CVS Health – Aetna One Advocate (A1A) Training Practice Test

These questions are part of the practice quiz. Start practicing

• What is the purpose of the Marketplace in health insurance?
• What type of plan is represented by the abbreviation MC?
• Which term refers to the payment from an insurance policy that is made directly to health care provider?
• What type of care does an HMO typically focus on?
• What document is required for children's dependent eligibility?
• What is the term for a drug not listed in a health insurance company's formulary?
• What is a qualifying life event in the context of health insurance?
• What is the key characteristic of a deductible in health insurance?
• What is the purpose of a health insurance deductible?
• What term refers to the monthly cost paid for health insurance coverage?
• In health plan terminology, which option indicates a specific point of service?
• What term describes the routing done by software to identify and connect the caller to an appropriate agent?
• What rule is applied to determine the primary insurance when a dependent has two plans?
• What type of service is offered by managed care plans like HMOs?
• Which option accurately describes generic drugs?
• What does OA MC represent in Aetna's terminology?
• What is the term for the existence of more than one disease or chronic illness in an individual?
• How is Medicare primarily funded?
• Which of the following is a type of care that focuses on both physical and emotional support for patients at the end of life?
• What type of document is required for proving a child's dependency in case of disability?
• What is the term for the method of organizing patients by diagnosis used as a basis for payment in hospitals?
• Which of the following services is kept confidential for active and retired employees and their families?
• What are non-covered charges in health insurance?
• Which of the following is defined as a complaint communicated to a health insurer?
• In health insurance, what does co-insurance refer to?
• What type of insurance plan typically has a network of providers that must be used for services to be covered?
• What do ICD Codes provide in relation to a member's visit to the provider?
• What is the term for the healthcare professional who oversees a patient's overall care in managed care?
• After meeting the deductible, what percentage of costs is typically covered by insurance that requires the individual to pay a portion?
• What is the primary requirement for a patient to receive benefits from an HMO plan?
• What is the primary purpose of a fee schedule in health care?
• Which document is required for a legal spouse dependency eligibility?
• Which term is used to refer to the person covered by the insurance policy?
• What is a common function of the Behavioral Health Department?
• What type of insurance typically involves fewer choices in healthcare providers?
• When Jane pays $30 each visit for her kids' doctor check-ups, what is this payment referred to?
• What type of health care service is provided to patients who have a life expectancy of six months or less?
• What Aetna service is required when a member has both Aetna insurance and Medicare insurance?
• What is a significant benefit of having dental coverage?
• In health insurance terminology, what does MC stand for?
• What is the maximum amount that a payer will reimburse any provider for each procedure or service referred to as?
• What does a “preferred provider” signify in health insurance?
• What is the term for healthcare providers that are not part of a predetermined group in a health insurance plan?
• What are the 5 W's related to claims?
• When should an A1A agent update their program link on the taskbar?
• What is the main benefit of using a PPO plan compared to an HMO plan?
• What is an out-of-pocket dollar amount paid at the time of service known as?
• Which of the following employees is entitled to the benefits of Family Medical Leave Act?
• What are the two common reasons a member is not displaying in GPA?
• What is the term for the scenario when Jane has to pay no further expenses after exceeding $10,000 in medical costs?
• What term describes a group of healthcare providers within a health insurance plan?
• What is the name of the federal program that assists with healthcare costs for individuals aged 65 and older?
• What is the fixed amount that you pay for specific services regardless of the total cost?
• Which of the following refers to a procedure or surgery that is planned in advance at the convenience of the surgeon and the patient?
• When is it necessary for an A1A agent to review the weekly updates on 'medical calls'?
• What do we call the amount a person pays to a healthcare provider at the time of service?
• Who typically acts as a doctor that coordinates general medical care?
• What does TC stand for in health care options?
• What does the abbreviation OA stand for when describing a healthcare choice?
• What is the term for the process where a provider contacts the insurance provider to check if a proposed procedure is covered?
• What must be submitted by a doctor for certain treatments to confirm they are "medically necessary"?
• What is the maximum amount an insured individual would have to pay for covered services in a plan year, after which the insurance company covers 100% of the costs?
• What does CMS stand for in relation to federal health programs?
• What document supports partner child dependent eligibility?
• What does the term "pre-existing condition" refer to?
• What type of medical services does not require an overnight stay at a hospital?
• Which term represents an option to elect a health plan?
• Which term describes a payment option where the insured pays a percentage of the costs after the deductible has been met?
• What term describes coverage provided for dependents who meet specific qualifications under an insurance plan?
• What is another term for other companies' HR departments?
