PLAHI Pennsylvania Life Accident and Health Insurance Exam - Set 4 - Part 3

Test your knowledge of technical writing concepts with these practice questions. Each question includes detailed explanations to help you understand the correct answers.

Question 41: A Pennsylvania subscriber must select a primary care physician who coordinates all of her care and must authorize any referral to a specialist working within a limited service area. Which of the following plan types has she enrolled in?

A preferred provider organization

A health maintenance organization

An indemnity major medical plan

A private fee-for-service plan

Question 42: A Pennsylvania employee may use any physician she wishes, but she pays noticeably less when she chooses a doctor who has agreed in advance to the plan's negotiated rates. Which of the following plan types does this describe?

A staff model health maintenance organization

A hospital indemnity plan

A scheduled dental plan

A preferred provider organization

Question 43: A Pennsylvania subscriber belongs to a plan that operates as a health maintenance organization when she stays inside the network, yet lets her go outside without a referral if she accepts a larger share of the cost. Which of the following describes it?

An exclusive provider organization

A basic surgical expense plan

A point of service plan

A private fee-for-service plan

Question 44: A Pennsylvania managed care plan reviews a proposed hospital admission before it ever happens, monitors the stay while it is under way, and then examines the file afterward. Which of the following describes this entire set of activities?

Coordination of benefits

Predetermination of benefits

Experience rating

Utilization management

Question 45: A child is born to a Pennsylvania family covered under a policy providing dependent coverage, and the parents want the coverage to continue past the opening weeks. Which of the following conditions may the insurer impose for continuation beyond that first period?

Evidence of the newborn's insurability

A separate application within one year

Notice and premium within thirty-one days

A waiting period for congenital conditions

Question 46: A Pennsylvania mother delivers her child by cesarean section at a hospital in Allentown, and her insurer proposes to end inpatient coverage after two days. Which of the following states the minimum inpatient coverage Pennsylvania requires after a cesarean delivery?

Forty-eight hours

Ninety-six hours

Twenty-four hours

No minimum applies

Question 47: A Pennsylvania employer asks whether it may elect coverage for employees' adult children beyond the federal age limit, and if so, what conditions the Commonwealth attaches to that election. Which of the following correctly describes Pennsylvania's optional adult child provision?

Optional coverage through age twenty-nine, with conditions

Mandatory coverage through age thirty-five

Optional coverage with no conditions attached

Mandatory coverage only for full-time students

Question 48: A Pennsylvania dental plan groups all covered treatment into several categories, and one of them covers the treatment of the soft tissue located at the center of each tooth. Which of the following categories covers that specific work?

Periodontics

Prosthodontics

Orthodontics

Endodontics

Question 49: A Pennsylvania group dental plan pays diagnostic and preventive care in full, shares basic services with the patient at a modest rate, and shares major services more heavily. Which of the following describes the usual coinsurance pattern across those three categories?

Full, then eighty-twenty, then fifty-fifty

Fifty-fifty across all three categories

Full coverage across all three categories

Eighty-twenty, then full, then fifty-fifty

Question 50: A Pennsylvania dentist submits a proposed treatment plan and the expected charges to the insurer before beginning extensive work, so that the patient learns in advance what the plan will pay. Which of the following describes that common practice?

Coordination of benefits

Utilization review

Predetermination of benefits

An integrated deductible

Struggling With Exams?

Less Time Studying, More Time Living – Finish Your Degree Faster! Pay-After-you-Pass!

Get Exam Support