Arkansas Life and Health Insurance Practice Exam 2025 – The Comprehensive All-in-One Guide for Exam Success!

The provisions of precertification, mandatory second surgical opinion, and concurrent review are categorized as managed care provisions. These concepts are designed to control costs and ensure that medical care is provided efficiently and effectively within a managed care framework.

Precertification helps insurers determine the medical necessity of a procedure before it occurs, ensuring that only appropriate services are covered. A mandatory second surgical opinion requirement encourages patients to seek verification of the necessity and appropriateness of a suggested surgical procedure, thereby reducing unnecessary surgeries. Concurrent review allows insurance companies to monitor the ongoing care of patients, ensuring that the treatment provided aligns with the planned course of action and remains medically necessary.

These provisions are not characteristic of group policies, which typically refer to arrangements that provide coverage to members of a group, such as employees of a company. Major medical plans focus on covering higher-than-normal medical expenses, while indemnity plans work on a fee-for-service basis without the integrated cost control mechanisms that define managed care. Thus, the correct classification for these specific provisions is managed care provisions, highlighting their role in the structure and regulation of healthcare services.