Public Health Insurance Quiz

Is a health insurance premium something you must pay every month, regardless of whether you use health care services, or do you only have to pay your health insurance premium during months when you use health care services?

Must pay every month, regardless of whether you use services.

Suppose your health plan covers lab tests in full if you go to an in-network lab, but only pays 60% of allowed charges if you go out of network. You forget to check and go get your blood test at a lab that turns out to be out of network. The lab bills you $100 for the blood test. Your health insurance allows only a $20 charge for that test. How much would you have to pay out of pocket for that lab test?

$88.. Your health plan will pay 60% of the $20 allowed charge, or $12. Because the lab is not in network, it is not required to accept the health insurance's discounted price, which is also called the allowed charge. The lab can bill you for the balance, which is $88.

Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day copay. You get sick and are hospitalized for 4 days, and the bill (after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?

2,000

Which of the following is the best definition of the term "health insurance premium?"

The amount health insurance companies charge each month for coverage.

Which of the following is the best definition of the term "annual health insurance deductible?"

The amount of covered health care expenses you must pay yourself each year before your insurance will begin to pay.

Which of the following best describes a health plan "provider network?"

The hospitals and doctors that contract with your health plan to provide services for an agreed-upon rate or fee schedule.

Which of the following best describes a "health insurance formulary?"

The list of prescription drugs your health plan will cover.

Which of the following best describes the "annual out-of-pocket limit" under a health insurance policy?

The most you will have to pay in deductibles, copays, and coinsurance for covered care received in network for the year.

True or false? If your health insurance or health plan refuses to pay for a service that you think is covered and your doctor says you need, you can appeal the denial and possibly get the insurance company to pay the claim.

True

True or false: If you receive inpatient care at a hospital that participates in your health plan's provider network, all the doctors who care for you while you're in the hospital will also be in network.

false