Core Health Plan Structures
Cost-Sharing & Limits
Other Health Coverages
Specialized Benefits & Exclusions
Other
100

Primary care Physician Or Primary care provider (PCP) Is know as a?

What is a Gatekeeper

100
This is the amount the insured must pay before benefits will be paid by the policy

What is a deductible?

100

_____ + _____ is made of comprehensive coverage

What is both major and basic?

100

This federal law requires employers with 20+ employees to offer continued group coverage under certain conditions.

What is the Consolidated Omnibus Budget Reconciliation Act (COBRA)?

100

This type of dental service includes routine checkups, x-rays, and cleaning

What are Diagnostic/Preventative Services


200

These are the 3 different basic medical policies.

Basic Medical, Basic Hospital, Basic Surgical



200

This is a percentage of claims the insured must pay after the deductible has been met

What is co-insurance

200

This government program provides health coverage for active duty or retired U.S military members and their dependents, offering plans like Standard, Prime, and ______ For Life.

What is TRICARE?

200

When benefits are based on the average fee charged by all providers in a given geographical area, it is called

 Usual, Customary, Reasonable (UCR)

200

Services like filings, periodontal treatments, and root canals fall under this category of dental care

What are basic services

300

This plan requires you to use specific doctors and hospitals within their network, often requiring a PCP

What is an HMO (Health Maintenance Organization)

300

This is the maximum a policy will pay for a covered loss per year.

What is an Annual Limit

300

Newborn Coverage begins ____

What is the moment of birth?

300

COBRA allows continued group health coverage for how many months after job loss (under normal circumstances)?

What is 18 months?

300

This specialized dental field focuses on irregularities and misalignment of teeth

What is orthodontics

400

This plan is more flexible than an HMO, allowing you to see a doctor without a referral, but you pay less if you use in network providers.

What is a PPO (Preferred Provider Organization)

400

A maximum of 2 or 3 deductibles will satisfy the deductible requirement for the entire family per calendar year. Is known as a?

Family Deductible

400

What Pays directly to the insured a specified dollar amount per day during hospitalization?

Hospital Indemnity

400

What is the period called when no benefits are paid at the start of a disability?

What is the elimination period?

400

What is a temporary coverage that provides limited benefits for a short period of time, typically 30 days to 12 months?

Short-Term Medical 


500

This is the "best of both worlds" plan; it lets you choose doctors freely, unlike an HMO, but generally cost less than a PPO

What is a POS (Point of Service) Plan?

500

A health plan has a $500 deductible, 80/20 coinsurance, and a $2,000 out-of-pocket max. After meeting the deductible, how much would the insured pay for a $6,000 covered bill?

What is $1,500?

500

This policy pays benefits if the insured person dies from an accident or suffers serious accidental injuries like losing a limb or eyesight, but specifically excludes losses due to sickness

What Accidental Death and Dismemberment

500

What is a common exclusion in most health insurance policies that prevents coverage for injuries sustained during war?

What is the war or act of war exclusion?

500

This is the maximum a policy will pay for a covered loss per claim.

What is  Per-cause ?