Health Insurance Terms Quiz

Questions and Answers

Match the terms with their definitions in health insurance:

Aggregate Deductible = A deductible structure where total family expenses are combined to meet a single amount. Lifetime Maximum = The maximum amount your insurance plan pays for your care over a lifetime. Coinsurance = The percentage of costs you pay for covered services after meeting your deductible. Copayment = A fixed amount paid for a specific health service at the time of service.

Match the health insurance terms with their descriptions:

Claims = A formal request for payment based on insurance policy terms. Allowed Amount = The maximum amount an insurance plan will pay for a covered service. Deductible = The amount you must pay out of pocket before insurance starts to pay. Embedded Deductible = Each family member has an individual deductible in addition to a family deductible.

Match the following pairs of health insurance terms and their examples:

Aggregate Deductible = Family must spend $5,000 before insurance begins to pay. Coinsurance = You pay 20% of costs after meeting your deductible. Copayment = You pay $25 for a doctor's visit at the time of service. Lifetime Maximum = Insurance stops paying after reaching a set limit over your lifetime.

Match health insurance terminology to its implications:

Allowed Amount = Different charges may result in balance billing. Claims = Includes requests for payments after healthcare services. Deductible = Must be met before insurance begins to contribute. Embedded Deductible = Individual members' expenses can trigger coverage. Signup and view all the answers

Match the health insurance terms with what they refer to:

Coinsurance = Your percentage share of health care costs. Copayment = A specific dollar amount due at service time. Lifetime Maximum = The total cap on insurance payments across your life. Embedded Deductible = Offers individual limits within family coverage. Signup and view all the answers

Match the following health insurance terms with their characteristics:

Aggregate Deductible = Family expenses must reach a total deductible. Allowed Amount = Might leave you with out-of-pocket costs if fees exceed it. Claims = Generated after receiving medical services. Deductible = Initial out-of-pocket expense before benefits begin. Signup and view all the answers

Match the definitions to the correct health insurance terms:

Coinsurance = You share costs with your insurer after your deductible. Copayment = Pays a set fee at the point of service. Lifetime Maximum = Insurance stops coverage after this threshold. Aggregate Deductible = Combination of costs from all family members. Signup and view all the answers

Match the health insurance terms with their functional descriptions:

Allowed Amount = Limits financial responsibility for out-of-network providers. Claims = Key process for receiving insurance payouts. Deductible = Precondition to receiving most insurance benefits. Embedded Deductible = Facilitates higher flexibility in family health expenses. Signup and view all the answers

Match the following terms related to health insurance with their definitions:

Member Responsibility = The portion of health care costs a plan member must pay. Out-of-pocket Cost = Amount you pay for services not covered by insurance. Member Policy = Document outlining coverage terms and conditions. Affordable Care Act = Health care reform law enacted in 2010. Signup and view all the answers

Match the following types of medications with their descriptions:

Brand Name = Drug sold under a trademarked name. Generic = Medication sold under its chemical name at a lower cost. Specialty Brand Name Drug(s) = High-cost medications for complex conditions. Prescription Drug = Medication that requires a prescription to dispense. Signup and view all the answers

Match the following concepts with their characteristics:

Formulary = List of prescription drugs covered by a health plan. Pharmacy = Facility where prescription medications are dispensed. Out-of-pocket Cost = Includes deductibles, copayments, and coinsurance. Member Responsibility = Obligation to pay certain health care costs. Signup and view all the answers

Match the following health care terms with their roles:

Prescription Drug = Regulated for safety and efficacy by the FDA. Pharmacy = May provide advice on medication management. Affordable Care Act = Aims at expanding health insurance coverage. Formulary = Categorizes drugs into tiers for payment purposes. Signup and view all the answers

Match the following insurance-related terms with their descriptions:

Member Responsibility = Includes deductibles and copayments. Out-of-pocket Cost = Costs exceeding the plan’s allowed amount. Brand Name = Often protected by patents. Generic = Has the same active ingredients as its brand-name counterpart. Signup and view all the answers

