Chapter 11 quiz

What is the minimum number of employees needed for a small employer medical expense plan in Ohio? A. 2 B. 5 C. 10 D. 15

A. 2

Under the Affordable Care Act (ACA), health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition UNLESS it is a A. Grandfathered health plan B. Transitional plan C. Any group health plan D. Some individual health plan

A. Grandfathered health plan

Most prepaid dental plans cover A. Mouth cancer B. Oral exams C. Cosmetic dentistry D. Work related injuries

B. Oral exams

The marketing of Medicare Supplements is regulated to prevent all of the following EXCEPT A. Sale of excessive insurance B. Replacement of any existing coverage C. Inaccurate policy provisions D. Failure to display notice of limitations to buyer

B. Replacement of any existing coverage

What must the claimant do if the proper forms are not provided by the insurer? A. Resubmit the claim B. Talk to a lawyer C. Proceed by providing written verification of the loss D. Assume that the claim has been denied

C. Proceed by providing written verification of the loss

Which of the following describes the treatment service of a crown? A. Endodontics B. Periodontics C. Prosthodontics D. Orthodontics

C. Prosthodontics

Under the Affordable Healthcare Act, which group works with states to establish new Health Insurance Marketplaces? A. CICCIO B. OOIICC C. IIOCC D. CCIIO

D. CCIIO

Group dental insurers can discourage adverse selection by A. Limiting benefits for late enrollees B. Covering pre-existing conditions C. Allowing open enrollments D. Limiting the duration of coverage

D. Limiting the duration of coverage

How would preventative care be encouraged in a dental plan? A. Deductibles B. Exclude pre-existing conditions C, Closed dentist panels D. No deductible or coinsurance required on teeth cleanings

D. No deductible or coinsurance required on teeth cleanings

All of these are common limiting factors with dental insurance EXCEPT for A. Limit placed on how many teeth can be treated annually B. Limit on cosmetic-related procedures C. Limit on number of X-rays per year D. Limit on number of annual teeth cleanings

A. Limit placed on how many teeth can be treated annually

Under HIPPA rules, a medical plan's pre-existing conditions exclusion may be reduced by A. Any period of treatment in the six months prior to enrollment in the plan B. Any period of prior coverage C. The number of months that the exclusion was satisfied under previous qualifying coverage D. A flat three months if the condition was excluded under an

B. Any period of prior coverage

Except for fraud, the time after issuance of a policy during which an insurance company may contest an accident and health insurance claim due to the statements on an application is A. 10 days B. 90 days C. 2 years D. 5 years

C. 2 years

In Ohio, how much advance notice must be given before terminating a long-term care policy for nonpayment of premium? A. 10 days B. 20 days C. 30 days D. 60 days

C. 30 days

What is a prosthodontics dental procedure? A. A filling B. A root canal C. Bridgework D. Teeth cleaning

C. Bridgework

All of these are used to prevent adverse selection in a group dental plan EXCEPT A. Provide evidence of insurability B. Waiting periods C. Decreased participation

C. Decreased participation

All of the following are examples of unfair claim settlement practices EXCEPT A. Failing to promptly provide a reason for a claim denial B. Refusing arbitrarily and unreasonably to pay claims C. Denying unsubstantiated claims on a timely basis D. Misrepresenting pertinent facts of coverage

C. Denying unsubstantiated claims on a timely basis

In Ohio, continuation of medical plan coverage for a handicapped child beyond the age limit stated in the policy may require proof of the child's A. Continued insurability B. Incapacity only C. Incapacity and dependency upon reaching the age limit D. Dependency for the first two years of continued coverage only

C. Incapacity and dependency upon reaching the age limit

Which of the following is required to be included in a noncontributory accidental death and dismemberment group certificate of coverage? A. name of the group members B. number of group members C. operating expenses and cost of the policy D. description of coverage

D. description of coverage

Employer group dental plans may attempt to minimize adverse selection by utilizing all of the following EXCEPT A. deductibles B. probationary periods C. coinsurances D. encouragement of reduction in employee participation

D. encouragement of reduction in employee participation

Claims settlement practices of insurers are regulated by: A. The Internal Revenue Service B. The National Association of Insurance Commissioners C. Claims adjusters D. State insurance departments

D. State insurance departments

If an agent misleads or fails to adequately disclose the title and true nature of a policy offered to a potential insured, it may be considered A. Defamation B. Unfair discrimination C. Misrepresentation D. Rebating