• In a managed care setting, what document typically dictates the specific drugs covered by an insurance plan?
• Which federal regulation is designed to protect individuals' privacy and the security of health information?
• When is it acceptable to bypass validation on a blocked or restricted account?
• What term describes individuals who are eligible for coverage under a specific health plan?
• What is an example of a private health insurance company?
• Which department is responsible for helping members enhance their overall health and well-being?
• What type of insurance provides coverage for those with low income and limited resources?
• What does EC stand for in the context of health care options?
• How is a full-time employee defined in terms of hours worked per week?
• What is the primary reason members call support services?
• What do you call a prescription drug that contains the same active ingredients as a brand-name drug?
• Which event would constitute a qualifying life event?
• What is required as a fixed amount each time a medical service is accessed?
• What are the two requirements for a member to be assigned an OBGYN?
• What defines a brand name drug?
• Which type of managed care plan typically has a primary care physician coordinating all healthcare?
• What is required to be automatically enrolled in Medicare Part A?
• What is the financial threshold an individual must meet before health insurance covers expenses?
• Which document is necessary for a grandchild dependent's eligibility?
• What type of account allows a person to set aside pre-tax money for common medical costs and dependent care?
• What term refers to the percentage of a covered medical expense that the member must pay?
• What is meant by out-of-pocket costs in health insurance?
• Which type of health insurance provider typically includes less network restriction for patients seeking care?
• What is the term for a fixed dollar amount that must be paid by the insured for charges of providers each year?
• What is the term for intentional deception that results in unauthorized benefits in the insurance context?
• Which of the following best describes the cost-sharing aspect of health insurance where a patient pays a percentage of the covered service?
• What payment method in managed care involves a fixed prepayment to the physician?
• What is the monthly deduction from Bob’s paycheck to cover his health insurance known as?
• What type of plan is a PPO an example of?
• Which of the following describes a PPO insurance plan?
• What insurance plan type includes a managed care organization with contracted medical providers?
• Which group is specifically covered under the Children’s Health Insurance Program?
• What does the term durable medical equipment refer to?
• What describes the circumstance John faced when his insurance did not pay until he paid the first $500?
• Which law aimed to provide health insurance coverage for all Americans is also known as Obamacare?
• What classification is given to a hospital room that contains two beds?
• What is required for step-child dependent eligibility?
• What type of procedure typically requires approval before scheduling due to insurance guidelines?
• How many hours of PTO can roll over to the next year?
• Which of the following contexts best describes a “co-pay”?
• What does it mean when a procedure is medically necessary?
• What amount must be paid at the beginning of the year before any benefits can be utilized?
• What is the name given to the amount John paid before his insurance would begin to cover his medical bills?
• What kind of plan does the abbreviation EPO refer to?
• What federal law allows employees to take job-protected leave for illness or family reasons?
• What type of care addresses conditions that are urgent but not severe enough to require an emergency room visit?
• Which service is considered a first point of contact for computer application problems at Aetna?
• In most health insurance plans, what is required before certain treatments can begin?
• What is the primary focus of Medicare Part D?
• What is the term for a request for payment submitted by a healthcare provider to the insurance company?
• What do you call the insured person's share of the total cost for care?
• What do you call the amount of money paid monthly or yearly by an individual or employer for an insurance plan?
• What term is used for the fee charged by a healthcare provider for a specific service?
• Which program provides health coverage for low-income individuals and families?
• Which of the following refers to a charge made by the policyholder to maintain their insurance policy?
• What is the term for the total amount paid out-of-pocket before insurance coverage begins?
• What does OA EC refer to in health plans?
• What best describes a “deductible” in health insurance terms?
• What is a tax-advantaged savings account available for individuals in high-deductible health plans?
• If the copay line in GPC indicates 'None' or 'No Copay,' what benefit line should you quote instead?
• What type of physician acts as the primary care provider in a managed care plan?
• What is the nature of Medicare Part B in terms of payment structure?
• What refers to a change such as marriage or parenthood that impacts health insurance enrollment?
• What does the term “out-of-pocket maximum” refer to in health insurance?
• What is the term for the maximum amount a person pays out of pocket in a year before the insurance covers 100% of the costs?
• What type of crime is categorized as a felony and can lead to severe punishment or imprisonment?
• What does John pay after meeting his deductible when his insurance covers 80% of the remainder?
• What does a Health Maintenance Organization (HMO) require its members to do?
• What does Medicare Part A primarily provide coverage for?
• What does ACPOS II or CP II stand for?
• What does POS stand for in health care plans?