Match the following terms to their examples:

Specialty Brand Name Drug(s) = Used to treat rare conditions. Pharmacy = Where vaccinations may be administered. Member Policy = Details benefits and exclusions of the insurance plan. Affordable Care Act = Legislation aimed at health care reform. Signup and view all the answers

Match the following health care terms with key attributes:

Out-of-pocket Cost = Represents the amount paid by the patient. Prescription Drug = Requires a licensed provider's prescription. Formulary = Shows which drugs the insurance plan will cover. Member Responsibility = Involves costs members must manage. Signup and view all the answers

Match the following terms with the correct categories:

Generic = Lower-cost medication. Pharmacy = Dispenses medications. Brand Name = Trademarked drug. Affordable Care Act = Regulatory framework for health insurance. Signup and view all the answers

Study Notes

Aggregate Deductible

Combines total medical expenses for an entire family to meet a single deductible amount.
Once $5,000 is met collectively, insurance starts covering expenses for all family members.

Allowed Amount

Represents the maximum payment an insurance plan will authorize for a covered health service.
If provider charges exceed this amount, balance billing may occur unless using an in-network provider.

Claims

Formal requests for payment submitted by you or your healthcare provider to the insurance company.
Claims pertain to services like doctor visits, hospital stays, or treatments requiring insurer payment.

Coinsurance

A percentage of costs for healthcare services paid by the insured after the deductible is met.
Example: With a 20% coinsurance, you pay 20% of service costs, while insurance covers 80%.

Copayment

Fixed fee paid for specific healthcare services, such as physician visits or prescriptions at the time of service.
Varies by service type and insurance plan, separate from overall deductible.

Deductible

Financial threshold that must be met out of pocket before insurance starts contributing to covered services.
For instance, a $1,500 deductible means that amount must be paid prior to insurer payments.

Embedded Deductible

Family deductible structure where each member has an individual deductible alongside an overall family deductible.
Individual coverage begins once an individual’s deductible is met, regardless of the family’s total.

Lifetime Maximum

The cap on the total amount the insurance will pay over a policyholder’s lifetime.
Most plans post-Affordable Care Act prohibit lifetime maximum limits for essential health benefits.

Member Responsibility

The share of healthcare costs that a plan member must cover, including deductibles, copayments, and coinsurance.
Additionally includes costs for out-of-network services or uncovered expenses.

Out-of-pocket Cost

Total expenses incurred for healthcare services not reimbursed by insurance, including various cost types.
Covers deductibles, copayments, and costs exceeding allowed amounts or coverage limits.

Pharmacy

Facility where prescription medications are dispensed along with healthcare services like vaccinations.
Pharmacies may offer drug management and interaction advice.

Brand Name

Pharmaceuticals sold under trademarked names, generally higher priced than generic versions.
Often protected by patents granting exclusive selling rights for a specific period.

Formulary

A comprehensive list of prescription medications covered under a health insurance plan, including generics and brand names.
Drugs are organized into tiers which influence patient cost shares.

Generic

Medications containing the same active ingredients and intended uses as brand-name drugs, sold at lower prices post-patent expiration.
Identified by their chemical names rather than brand labels.

Prescription Drug

Medication requiring a legal prescription from a licensed provider for dispensing.
Regulated by the FDA to ensure safety and efficacy.

Specialty Brand Name Drug(s)

Expensive prescription medications for complex or rare health conditions like cancer or autoimmune diseases.
Require special handling and monitoring, usually costing more than standard medications.

Member Policy

Document detailing coverage terms, including benefits, exclusions, premiums, deductibles, and copayments.
Serves as an agreement between the insured member and the health insurance provider.

Affordable Care Act

A significant healthcare reform law enacted in 2010 focused on expanding insurance coverage and reducing healthcare costs.

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Description

Test your knowledge of health insurance terminology by matching terms with their definitions. This quiz will help you understand essential concepts related to health insurance, increasing your financial literacy and awareness.