C. Misrepresentation

Inflation protection must be included in all long-term policies delivered in Ohio UNLESS A. The inflation rate is below a specified level B. The policyholder rejects the coverage in writing C. The policyholder elects a coverage percentage equal to reasonable charges D. The policy contains a premium rate guarantee

C. The policyholder elects a coverage percentage equal to reasonable charges

When an HIV test is requested for an individual applying for a health and accident policy, who must sign the consent form? A. agent B. insurer C. applicant D. test administrator

C. applicant

In Ohio, when an individual is covered under a small employer's accident and health plan, the pre-existing conditions exlcusion period may be partially or wholly satisfied by A. having creditable coverage with a previous employer B. owning an individual dread disease policy C. electing a high deductible plan D. paying a fee

A. having creditable coverage with a previous employer

An Ohio agent's license to sell insurance may be revoked for all of the following reasons EXCEPT A. Rebating or twisting B. Misrepresenting contract provisions C. Being convicted of a felony D. Sharing commissions with licensed agents

D. Sharing commissions with licensed agents

Which of the following is true regarding an agent who is found to have violated a state insurance law by the Superintendent of Insurance in Ohio? A. All policies written by the agent will be voided B. The agent's license will be automatically reinstated after 6 months C. The agent must reimburse any customer effected double premiums paid D. The agent must pay the administrate costs associated with the investigation of such violations

D. The agent must pay the administrate costs associated with the investigation of such violations

Who must notify the Superintendent of a licensee's change of address? A. agent B. agency C. insurer D. managing agent

A. agent

How do preferred provider organization (PPO) dental plans compensate providers for standard dental procedures? A. Capitation B. Prepayment C. Reduced fee schedules D. Usual and customary fees

C. Reduced fee schedules

Attainment of the limiting age for dependent children will not terminate the coverage of a dependent child if A. the child is not married B. the child still lives at home C. the child is incapable of self-sustaining employment by reason of physical or mental disability D. the child is unemployed

C. the child is incapable of self-sustaining employment by reason of physical or mental disability

In Ohio, a group accident and health certificate of insurance must contain A. A copy of the group contract B. A list of all participating physicians C. The insurer's financial statement D. A listing of policy features and benefits

D. A listing of policy features and benefits

In Ohio, a group accident and health certificate of insurance must contain A. A copy of the group contract B. A list of all participating physicians C. The insurer's financial statement D. A summary of policy features and benefits

D. A summary of policy features and benefits

Which of these is NOT considered a preventative service in a dental plan? A. Fluoride treatment B. Oral examination C. Teeth cleaning D. Amalgamated filling

D. Amalgamated filling

An individual who declines coverage under a small group accident and health benefit plan and later enrolls is called A. A late enrollee B. A re-entry enrollee C. An eligible enrollee D. A qualified enrollee

A. A late enrollee

In Ohio, a period of accident and health insurance coverage which may be applied to reduce the length of a pre-existing condition exclusion under a new plan is called A. Creditable coverage B. Pre-existing coverage C. Prior coverage D. Continuation of coverage

A. Creditable coverage

All of the following are causes for termination of an employee's group insurance coverage EXCEPT A. The plan's coinsurance limit is reached B. The employee fails to make a required contribution C. The employment relationship is terminated D. The master contract is cancelled

A. The plan's coinsurance limit is reached

In dental insurance coverage, which of the following typically is EXCLUDED? A. Treatment started prior to the eligibility date B. Preventative care C. Dental X-rays D. Root canal therapy

A. Treatment started prior to the eligibility date

A MET third-party administrator may perform all of the following functions EXCEPT A. Insuring the plan B. Marketing the plan C. Underwriting D. Claims administration

B. Marketing the plan

An example of illegal inducement would be A. Announcing the opening of a new agency B. Publishing guaranteed dividend rates on a new type of policy C. Delaying payment on a claim because of an incomplete accident report D. Advertising that your agency can provide policies with competitive rates

B. Publishing guaranteed dividend rates on a new type of policy

Long-term care insurance policies may contain exclusions for all of the following EXCEPT A. Acute care B. Care outside the U.S. C. Care for intentionally self-inflicted injury D. Care for incurable conditions

D. Care for incurable conditions

Which of these is typically regarded as a major treatment in an individual dental plan? A. Fluoride treatment B. X-rays C. Restorative fillings D. Dentures

D. Dentures

Under which marketing system do insurers solicit customers by mass media advertising and mail without the services of an agent? A. Branch office B. Contingent C. Internet exchange D. Direct response

