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Health Insurance Humana Practice Test
Q1. What are the main types of health insurance plans Humana offers?
A: Humana offers several types of plans:
- Medicare Advantage: For those eligible for Medicare, these plans include benefits beyond Original Medicare, like dental, vision, and wellness programs.
- Medicare Supplement (Medigap): Helps pay for out-of-pocket costs not covered by Original Medicare, such as deductibles and copayments.
- Prescription Drug Plans: Standalone Part D plans for Medicare recipients that cover prescription drugs.
- Individual and Family Plans: Health plans available to those under 65 and not eligible for Medicare.
Q2. How do I know if I qualify for a Medicare plan?
Ans: Medicare is typically available to U.S. citizens and legal residents who are 65 or older, or those under 65 with certain disabilities. If you have end-stage renal disease (ESRD), you may also qualify.
Q3. What is the difference between an HMO and a PPO plan?
Ans:
- HMO (Health Maintenance Organization): Requires you to choose a primary care physician (PCP) and get referrals to see specialists. It has lower out-of-pocket costs but restricts you to in-network providers.
- PPO (Preferred Provider Organization): Offers more flexibility in choosing providers and doesn’t require referrals. You can see both in-network and out-of-network providers, but seeing out-of-network providers may cost more.
Q4. What is a high-deductible health plan (HDHP), and who is it best for?
Ans: An HDHP is a plan with lower monthly premiums but higher deductibles. It’s often paired with a Health Savings Account (HSA), allowing you to save money tax-free for medical expenses. This plan works well for healthy individuals who don’t expect frequent healthcare visits or significant medical expenses.
Q5. Can I get help with prescription drug costs?
Ans: Yes, Humana offers standalone Prescription Drug Plans (PDPs) or drug coverage within some Medicare Advantage plans. If you have Medicare and need prescription coverage, a PDP or an Advantage plan with Part D is a good choice.
Q6. Are dental and vision benefits included in Humana health plans?
Ans: Some Medicare Advantage plans include dental, vision, and hearing benefits, whereas Original Medicare does not. Humana also offers separate dental and vision plans if your health plan doesn’t cover these services.
Q7. How do I know if a specific doctor is in-network with Humana?
Ans: You can check if a doctor is in-network by using Humana’s provider lookup tool on their website or calling their customer service. Staying in-network usually helps lower costs, especially with HMO plans.
Q8. What if I need healthcare while traveling?
Ans: Some plans, such as PPOs and Medicare Supplement plans, offer more flexibility for out-of-state or emergency care. Medicare Advantage HMOs may have more limited coverage outside their network area, so always check your plan’s specifics if you travel frequently.
Q9. How do I make the most of my Humana health plan?
Ans: Take advantage of preventive services, wellness programs, and telemedicine options if offered by your plan. Additionally, some Medicare Advantage plans include SilverSneakers fitness memberships, which can be used at participating fitness centers nationwide.
Q10. Can I change my Humana plan if my needs change?
Ans: If you’re in Medicare, you can typically change plans during the Annual Enrollment Period (Oct. 15 – Dec. 7) or during the Medicare Advantage Open Enrollment Period (Jan. 1 – Mar. 31). For individual and family plans, changes can usually be made during the Open Enrollment Period or if you have a qualifying life event.
Assignment by a policy owner of all control and omiership rights of an insurance
policy.
Absolute Assignment
Provision in life insurance policies that allow the life insurance policy’s death
benefits to be used while the insured is still living (insured must be tenninally ill).
Accelerated Benefits
Bodily injury resulting from an accident.
Accidental Bodily Injury
1) A type of health insurance policy
(2) A provision or rider attached to a life or disability income policy that pays either a specified amount if the insured dies. loses his/her sight. or loses a limb as
the result of an accident.
Accidental Death and Dismemberment (AD&D)
An unforeseen and unexpected cause of an accident that results in an injury. The cause of the action and the result must be unintentional or there will be no
coverage.
Accidental Means
The period during which the owner of a deferred annuity makes payments to build up assets.
Accumulation Stage
Everyday living functions and activities performed by individuals without assistance. These functions include walking. transferring, bathing, dressing, continence. and eating.
