A health plan issued to an employer under a single master contract, with covered employees receiving individual certificates of coverage, describes which type of coverage?
A. Group health insurance
B. Individual health insurance
C. Blanket accident insurance
D. Credit health insurance
Source: General insurance principle
The dollar amount a policyholder must pay out of pocket for covered services before the health plan begins to pay is called the:
A. Copayment
B. Premium
C. Deductible
D. Coinsurance
Source: General insurance principle
After a policyholder meets their deductible, a plan that pays 80% of covered costs while the policyholder pays the remaining 20% is describing which cost-sharing feature?
A. Elimination period
B. Coinsurance
C. Pre-existing condition exclusion
D. Copayment
Source: General insurance principle
A health plan that generally requires members to choose a primary care physician and obtain referrals to see specialists, while using only in-network providers except in emergencies, is characteristic of which plan type?
A. HMO
B. Indemnity plan
C. PPO
D. POS plan used only for out-of-network care
Source: General insurance principle
An EPO (Exclusive Provider Organization) health plan is best distinguished from a PPO by which feature?
A. A PPO requires a primary care physician referral for every specialist visit, while an EPO never does
B. An EPO covers only dental services
C. An EPO requires no premium payment
D. An EPO generally does not cover non-emergency out-of-network care at all, while a PPO typically covers out-of-network care at a higher cost-share
Source: General insurance principle
