In a health insurance policy, what is the fixed dollar amount the insured pays out of pocket for a covered service at the time it is received?
A. Deductible
B. Copayment
C. Coinsurance
D. Premium
Source: West Virginia Insurance Candidate Handbook -- Accident and Health or Sickness Producer Exam (Pearson VUE, March 2025)
What term describes the amount an insured must pay out of pocket each year before the health insurer begins paying benefits?
A. Coinsurance
B. Deductible
C. Stop-loss limit
D. Vesting period
Source: West Virginia Insurance Candidate Handbook -- Accident and Health or Sickness Producer Exam (Pearson VUE, March 2025)
After the deductible is satisfied, an insured's policy requires the insured to pay 20% of covered charges while the insurer pays 80%. What is this cost-sharing arrangement called?
A. Copayment
B. Coinsurance
C. Premium loading
D. Elimination period
Source: West Virginia Insurance Candidate Handbook -- Accident and Health or Sickness Producer Exam (Pearson VUE, March 2025)
Which health plan structure generally requires members to select a primary care physician and obtain referrals to see specialists?
A. Preferred Provider Organization (PPO)
B. Health Maintenance Organization (HMO)
C. Indemnity plan
D. High-deductible health plan alone
Source: West Virginia Insurance Candidate Handbook -- Accident and Health or Sickness Producer Exam (Pearson VUE, March 2025)
Which health plan type allows members to see any provider but pays a higher benefit level for in-network providers?
A. HMO
B. PPO
C. Exclusive Provider Organization (EPO)
D. Point-of-Service without out-of-network benefit
Source: West Virginia Insurance Candidate Handbook -- Accident and Health or Sickness Producer Exam (Pearson VUE, March 2025)