Activities of Daily Living (ADLs)
An insurance professional skilled in the analysis, evaluation, and management of
statistical information. Evaluates insurance Finns’ reserves, detemiines rates and
rating methods, and delemiines other business and financial risks.
Actuary
Insurance policies are contracts of adhesion because the terms are written by the insurer and the insured simply “adheres.” For this reason, vague or ambiguous provisions are often interpreted by courts in favor of the insured.
Adhesion
The agreed right of an insurance company to modify the insureds premium
payments under certain conditions.
Adjustable Premium
An insurance company authorized and licensed to do business in a given state.
Admitted (Authorized) Company
The tendency of those exposed to a higher risk to seek more insurance coverage than those at a lower risk. Insurers react either by charging higher premiums or not insuring at all.
Adverse Selection
This involves minimum or maximum age limits for insuring of new applicants or
for renewing policies.
Age Limits
Producers may function as agents, representing the insurance company. Agents are appointed by the insurer through a written agreement (contract) which outlines the agent’s authority to represent the insurer.
Agent
The maximum dollar amount that can be collected from a policy, for any
disability or period of disability.
Aggregate Amount
A contract in which the number of dollars to be given up by each party is not
equal, insurance contracts are aleatory because the policyholder pays a premium and may collect nothing from the insurer or may collect a great deal more than the amount of the premium if a loss occurs.
Aleatory
An insurer organized and domiciled in a country other than the United States.
Alien Insurer
Term life insurance that may be renewed annually without evidence of insurability until some stated age
Annual Renewable Term
The person or persons who receives the payment from an annuity contract
Annuitant
The conversion of the account balance of an annuity contract to mcomc payments.
Annuitization
A life insurance product that pays periodic income benefits for a specific period of time or over the course of the annuitants lifetime.
Annuity
In certain types of annuities, a person who receives annuity contract payments if the annuity owner or annuitant dies while payments are stilldue.
Annuity Beneficiary
The person or entity that purchases an annuity and has all rights to the contract. Usually, but not always, the annuitant.
Annuity Contract Owner
The guarantee that if an annuity contract owner dies before annuitization, the beneficiary will receive the greater of the current cash value or the cost basis.
Annuity Death Benefits
The insurance company that issues the annuity.
Annuity Issuer
Legal document providing detailed information about variable annuity contracts.
Annuity Prospectus
Authority of an agent Ihat is created when the agent oversteps express or implied authority, and when inaction by the insurer does nothing to counter the public impression that such authority exists.
Apparent Authority
1) Transfer of rights in a policy to an individual or entity other than the policy owner
2) Under Medicare, agreement by the health care provider to accept Medicare’s approved amounts as full payment.
Assignment
See Admitted Company.
Authorized Company
In life insurance, an optional provision that allows the insurer to use, automatically, whatever portion of the cash value is needed to pay premiums not paid by the end of the grace period.
Automatic Premium Loan Provision
See Relation of Earnings to Insurance
Average Earnings Clause
1) A person who may become eligible to receive, or is receiving, benefits under
an insurance plan other than as an insured.
(2) Any person enrolled in Medicare.
Beneficiary
Entitles the insured, who suffered a bodily injury, to collect up to a maximum established in the policy for all hospital and medical expenses incurred, without any limitation on individual types of medical expenses.
Blanket Policy
An independant, nonprofit membership association providing protection against the costs of hospital care in a limited geogra-phi-cal area. Provides coverage for hospital costs.
Blue Cross
An independant, nonprofit membership association providing protection against the costs of surgery and other items of medical care in a limited geographical area. Provides coverage for doctors’ fees.
Blue Shield
An insurance producer, licensed by the state, who represents various insureds, and who is permitted to place general insurance coverages with any insurance
company authorized to transact business in the state in which he/she is licensed.
Broker
A type of business disability income insurance designed to pay for continuing overhead while an owner is disabled.
Business Overhead Expense Insurance
A policy that may be terminated either by the insured or the insurance company by notification to the other party in accordance with the terms of the policy.
Cancellable Policy
This is am amount payable under accidental death and dismemberment coverage. It would be the amount payable for accidental loss of 1 limb.
Capital Sum
A system, under Health Maintenance Organization (HMO) forms of health
benefits, whereby physicians receive a payment from the HMO for every member of the HMO without regard to actual services the physician provides.
