Medical Insurance Final Exam Review
(2025/2026) questions n answers
The amount of money paid to keep an insurance policy in force is the.... - correct answer
✔✔Premium
Health insurance typically covers services and procedures considered medically necessary. Most
insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are
not considered medically necessary. - correct answer ✔✔False.
The amount payable by an insurance company for a monetary loss to an individual insured by
that company, under each coverage is called the.... - correct answer ✔✔Benefits.
Health insurance designed for military dependents and retired military personnel is called.. -
correct answer ✔✔TRICARE
Veterans of the U.S. armed forces may be covered by.... - correct answer ✔✔CHAMPVA
A policy that covers a number of people under a single master contract issued to the employer
or to an association with which they are affiliated and that is not self-funded is usually called... -
correct answer ✔✔Group Policy
Organizations that fund their own insurance programs offer their employees.... - correct answer
✔✔Self-funded plans
Entities that make payment on an obligation or debt but are not parties of the contract that
created the debt are called... - correct answer ✔✔Third-party payers.
,The maximum amount of money third-party payers will pay for a specific procedure or service is
called the... - correct answer ✔✔Allowable Amount
The federal- and state-sponsored health insurance program for the medically indigent is
called.... - correct answer ✔✔MEDICAID
The physician who enters into a contract with an insurance company and agrees to certain rules
and regulations is called a ______ provider. - correct answer ✔✔Participating
A review of individual cases by a committee to make sure that services are medically necessary
and to study how providers use medical care resources is called a(n) - correct answer
✔✔Utilization Review
The amount of money the policyholder pays per claim or per accident toward the total amount
of an insured loss before the company will pay on the claim is known as the... - correct answer
✔✔Deductible
Which of the following is not an advantage of managed care?
a. Healthcare costs are usually contained.
b. Access to specialized care and referrals is limited.
c. Most preventive medical treatment is covered.
d. Out-of-pocket expenses tend to be less than traditional insurance. - correct answer ✔✔B.
Access to specialized care and referrals is limited.
Which of the following is not a disadvantage of managed care?
a. Authorized services usually are covered.
b. Physicians' choices in the treatment of patients can be limited.
, c. More paperwork may be necessary.
d. Reimbursement is historically less than with traditional health insurance. - correct answer
✔✔A. Authorized services usually are covered.
Which type of HMO model consists of physicians with separately owned practices who formally
organize into a group but continue to practice in their own offices? - correct answer
✔✔Independent Practice Association
Which of the following individuals would not normally be eligible for Medicare?
Select one:
a. A 66-year-old retired woman Incorrect
b. A blind teenager
c. A 23-year-old recipient of AFDC
d. A person on dialysis - correct answer ✔✔C. A 23 year old recipient of AFDC
Which of the following expenses would be paid by Medicare Part B? - correct answer ✔✔C.
Physicians Office Visits.
Which part of Medicare covers prescription drug services? - correct answer ✔✔D.
A type of insurance that protects workers from loss of wages after an industrial accident that
happened on the job is called... - correct answer ✔✔Workers compensation.
Health Insurance benefits are determined by... - correct answer ✔✔Indemnity Schedules.
Service Benefit Plans.
Relative Value Studies
(2025/2026) questions n answers
The amount of money paid to keep an insurance policy in force is the.... - correct answer
✔✔Premium
Health insurance typically covers services and procedures considered medically necessary. Most
insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are
not considered medically necessary. - correct answer ✔✔False.
The amount payable by an insurance company for a monetary loss to an individual insured by
that company, under each coverage is called the.... - correct answer ✔✔Benefits.
Health insurance designed for military dependents and retired military personnel is called.. -
correct answer ✔✔TRICARE
Veterans of the U.S. armed forces may be covered by.... - correct answer ✔✔CHAMPVA
A policy that covers a number of people under a single master contract issued to the employer
or to an association with which they are affiliated and that is not self-funded is usually called... -
correct answer ✔✔Group Policy
Organizations that fund their own insurance programs offer their employees.... - correct answer
✔✔Self-funded plans
Entities that make payment on an obligation or debt but are not parties of the contract that
created the debt are called... - correct answer ✔✔Third-party payers.
,The maximum amount of money third-party payers will pay for a specific procedure or service is
called the... - correct answer ✔✔Allowable Amount
The federal- and state-sponsored health insurance program for the medically indigent is
called.... - correct answer ✔✔MEDICAID
The physician who enters into a contract with an insurance company and agrees to certain rules
and regulations is called a ______ provider. - correct answer ✔✔Participating
A review of individual cases by a committee to make sure that services are medically necessary
and to study how providers use medical care resources is called a(n) - correct answer
✔✔Utilization Review
The amount of money the policyholder pays per claim or per accident toward the total amount
of an insured loss before the company will pay on the claim is known as the... - correct answer
✔✔Deductible
Which of the following is not an advantage of managed care?
a. Healthcare costs are usually contained.
b. Access to specialized care and referrals is limited.
c. Most preventive medical treatment is covered.
d. Out-of-pocket expenses tend to be less than traditional insurance. - correct answer ✔✔B.
Access to specialized care and referrals is limited.
Which of the following is not a disadvantage of managed care?
a. Authorized services usually are covered.
b. Physicians' choices in the treatment of patients can be limited.
, c. More paperwork may be necessary.
d. Reimbursement is historically less than with traditional health insurance. - correct answer
✔✔A. Authorized services usually are covered.
Which type of HMO model consists of physicians with separately owned practices who formally
organize into a group but continue to practice in their own offices? - correct answer
✔✔Independent Practice Association
Which of the following individuals would not normally be eligible for Medicare?
Select one:
a. A 66-year-old retired woman Incorrect
b. A blind teenager
c. A 23-year-old recipient of AFDC
d. A person on dialysis - correct answer ✔✔C. A 23 year old recipient of AFDC
Which of the following expenses would be paid by Medicare Part B? - correct answer ✔✔C.
Physicians Office Visits.
Which part of Medicare covers prescription drug services? - correct answer ✔✔D.
A type of insurance that protects workers from loss of wages after an industrial accident that
happened on the job is called... - correct answer ✔✔Workers compensation.
Health Insurance benefits are determined by... - correct answer ✔✔Indemnity Schedules.
Service Benefit Plans.
Relative Value Studies
