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California Insurance Exam Prep
California Insurance Exam Prep
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Chapter 5
Medical Expense: Individual Insurance
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HMOs: prepaid care under the Knox-Keene Act
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How HMOs manage care, and the protections enrollees keep
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HMO timely access, grievances and independent medical review
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PPOs: pay less in network, still covered outside it
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EPOs, and HMO vs. PPO vs. EPO
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Network protections in insurer plans: surprise bills, continuity of care and reviews
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Consumer-driven health plans and HRAs
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Medical savings accounts: Archer MSAs and Medicare Advantage MSAs
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HDHPs and HSAs: who qualifies and who can contribute
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HSA withdrawals, inherited HSAs and the California difference
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Health FSAs: the use-it-or-lose-it account
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Dental and vision: optional for adults, mandatory for children
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Contract provisions: cost sharing, the out-of-pocket limit and coordination of benefits
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Grace period, renewal and when an insurer may end coverage
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Common exclusions and limitations, and what California will not let a policy exclude
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