AAM Phase 1 Practice Exam

These questions are part of the practice quiz. Start practicing

• What is the "loss of earnings AND duties" definition of disability?
• Aggregating specific deductibles must be met by one or more members combined.
• What does MEC (Minimum Essential Coverage) refer to?
• Which of the following statements about run-out protection is true?
• Why do networks matter when selecting a health plan?
• Definition of a deductible?
• In aggregating deductible scenarios, the aggregating deductible is subtracted from the reimbursement.
• How do you calculate rate of change?
• Which statement about HSA ownership is accurate?
• In dental benefit terminology, what does the term "balance bill" refer to?
• What is a formulary drug?
• Which statement best describes the cost controls for specialty medications?
• Which disability definition requires both a loss of income and an inability to perform duties?
• Which statement best describes the 'bitter pill' concept for ACA individual coverage?
• What is the STD percentage and maximum weekly benefit?
• What is an indemnity plan?
• When did MEC begin?
• Are all dental basic and major benefit provisions the same across plans?
• Which statement about essential health benefits is accurate?
• Which plan may require a PCP but typically doesn't need referrals?
• In the Mary scenario, with SL = 200k and agg spec = 50k, what is the reimbursement amount?
• What is an aggregating specific deductible?
• Which of the following is a benefit of a PPO?
• CHIP is targeted to which group?
• CHIP stands for?
• An FTE is defined as working how many hours per week?
• Cal-COBRA applies to which employers?
• Tier 1 penalty is imposed for not offering MEC and equals which amount?
• Which outcome would indicate run-out protection is in effect?
• Which statement correctly describes the relationship between federal COBRA and Cal-COBRA?
• What is a mature rate?
• Under a PPO, how is out-of-network care typically paid relative to in-network care?
• Leverage trend is used in underwriting to reflect the impact of what on premiums?
• Which feature distinguishes a high-deductible health plan (HDHP) from traditional plans?
• What does subsidized coverage mean?
• Which statement about HSAs is true?
• Is it possible to contribute to an HSA while enrolled in Medicare?
• What is an EPO?
• Is an HDHP required for an HRA?
• Which statement about MEC is true?
• What is the elimination period for LTD?
• Which statement best describes a Pharmacy Benefit Manager (PBM)?
• Which items are excluded from weekly earnings?
• Which statement best describes the eligibility requirement for disability benefits?
• Stop loss policies are reimbursement policies.
• Which acronym corresponds to the Health Insurance Portability and Accountability Act?
• What does IBNR stand for?
• What is a carve-in pharmacy benefit?
• Under stop-loss, a specific deductible describes.
• In a plan timeline, run-out protection activates to cover which of these?
• Run-out protection extends to claims paid after what event?
• Under COBRA, what is the amount you must pay toward the plan?
• Which statement correctly describes the distribution of the 1094B and 1094C forms?
• Which statement best identifies a Health Savings Account (HSA)?
• What is run-out protection?
• What is the maximum waiting period under the ACA?
• Can someone age 65 use HSA money for a non-medical expense without penalty?
• Dental benefits are based on what principle?
• Cal-COBRA applies to small California employers with how many employees?
• In an embedded deductible in an HDHP, which statement is true?
• What is the STD maximum duration of benefits?
• Which statement best contrasts a PPO with a traditional indemnity plan?
• COBRA can be issued under which conditions?
• What does paid claim mean?
• Which statement correctly characterizes aggregate stop loss?
• What does IBNR mean?
• What is the triple tax benefit of an HSA?
• What kind of FSA can you have with an HSA?
• What is Guarantee Issue?
• Which statement is NOT a typical feature of IBNR reserves?
• Who owns an HSA?
• Mental health disability is limited to how many months during your lifetime?
• What is an HMO?
• Which statement best describes a specialty pharmacy?
• What is a carve-out pharmacy benefit?
• Which term describes a pharmacy benefit managed by a separate entity from the medical plan?
• A recurrent disability is relapse within how many months after returning to work?
• Can someone on a spouse's non-QHDHP contribute to an HSA?
• In the context of disability and health coverage, pre-existing conditions are considered for LTD but not for typical health or medical plans.
• TRICARE is best described as?
• Which term describes the group of mandated health plan benefits that includes preventive services?
• Which form acts as the plan sponsor's transmittal for 1095-C submissions?
• Which group is excluded from eligibility for disability benefits?
• What is a formulary in the context of an insurance plan?
