WISCONSIN ACCIDENT AND HEALTH
INSURANCE TEST PAPER QUESTIONS AND
SOLUTIONS 100% CORRECT FOR THE 2026
FINAL.
⫸ What is a major difference between private commercial insurers
and HMO's?
An HMO pays claims on a fee-for-service basis.
A private commercial insurer typically has fewer health provider
choices.
An HMO combines medical care delivery and funding in one
organization.
A private commercial insurer only offers individual coverage.
Answer: An HMO combines medical care delivery and funding in
one organization
⫸ Which of the following health plans pay benefits on a pre-paid
service basis?
Medicare.
Medicaid.
Group medical expense.
HMO. Answer: HMO
,⫸ In a staff model HMO, enrollees normally have which of the
following pharmacy options available to them?
Mail-order pharmacy.
In-house pharmacy.
Captive pharmacy.
Network pharmacies. Answer: In-house pharmacy.
⫸ Inpatient psychiatric care is covered under Part A Medicare for
190 days per
Admission.
Year.
Benefit period.
Lifetime. Answer: Lifetime.
⫸ An HMO prescription drug plan is generally characterized by
Generic drugs only.
Annual deductibles.
Drugs dispensed through participating pharmacies.
Drugs dispensed through online pharmacies. Answer: Drugs
dispensed through participating pharmacies.
,⫸ A characteristic of preferred provider organizations (PPO) is
PPOs operate like an HMO on a prepaid basis.
If service is obtained outside the PPO, benefits are reduced and costs
increase.
PPOs are generally public in nature rather than private.
Health care providers themselves are barred from forming a PPO due
to conflict of interest. Answer: If service is obtained outside the PPO,
benefits are reduced and costs increase.
⫸ Individuals who participate in an HMO plan are called
Certificate holders.
Subscribers.
Policyowners.
Beneficiaries. Answer: Subscribers.
⫸ Tim had an on-the-job accident and collects benefits from his
individual disability income policy. Which factor could possibly
reduce these benefits?
State and federal income taxes.
Benefits he receives from workers compensation.
Total household income.
, Assistance he receives from friends and family. Answer: Benefits he
receives from workers compensation.
⫸ Which of these procedures is NOT designed for ambulatory care
centers?
Inpatient surgery.
Vaccinations.
Outpatient surgery.
Physical examinations. Answer: Inpatient surgery.
⫸ Specialty care is provided by which of the following health
maintenance organization (HMO) providers?
Neurologist.
HMO administrator.
HMO director.
Gatekeeper. Answer: Neurologist.
⫸ A MET third-party administrator may NOT perform which of the
following functions?
Claims processing.
Marketing the plan.
Underwriting the plan.
INSURANCE TEST PAPER QUESTIONS AND
SOLUTIONS 100% CORRECT FOR THE 2026
FINAL.
⫸ What is a major difference between private commercial insurers
and HMO's?
An HMO pays claims on a fee-for-service basis.
A private commercial insurer typically has fewer health provider
choices.
An HMO combines medical care delivery and funding in one
organization.
A private commercial insurer only offers individual coverage.
Answer: An HMO combines medical care delivery and funding in
one organization
⫸ Which of the following health plans pay benefits on a pre-paid
service basis?
Medicare.
Medicaid.
Group medical expense.
HMO. Answer: HMO
,⫸ In a staff model HMO, enrollees normally have which of the
following pharmacy options available to them?
Mail-order pharmacy.
In-house pharmacy.
Captive pharmacy.
Network pharmacies. Answer: In-house pharmacy.
⫸ Inpatient psychiatric care is covered under Part A Medicare for
190 days per
Admission.
Year.
Benefit period.
Lifetime. Answer: Lifetime.
⫸ An HMO prescription drug plan is generally characterized by
Generic drugs only.
Annual deductibles.
Drugs dispensed through participating pharmacies.
Drugs dispensed through online pharmacies. Answer: Drugs
dispensed through participating pharmacies.
,⫸ A characteristic of preferred provider organizations (PPO) is
PPOs operate like an HMO on a prepaid basis.
If service is obtained outside the PPO, benefits are reduced and costs
increase.
PPOs are generally public in nature rather than private.
Health care providers themselves are barred from forming a PPO due
to conflict of interest. Answer: If service is obtained outside the PPO,
benefits are reduced and costs increase.
⫸ Individuals who participate in an HMO plan are called
Certificate holders.
Subscribers.
Policyowners.
Beneficiaries. Answer: Subscribers.
⫸ Tim had an on-the-job accident and collects benefits from his
individual disability income policy. Which factor could possibly
reduce these benefits?
State and federal income taxes.
Benefits he receives from workers compensation.
Total household income.
, Assistance he receives from friends and family. Answer: Benefits he
receives from workers compensation.
⫸ Which of these procedures is NOT designed for ambulatory care
centers?
Inpatient surgery.
Vaccinations.
Outpatient surgery.
Physical examinations. Answer: Inpatient surgery.
⫸ Specialty care is provided by which of the following health
maintenance organization (HMO) providers?
Neurologist.
HMO administrator.
HMO director.
Gatekeeper. Answer: Neurologist.
⫸ A MET third-party administrator may NOT perform which of the
following functions?
Claims processing.
Marketing the plan.
Underwriting the plan.