D. Direct response

Before a policyowner replaces an existing individual health insurance policy, all of the following types of provisions in the new policy need to be reviewed EXCEPT A. Coverage exclusions B. Benefit levels C. Coverage limitations D. Experience rating

D. Experience rating

All of these are normally covered under most dental plans EXCEPT for A. Braces B. Tooth extraction C. Dental bridge D. Oral cancer

D. Oral cancer

Splitting the commission with the buyer on a sale of insurance is known as A. Twisting B. Binding C. Soliciting D. Rebating

D. Rebating

Long-term care insurance policies may exclude coverage for all of the following EXCEPT A. War and acts of war B. Alcohol and drug dependency C. Self-inflicted injury D. Senile dementia

D. Senile dementia

When recommending the replacement of a health and accident policy, all of the following provisions should be carefully reviewed EXCEPT A. preexisting conditions B. waiting periods C. exclusions D. grace period

D. grace period

When a Medicare supplement policy is purchased during the open enrollment period A. the premium cost may be higher than usual B. the benefits may be lower than usual C. the exclusions may be more numerous than usual D. the policy must be issued regardless of health status

D. the policy must be issued regardless of health status

In Ohio, a long-term care policy which lapses may be reinstated within five months if A. The covered individual was mentally incapacitated B. The covered individual lost the premium notice C. The insurer failed to send a termination notice D. The insurer failed to send a second premium notice

A. The covered individual was mentally incapacitated

Under what circumstances must an agent provide his or her business records to the Director of Insurance? A. Upon request of an insured B. Upon request of the Director C. Under no circumstances due to privacy consideration D. By authorization from the National Association of Insurance Commissioners (NAIC)

B. Upon request of the Director

According to the Affordable Care Act (ACA), under what circumstances would lifetime limits and annual limits be permitted on a health plan or insurance policy? A. When coverages are not considered medically necessary B. When coverages are not considered essential health benefits C. When the insured is not considered essentially healthy D. When the insured not considered essential benefit

B. When coverages are not considered essential health benefits

Under the Affordable Care Act (ACA), parents can insure their dependent adult children up to their: A. 25th birthday B. 26th birthday C. 28th birthday D. 30th birthday

B. 26th birthday

Ohio requires advertisements for accident and health insurance policies covering ONLY a specified illness to prominently display A. The premium guarantee B. A statement that the policy is limited C. A schedule of payments D. The policy exclusions

B. A statement that the policy is limited

Misrepresenting pertinent policy provisions relating to coverage after a loss is A. A concealment in insurance application B. An unfair claims settlement practice C. An unfair discrimination between individuals D. A violation of the principle of adhesion

B. An unfair claims settlement practice

When an agent engages in unfair practices, all of the following are true EXCEPT A. The Director can investigate the problem and hold a hearing B. The Director's decision is final C. The Director can suspend the agent's license D. The Director can issue a cease and desist order

B. The Director's decision is final

Under the Affordable Care Act (ACA), what is the proportion of premium revenues spent on clinical services and quality improvements? A. Medical loss ratio B. Minimum essential coverage C. Issue rebate D. Market rate reform

A. Medical loss ratio

When an accident and health insurance policy provision is in conflict with the statutes of Ohio, it is A. Declared void and removed from the policy B. Used as is until the policy renewal date C. Amended to conform to the minimum statutory requirements D. Amended to conform to the maximum statutory requirements

C. Amended to conform to the minimum statutory requirements

If a group endorses an accident and health insurance product in an advertisement, the public must be made aware of A. The names of the group members B. The number of group members C. Any control by the insurer over the group D. Whether the group members are insured

C. Any control by the insurer over the group

A prepaid dental plan has an agreement in place with a network of dentists which A. allows the dentists to determine the deductible and coinsurance amounts B. establishes amounts that are considered full payment for services rendered C. requires all the dentists to be located within the same state D. must cover 100% of all orthodontic treatments

B. establishes amounts that are considered full payment for services rendered

Prepaid dental plans differ from most other types of dental plans in what way? A. X-rays and teeth cleanings are fully covered B. Possible exclusion of pre-existing conditions C. Closed panel of dentists can only be used D. Deductibles may have to be met

C. Closed panel of dentists can only be used

For long-term care insurance, when does Ohio require provision of a written notice of available insurance counseling programs? A. At policy delivery B. At the time of a claim for benefits is made C. When coverage is solicited D. Only when requested by policyholder

C. When coverage is solicited