• Who sets the limits on an HRA account?
• How is EPO different from PPO?
• What is the definition of a Health Savings Account (HSA) eligible HDHP?
• Tier 2 penalty applies to not offering which type of plan?
• In HDHP terminology, End Stage Renal Failure is abbreviated as?
• What is the LTD percentage and maximum monthly benefit?
• What are network discounts?
• Reserves are funds set aside for IBNR; which statement is accurate?
• Which statement about MEC inception is accurate?
• Michelle's Law allows dependents to stay on a parent's health plan under what condition?
• In a stop-loss contract basis notation, what does 15/12 indicate?
• Indemnity - no network typical usage?
• If a person returns to work full-time and the same disability returns within six months, how is the claim treated?
• What is balance billing?
• Pick the statement that correctly identifies run-out protection.
• Which plan requires a PCP upon enrollment?
• What is the definition of a Health Maintenance Organization (HMO)?
• Can self-employed individuals contribute to an HRA or FSA?
• In terms of plan timing, run-out protection covers which of these?
• Which of the following best describes the employer-sponsored wellness program notice?
• Which description best matches a POS plan?
• What is the minimum value requirement for a plan?
• Which form is filed directly with the IRS by fully insured carriers and sent to the member?
• What does FTE stand for in this context?
• Which factors affect the choice of a specific deductible?
• What does the term 'bitter pill ACA' refer to?
• What is the purpose of the 1095-C form?
• In an embedded deductible in an HDHP, which statement is true?
• If a claim is paid after the plan year ends, which protection would cover it?
• Which statement best describes the 1095-B form?
• Which statement describes network discounts?
• Why can a DHMO be less expensive than a PPO?
• Individual stop loss coverage does what?
• What does PPO stand for?
• What does EOB stand for?
• Which statement best describes the right to designate a primary care provider (PCP) under the plan?
• Are there any limitations on disabilities due to mental health?
• The affordable threshold for plan costs is defined as a percentage of household income. Which statement correctly reflects this threshold?
• In insurance, IBNR means the event has happened, but the claim has not yet been reported.
• Which items are included in fixed costs for pricing?
• Run-out protection is primarily concerned with which timing of claims?
• What is leveraged trend?
• HIPAA stands for?
• What is an example of a stop-loss specific deductible?
• InfoLock is best described as what?
• Which of the following is true about COBRA eligibility?
• What is Extension of Benefits?
• What is a recurrent disability?
• Which option correctly defines run-out protection?
• What is a grandfathered plan under ACA?
• What are the 1094 forms?
• If a disability occurs and a new plan starts during that period, what happens to the disability benefits?
• What is an HDHP?
• Which network is smaller than a PPO but larger than an HMO?
• If COBRA is elected, how long can coverage continue, including extensions?
• What is a secondary dental plan?
• What do fixed costs consist of?
• What makes up the total dental cost paid by the insured?
• Do PPO members still pay copays after hitting the out-of-pocket max?
• Which of the following best describes the scope of run-out protection?
• What's typically the smallest network and lowest-cost plan?
• Public exchanges are best described as which of the following?
• What is a primary dental plan?
• In the context of stop loss, which statement is accurate?
• How is an indemnity plan best described?
• Can you contribute to an HSA if you're on Medicare?
• When you have COBRA coverage, what must you do?
• What does PCORI stand for?
• The affordable threshold under the ACA is defined as what percentage of household income?
• Monte Carlo simulation is used to help select the right specific deductible level.
• PBM stands for?
• When a disability recurs within six months of returning to work, is a new waiting period required?
• What is Medigap?
• Which of the following is a pro of self-funding?
• What is a DHMO?
• What does the elimination period mean?
• What does ESRF stand for?
• MEC plans are commonly used in which industry?
• Coinsurance concept?
• What is a margin in insurance funding?
• Which plan is typically distinguished by having the largest provider network?
• What is a generic drug?
• How long does a qualified beneficiary have to elect COBRA coverage?
• Stop loss policies protect individuals on the plan.
• Which statement about MEC rules apply to large employers?
• Which statement describes a paid claim?
• When must the general COBRA rights notice be provided?
• Who is eligible for disability benefits?
• What is a POS plan?
• What is a disclosure?
• What is the "loss of earnings OR duties" definition of disability?
• Which plan is described as having no network and thus offers freedom to choose any provider?
• Which statement about PCORI is accurate?
