AHIP PHIAS Practice Questions - Professional, Health Insurance Advanced Studies Exam - AHIP PHIAS Practice Questions - Professional, Health Insurance Advanced Studies Exam

Question 1

Which managed care model requires members to select a primary care physician (PCP) who acts as a gatekeeper and generally provides NO coverage for out-of-network care except in emergencies?

HMO PPO POS Indemnity plan

Correct Answer:

HMO

Question 2

A key distinguishing feature of a Preferred Provider Organization (PPO) compared with an HMO is that a PPO:

Provides coverage for out-of-network providers at higher cost sharing Requires a PCP referral for all specialist visits Pays providers exclusively through capitation Excludes all out-of-network care except emergencies

Correct Answer:

Provides coverage for out-of-network providers at higher cost sharing

Question 3

An Exclusive Provider Organization (EPO) is best described as a plan that:

Requires referrals but covers out-of-network care Has no network and pays any licensed provider Covers only in-network providers but typically does not require PCP referrals Pays providers solely through global capitation

Correct Answer:

Covers only in-network providers but typically does not require PCP referrals

Question 4

A Point-of-Service (POS) plan is characterized by which combination of features?

A PCP gatekeeper plus the option to use out-of-network providers at higher cost No PCP, no out-of-network coverage Only out-of-network coverage Mandatory capitation and no member choice

Correct Answer:

A PCP gatekeeper plus the option to use out-of-network providers at higher cost

Question 5

To be qualified to pair with a Health Savings Account (HSA), a High Deductible Health Plan (HDHP) must:

Meet IRS minimum deductible and maximum out-of-pocket limits Cover all services at 100% before the deductible Be sold only on the ACA marketplace Use a closed HMO network

Correct Answer:

Meet IRS minimum deductible and maximum out-of-pocket limits

Question 1

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About this Exam

Prepare with the AHIP PHIAS Practice Questions - Professional, Health Insurance Advanced Studies Exam practice quiz. This question bank includes 100 questions covering plan, medicare, health, care, and part. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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AHIP PHIAS Practice Questions - Professional, Health Insurance Advanced Studies Exam

This practice set contains 100 questions from the matching question bank and focuses on plan, medicare, health, care, and part. Work through each question carefully, review the provided solutions, and revisit topics that need more study before your next attempt.

This is an independent study resource intended for practice and review; it is not an official examination or an endorsement by any organization named in the title.

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AHIP PHIAS Practice Questions - Professional, Health Insurance Advanced Studies Exam

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