or
accidents.
Which health coverage systems are administered or mandated by government
entities?
Answer: ✔️✔️ These include Medicare, Medicaid, Social Security Disability, and
State Workers' Compensation.
What is the specific definition and target demographic of Medicare?
Answer: ✔️✔️ It is a Federal insurance program primarily designed for individuals
aged 65 and older, as well as some younger people with specific disabilities.
How does Medicaid differ from Medicare in terms of funding and eligibility?
Answer: ✔️✔️ Medicaid is a State-run assistance program (with partial Federal
funding) that provides health coverage for low-income individuals of any age.
,Under what life circumstances can a policyholder add dependents to their
health insurance plan?
Answer: ✔️✔️ Dependents are typically added following specific "qualifying life
events," such as birth, legal adoption, or marriage.
Who has primary authority to regulate health insurance? -ANSWER ✔️✔️States
But.... federal govt regulates PPACA aka ACA (affordable care act)
What is the ACA? -ANSWER ✔️✔️Affordable Care Act
- policy is sold on guaranteed issue basis
- med coverage is available regardless of pre-existing coniditons
- dependent children are coverd
- low-income can take advantage of Fed subsidies and medicaid
- coverage must meet a minimum standard
- states set up health insurance exchanges for small biz and individual
**** only applies to medial expense insurance
Small Employer Medical Expese Plan -ANSWER ✔️✔️- 50 employees
- must offer medical expense coverage to all eligible employee
-preexisting conditions cannot be excluded for more than 1 year
- employer must offer at least 2 medical plan options
,Health insurance marketplace (health insurance exchange) -ANSWER ✔️✔️the
public can compare plans, shop around, buy from private insurance
healthcare.gov
Can a person enroll after open enrollment? -ANSWER ✔️✔️only if there is a
qualifying life event:
- marriage
- birth
- loss of other health insurance (quitting your plan does NOT count)
- moving
- becoming a US citizen
- release from prison
People who help you enroll in health insurance? -ANSWER ✔️✔️1. navigators
2. non-navigators assitant
3. exchange enrollment facilitators
4. certified application counselor
and producers
What are the Essential Health Benefits -ANSWER ✔️✔️- anbulance
- emergency servies
- hospitalization
- maternity and newborn care
, - mental health & substance abuse
- prescription drugs
- rehab
- lab service
- preventative and wellness services
- chronic disease management
- pediatric
Are their lifetime limits on health plans? -ANSWER ✔️✔️NO the ACA protects that
for all health plans
Metal Levels of health insurance -ANSWER ✔️✔️Bronze: plan(60%) you(40%)
Silver: plan(70%) you(30%)
Gold: plan(80%) you(20%)
Platinum: plan(90%) you(10%)
Catastrophic Plan -ANSWER ✔️✔️-Must be under 30 years old.
-Pays for 3 primary care physician visits before deductible applies.
-High deductible and low premium
-After deductible is met, costs are covered 100%.
Preventative Care Services -ANSWER ✔️✔️insured does NOT pay copayment or
coinsurance even if annual deductible has not been met
- blood pressure
- depression screening
SECTION QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS 100%
CORRECT!!!
What are the primary categories of health insurance coverage?
Answer: ✔️✔️
1. Disability Income: Replaces lost wages if you can't work.
2. Medical Expense: Covers hospital and doctor visits.
3. Accidental Death & Dismemberment: Pays out for specific severe injuries
or death.
4. Medicare: Federal coverage for seniors and certain disabilities.
5. Long-Term Care (LTC): Covers extended nursing or home care.
6. Limited Benefit (Voluntary): Specialized policies for specific illnesses or
accidents.
Which health coverage systems are administered or mandated by government
entities?
Answer: ✔️✔️ These include Medicare, Medicaid, Social Security Disability, and
State Workers' Compensation.
What is the specific definition and target demographic of Medicare?
Answer: ✔️✔️ It is a Federal insurance program primarily designed for individuals
aged 65 and older, as well as some younger people with specific disabilities.
How does Medicaid differ from Medicare in terms of funding and eligibility?
Answer: ✔️✔️ Medicaid is a State-run assistance program (with partial Federal
funding) that provides health coverage for low-income individuals of any age.
,Under what life circumstances can a policyholder add dependents to their
health insurance plan?
Answer: ✔️✔️ Dependents are typically added following specific "qualifying life
events," such as birth, legal adoption, or marriage.
Who has primary authority to regulate health insurance? -ANSWER ✔️✔️States
But.... federal govt regulates PPACA aka ACA (affordable care act)
What is the ACA? -ANSWER ✔️✔️Affordable Care Act
- policy is sold on guaranteed issue basis
- med coverage is available regardless of pre-existing coniditons
- dependent children are coverd
- low-income can take advantage of Fed subsidies and medicaid
- coverage must meet a minimum standard
- states set up health insurance exchanges for small biz and individual
**** only applies to medial expense insurance
Small Employer Medical Expese Plan -ANSWER ✔️✔️- 50 employees
- must offer medical expense coverage to all eligible employee
-preexisting conditions cannot be excluded for more than 1 year
- employer must offer at least 2 medical plan options
,Health insurance marketplace (health insurance exchange) -ANSWER ✔️✔️the
public can compare plans, shop around, buy from private insurance
healthcare.gov
Can a person enroll after open enrollment? -ANSWER ✔️✔️only if there is a
qualifying life event:
- marriage
- birth
- loss of other health insurance (quitting your plan does NOT count)
- moving
- becoming a US citizen
- release from prison
People who help you enroll in health insurance? -ANSWER ✔️✔️1. navigators
2. non-navigators assitant
3. exchange enrollment facilitators
4. certified application counselor
and producers
What are the Essential Health Benefits -ANSWER ✔️✔️- anbulance
- emergency servies
- hospitalization
- maternity and newborn care
, - mental health & substance abuse
- prescription drugs
- rehab
- lab service
- preventative and wellness services
- chronic disease management
- pediatric
Are their lifetime limits on health plans? -ANSWER ✔️✔️NO the ACA protects that
for all health plans
Metal Levels of health insurance -ANSWER ✔️✔️Bronze: plan(60%) you(40%)
Silver: plan(70%) you(30%)
Gold: plan(80%) you(20%)
Platinum: plan(90%) you(10%)
Catastrophic Plan -ANSWER ✔️✔️-Must be under 30 years old.
-Pays for 3 primary care physician visits before deductible applies.
-High deductible and low premium
-After deductible is met, costs are covered 100%.
Preventative Care Services -ANSWER ✔️✔️insured does NOT pay copayment or
coinsurance even if annual deductible has not been met
- blood pressure
- depression screening