Capitation
For health insurance, it is a percentage of each claim above the deductible paid by the policyholder. For a 20 percent health insurance coinsurance clause, the policyholder pays for the deductible plus 20 percent of his covered losses.
Coinsurance
Assignment of a life insurance policy as security for a loan or debt with the
creditor to receive the proceeds or cash values to the extent of the interest
assigned.
Collateral Assignment
An illegal practice that occurs when a producer mixes the insureds funds mth
his/her own with the insurers funds.
Commingling
A company or concern engaged in the transportation of goods or persons for a fee.
Common Carrier
A provision that can be included in a life insurance contract providing that the primary beneficiary must outlive the insured for a specified period of time in order to receive the proceeds.
Common Disaster Provision
A policy designed to give the protection offered by both a basic and a major
medical policy.
Comprehensive Major Medical Insurance
A plan of insurance under the supervision of a state or the Federal Government that requires protection for medical, hospital, surgical, and/or disability’ benefits.
Compulsory Health Insurance
A receipt that provides that if the premium accompanies the application, the coverage is in force from the date of application (whether the policy has yet been issued or not), provided the insurer would have issued the coverage on the basis of facts as revealed by the application and other usual sources of underwriting information.
Conditional Receipt
Requires confinement of the insured in a hospital, or in a sanitarium to be entitled to collect disability income benefits.
Confining Disability
The exchange of values on which a contract is based. In insurance, the consideration offered by the insured is the premium. The consideration offered by the insurer is the promise to pay in accordance with the terms of the contract.
Consideration
A provision in an insurance policy setting forth the conditions under which, or the period of time (2 years) during which the insurer may contest or void the policy. After that time has lapsed, the policy cannot be contested.
Contestable Clause
A secondary beneficiary designated to receive the proceeds of a policy if the primary beneficiary predeceases the insured, or dies in a common accident.
Contingent Beneficiary
The act of obtaining an insurance license to write coverage on the producer’s own life, and/or on the lives the producer’s relatives and business associates.
Controlled Business
The right granted the insured to change his/her coverage from a group policy to individual policy. If a member of a group has a qualifying event he/she is given an opportunity to secure an individual policy within a specified period thereafter, regardless of whether or not he/she is in good health at that time.
Conversion Privilege
A term policy that can be converted to permanent without proof of insurability.
Convertible Term Insurance
The method of determining which company pays as primary insurer and which company pays as secondary or excess insurer when a working couple or their dependants have a claim covered by more than one insurance contract.
Coordination of Benefits
In an HMO, it is a nominal use charge the subscriber is required to pay for
services in addition to the prepaid amounts (premiums). Under Medicare, any amount, other than deductibles that the recipient must pay.
Co-Payment (Co-pay)
A rider that may be attached to policies adjusting the benefits based upon a
formula tied to inflationary trends.
Cost of Living Adjustment (COLA) Rider
Life insurance coverage on a borrower designed to repay the balance of a loan in the event tte borrower dies before the loan is repaid.
Credit Life Insurance
Care that is primarily for meeting personal needs such as help in the activities of daily living.
Custodial Care
Term insurance for which the initial amount gradually decreases until the
expiration date of the policy, at which time it reaches zero.
Decreasing Term Insurance
The amount of loss or expense that must be paid by the insured before benefits become payable. The insurance company pays benefits only for the loss in excess of the amount specified in the deductible provision. There are various types of deductible provisions.
Deductible
Under insurance law an unfair trade practice involving false, maliciously critical or derogatory statements intended to injure a person engaged in the insurance business.
Defamation
A physical condition that makes an insured incapable of performing one or more duties of his/her occupation, or, in the case of total disability, that prevents him/her from performing any other type of work for remuneration.
Disability
Loss of arm or leg by severance above the wrist or ankle. It also includes the total and permanent loss of sight.
Dismemberment
The return of part of the premium paid for a participating policy.
Dividend
An insurer formed under the laws of the State in which the insurance is written.
Domestic Company
A clause for the payment of twice the regular benefit if an insured dies under certain specified circumstances (usually as the result of an accidental injury).
Double Indemnity
Gross, salary, wages, commissions, fees, etc. derived from active employment.
This does not include non-earned income, such as income from investments, rents, an-nuities, insurance policies, etc.
Earned Income
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