• What are the terms insured, member, policy holder, and recipient all synonymous with?
• Which of the following best describes coinsurance?
• What term is used to describe services that involve hospitalization and a room and board charge?
• What term refers to the payment that pharmacy requests from the insurance company to obtain reimbursement?
• What is the written order from a physician that allows a patient to see a specialist?
• What is the term for the flat fee expected to be paid for a single medical service, such as a doctor's appointment?
• Which managed care plan typically offers lower costs but has more restrictions than a PPO?
• What do we call services or medications deemed necessary for diagnosing or treating a medical condition?
• In what year was the Health Insurance Portability and Accountability Act (HIPAA) created?
• What is the purpose of the open enrollment period?
• What is the primary purpose of Medicaid?
• What term describes a healthcare provider that has a contract with an insurance company to provide discounted services?
• Which of the following documents is NOT required for a child's dependent eligibility?
• According to A1A plans, dependent children are covered up to what age under Health Care Reform guidelines?
• What is a medical provider that focuses on a specific diagnosis called?
• What event might allow an individual to enroll in health insurance outside of the standard enrollment period?
• What does co-insurance typically represent?
• What is the term for a fixed fee that an insured individual pays at the time of service?
• What does C.O.B stand for, and when is it required?
• What is necessary for patients prior to receiving any elective procedure in terms of financial obligations?
• Which document is needed for a partner dependent's eligibility?
• What does OC refer to in the context of health plan options?
• What is the role of diagnosis related groups in hospital billing?
• What is the agreement between an insurance company and the policyholder called?
• What does it mean if an individual has a pre-existing condition?
• What is typically true about an Out-of-Pocket Maximum (OOMP)?
• Which of the following is NOT a typical characteristic of managed care plans?
• For which demographic is Medicaid specifically designed to assist?
• What is the term for a list of prescription medications that are covered by a drug plan?
• What does CMED stand for in relation to health plans?
• What is a co-pay in terms of health insurance?
• What is the definition of co-insurance in the context of health insurance?
• What does EPO mean in insurance plans?
• Which aspect of insurance involves the cost-sharing mechanism where the insured pays a portion of the bill after the deductible is met?
• In which scenario is a Federal Tax Return needed for dependent eligibility?
• Which of the following is accepted as proof of joint ownership under the partner dependency requirements?
• What type of health insurance plan offers the least restrictions but is generally more costly?
• What does a prescription represent in the context of health insurance?
• What age group primarily benefits from the Medicare program?
• What is the term for a request to review a denied insurance benefit?
• Which choice is associated with a flexible health care plan option?
• What do we call a hybrid managed care plan that offers more flexibility than traditional HMOs?
• What term refers to the amount of money that must be paid out of pocket before insurance coverage begins?
• What are the groups of five numbers used to classify medical services for billing purposes called?
• Which type of provider may charge higher costs or not be covered by the insurance plan?
• What is the name of the process by which a provider contacts the insurance provider to verify coverage for a procedure?
• What must be provided if a child is disabled for dependent eligibility?
• What is the function of the National Advantage Program (NAP)?
• What is the term for the maximum amount an individual will have to pay out of pocket before insurance covers 100% of later medical expenses?
• What term describes a medication that requires authorization from a healthcare provider before it can be dispensed?
• What program is designed to reduce medical claim costs for plan sponsors and members?
• What process involves determining the disease or medical condition a patient has?
• What is the regular payment made to maintain health insurance coverage called?
• Which type of managed care plan is known for being the cheapest and most restrictive?
• What characterizes the coverage under Medicare Part A?
• What defines a list of usual fees typically charged to patients under normal conditions?
• Which of the following is a characteristic of Medicaid?
• What does meeting the out-of-pocket max amount signify for an insured individual?
• What does SPOC stand for in the context of Aetna employee support?
• How does the co-insurance structure typically work in a PPO plan?
• What defines a health issue that existed prior to the start of new health insurance coverage?
• What payment system requires a defined amount paid per visit regardless of the total cost of services?
• What does Medicare Part B primarily cover?
• What is one role of the Marketplace in health insurance?
• What is the primary purpose of a referral within the healthcare system?
• In the context of health insurance, what is predetermination?
• Who is classified as a part-time employee?
• What is TRICARE?
• For how long does an occurrence remain on an employee's record?
• In which of the following scenarios would an individual most likely have to pay the full cost of medical services?
• What allows a person to set aside pre-tax money for medical costs and dependent care through an employer?
• What type of insurance coverage helps pay for visits to a dentist for preventive services?
• What organization utilizes diagnosis related groups as a basis for payment systems?