Exclusive Provider Organizations

Question 1

The biggest difference between an Exclusive Provider Organization(EPO) and a Preferred Provider Organization (PPO) is the :

Answer 1

Use of Providers within the network;An EPO will only pay benefits if the subscribers uses in- network provider.

Question 2

All would be considered exclusions from a medical insurance plan except

Answer 2

Routine medical procedures; would certainly be covered under a medical plan. The other answerers would normally be considered exclusions from coverage not payable.

Question 3

What year was every state supposedly required to have an insurance exchange for to provide coverage for individuals and small employer groups

Answer 3

2014. The federal Government required every state to have an insurance exchange beginning in 2014.

Question 4

All are true statements about the Insurance Exchange Except:

Answer 4

Premiums can be higher due to pre existing conditions or applicants gender.

Question 5

What is the term that requires all individuals not covered by an employer group plan to acquire individual insurance through the exchange or pay a penalty.

Answer 5

Individual Mandate

Question 6

What is the name of the subsidy that is provided to low income families in an effort to make insurance premiums more affordable called?

Answer 6

Advanced Premium Tax Credit

Question 7

An individual who purchases a Silver Metal Plan may qualify for lower deductibles and co-payment through what provisions of the Affordable Care Act?

Answer 7

Cost Share Reduction

Question 8

The ACA requires an exchange to provide 4 Metal Tiers of benefit coverage. Which Tier would be the least expensive?

Answer 8

Bronze; only required 60% of the expected actuarial derived medical expenses.

Question 9

Depending upon their income, an individual may receive a tax credit that can be applied against the cost of their medical plan purchased through the exchange. Which plan is used as the benchmark to determine this tax credit?

Answer 9

Silver - The second lowest priced plan available within a state health insurance exchange

Question 10

This type of plan is found within an insurance exchange and has very large deductibles. In addition, it is only sold to those individuals age 30 or under and is designed only to pay for very high claims or losses.

Answer 10

Catastrophic

Question 11

All are true statements regarding Catastrophic plans except:

Answer 11

Are not required to pay for all of the Essential Benefits required by the ACA; A Catastrophic plan is required to provide coverage for all Essential Benefits, although these plans do have high front end deductibles

Question 12

The Affordable Care Act requires a specific percentage of premiums collected to be returned to the insured in the form of a medical benefit. What percentage premium collected is required to be returned in the form of benefits when discussing individual or small group plans?

Answer 12

80%

Question 13

All are true statements regarding polices sold within the state run exchange program except:

Answer 13

Requires pre authorization for emergency medical services ; Emergency medical services require no pre- authorization

Question 14

Which of the following groups are exempt from having to pay the Individual Mandate

Answer 14

Individuals with income below the poverty level
Families with an income below the poverty level
Religious objectors

Question 15

All are true statements regarding the Employer Shared Responsibility EXCEPT

Answer 15

Benefits only need to be offered to the employee and not the employee benefits

Question 16

Special enrollment allows changes to be made to an insured’s coverage choices only certain qualifying events occur. All of qualifying events EXCEPT;

Answer 16

All are true
Loss of Job insurance
The death of the spouse who provided family coverage through their workplace
Adding a dependent due to marriage or the birth of a child.