• What is the elimination period for STD?
• Regarding STD elimination period, when do STD benefits begin?
• What is the key difference between self-funded and fully insured plans on an experience report?
• What employers must follow MEC rules?
• Which statement is NOT a standard tier in pharmacy benefits?
• Which items are included in essential health benefits?
• Are there restrictions on when you can use HSA funds?
• What is the maximum waiting period allowed under the ACA?
• What does the Women's Health and Cancer Rights notice inform members about?
• Run-out protection would apply to claims that are paid after which time frame?
• Which extension option is described for COBRA beyond the initial 18 months?
• In insurance, what does incurred mean?
• When are ASL reimbursements made?
• What do ACA offers refer to in this context?
• What is the primary goal of an HMO?
• What is coordination of benefits?
• What does a lifetime maximum cap in dental or health benefits represent?
• What is InfoLock?
• What is an embedded deductible in an HDHP?
• What is the purpose of aggregate stop loss?
• Are dental benefits payable after coverage ends?
• What is Medicare?
• Which statement best defines a generic drug?
• Which statement describes the notation 24/18 in stop-loss?
• In the June scenario, what is the reimbursement amount?
• Which plan has the largest provider network?
• Which statement about EPO plans is accurate?
• What is a notice?
• The purpose of run-out protection is to ensure payments for claims made when?
• Which statement best describes the relationship between primary and secondary dental plans?
• What is a pre-existing condition?
• The aggregating specific deductible value used in the examples is set at how much?
• What is an EPO (Exclusive Provider Organization)?
• What determines the LTD maximum duration of benefits?
• Why is orthodontics typically set as a lifetime maximum rather than an annual maximum?
• What characterizes a Health Reimbursement Arrangement (HRA)?
• Balance billing occurs when the provider bills the patient for the difference between the provider's charge and the allowed amount.
• What is the Medicare Part D creditable/non-creditable notice?
• What is an aggregate deductible in an HDHP?
• Can you take HSA distributions for a 25-year-old non-dependent child's expenses?
• Which statement correctly lists the four classes of dental benefits?
• Spec-only stop loss coverage is typically chosen by which type of clients?
• When employment ends, who retains the HRA balances?
• Which statement about non-formulary drugs is true?
• What happens to HSA balances when employment ends?
• In the July scenario, what is the reimbursement amount?
• Who is responsible for sending 1094B and 1094C forms?
• What is typical in-network vs out-of-network coinsurance?
• Which relationship best describes HDHPs and HSAs?
• DHMO stands for and is characterized by which model?
• Can you have an HSA if your spouse has a healthcare FSA?
• What is unique about specialty medications?
• What tool is used to help select the right specific deductible level?
• Which statement is true about a brand formulary?
• Which plan has no network?
• In Mary's example, which expression represents the reimbursement calculation?
• When are ISL reimbursements made?
• Are aggregating specific deductibles part of ISL or ASL?
• Copay is?
• The "paid" amount in self-insured context refers to what?
• What does UCR stand for?
• What plan has the highest out-of-pocket costs?
• Which statement best describes the disability definition "loss of earnings OR duties"?
• Which plan typically requires selecting a primary care physician to manage care?
• What is a contract basis in stop-loss?
• What are the three tiers of pharmacy benefits?
• Which protections apply to the employer-sponsored wellness program notice?
• Which form is sent by the plan sponsor to the member and IRS to show coverage was offered?
• Notice of special enrollment describes enrollment timing for certain events. When must enrollment be requested?
• MEC stands for?
• What happens to HRA balances when employment ends?
• What is the earnings test definition of disability?
• Which statement about HDHPs and HRAs is true?
• Which statement best describes run-out protection?
• Which type of client might choose spec-only stop loss coverage?
• When must HIPAA privacy notices be provided?
• What does disability insurance say about pre-existing conditions?
• In an experience report, which elements are included in fully insured plans?
• Where can you generate the annual/health plan notice packet?
• What is the definition of a PPO?
• Run-out protection is designed to cover which of the following?
• Who is protected by stop loss reimbursements?
• What is a narrow network?
• Which statement describes non-formulary drugs?
• Which statement describes a stop-loss contract basis?
• Who pays for disability coverage?
• What is a non-formulary drug?
• Essential Benefits under the ACA can have which restriction?
• What is the standard COBRA duration of coverage?
• Which term describes the coordination between two benefit plans where one plan pays after the other and may adjust its payout accordingly?