WISCONSIN HEALTH INSURANCE EXAM - MEDICAL
PLANS KEY FACTS
Major medical is considered to be what type of insurance plan? (Med Plan Concepts) -
Answers :Comprehensive Insurance
What is the purpose of preadmission certification? (Med Plan Concepts) - Answers :"To
eliminate unnecessary treatment, thereby lowering premiums (cost saving)."
Who may be included as a HMO primary care physician? (Providers / Plan Types) -
Answers :"Those in family practice, pediatrics, obstetrics and gynecology, but not
internists."
What isn't usually covered by HMOs as a preventative care service? (Providers / Plan
Types) - Answers :Adult hearing exams
Where are HMO services provided for normal care and emergencies? (Providers / Plan
Types) - Answers :"In-network, except for emergencies"
Is pre-authorization needed by HMOs for out of network emergency treatment?
(Providers / Plan Types) - Answers :"NO, although providers must notify the HMO
afterwards."
Does managed care include indemity plans? (Providers / Plan Types) - Answers :"No,
this includes medical services provided by HMOs, PPOs and POS (point-of-service)
plans, but not indemnity."
How are Medical Expense Claims often paid? (Providers / Plan Types) - Answers :A
fee-for-service basis.
What type of deductible do Major Medical Expense policies often have? (Providers /
Plan Types) - Answers :A comprehensive calendar year deductible.
How is pre-certification different from a concurrent review in utilization management?
(Providers / Plan Types) - Answers :Pre-certification is done PRIOR to treatment.
What do basic medical expense plans cover? (Providers / Plan Types) - Answers :"In-
hospital only, with first dollar coverage. There is no deductible or coinsurance, but
coverage is subject to inside (maximum) limits."
What plan types have deductibles and coninsurance requirements? (Providers / Plan
Types) - Answers :Major medical and comprehensive major medical plans.
PLANS KEY FACTS
Major medical is considered to be what type of insurance plan? (Med Plan Concepts) -
Answers :Comprehensive Insurance
What is the purpose of preadmission certification? (Med Plan Concepts) - Answers :"To
eliminate unnecessary treatment, thereby lowering premiums (cost saving)."
Who may be included as a HMO primary care physician? (Providers / Plan Types) -
Answers :"Those in family practice, pediatrics, obstetrics and gynecology, but not
internists."
What isn't usually covered by HMOs as a preventative care service? (Providers / Plan
Types) - Answers :Adult hearing exams
Where are HMO services provided for normal care and emergencies? (Providers / Plan
Types) - Answers :"In-network, except for emergencies"
Is pre-authorization needed by HMOs for out of network emergency treatment?
(Providers / Plan Types) - Answers :"NO, although providers must notify the HMO
afterwards."
Does managed care include indemity plans? (Providers / Plan Types) - Answers :"No,
this includes medical services provided by HMOs, PPOs and POS (point-of-service)
plans, but not indemnity."
How are Medical Expense Claims often paid? (Providers / Plan Types) - Answers :A
fee-for-service basis.
What type of deductible do Major Medical Expense policies often have? (Providers /
Plan Types) - Answers :A comprehensive calendar year deductible.
How is pre-certification different from a concurrent review in utilization management?
(Providers / Plan Types) - Answers :Pre-certification is done PRIOR to treatment.
What do basic medical expense plans cover? (Providers / Plan Types) - Answers :"In-
hospital only, with first dollar coverage. There is no deductible or coinsurance, but
coverage is subject to inside (maximum) limits."
What plan types have deductibles and coninsurance requirements? (Providers / Plan
Types) - Answers :Major medical and comprehensive major medical plans.
