Chapter 9: Other Health Insurance Concepts

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Under workers compensation, which of the following benefits are NOT included

Legal benefits

A woman's health insurance policy dictates which doctors she is allowed to see. Her health providers share an assumed risk for their patients and encourage preventative care. What best describes the health system that the woman is using?

Managed care

Which of the following premium modes would result in the highest annual cost for an insurance policy

Monthly

The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called

Nonoccupational coverage

An insured has health insurance that covers them at work and at home. This policy was written on what basis

Occupational

A woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnant. Which of the following is true about coverage for pregnancy

Pregnancy will be covered immediately

Which of the following describes taxation of individual disability income insurance premiums and benefits

Premiums are not tax deductible, and benefits are not taxable

Which of the following is correct regarding the taxation of group medical expense premiums and benefits

Premiums are tax deductible and benefits are not taxed

Workers Compensation benefits are regulated by which entity

State government

The legal process that gives the insurer, after payment of a loss, the right to seek recovery from a third party that was responsible for the loss is known as

Subrogation

A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim,

The insurance through his company is primary

Which of the following statements regarding the Change of Beneficiaries Provision is false

The policyowner has the right to change beneficiaries in any case

Premiums paid by self-employed sole proprietors or partners for medical expense insurance are

Totally tax deductible

Under what condition are group disability income benefits received by an employee NOT taxable as income

When the benefits received are equal or less than the employee's percentage of the contribution

When may an insured deduct unreimbursed medical expenses paid under a long-term care policy?

When the expenses exceed a certain percentage of the insured's adjusted gross income

A brain surgeon has an accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for all losses

"Own occupation" - less restrictive than other definitions

An insured is covered by a partially contributory group disability income plan that pays benefits of $4,000 a month. If the insured pays 25% of the monthly premium, how much of the monthly benefit would be taxable

$3000

What percentage of individually-owned disability income benefits is taxable

0%

According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan

60%

According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

60%

Unreimbursed Employee Expenses

7.5%

Under which condition would an employee's group medical benefits be exempt from income taxes?

An employee's group medical benefits are generally exempt from taxation as income

Disability income coverage specifies that the policy covers the insured if he is unable to perform any job for which he is qualified. In this case, total disability is defined as

Any occupation- more restrictive than other definitions

Which of the following are NOT true regarding Workers Compensation

Benefits are offered by the insurer

Which of the following is NOT true regarding Workers Compensation

Benefits are offered by the insurer

Which type of insurance provides funds for a business organization to purchase interest of a disabled partner

Disability Buy-Sell

Concerning group Medical and Dental insurance, which of the following statements is INCORRECT

Employee benefits are tax deductible the year in which they were received

An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. This results in a long hospitalization period. Which of the following is true

The group plan will not pay because the employee was injured at work

An employee is injured in a construction accident, rendering him unable to work for a year. Which of the following plans would provide him with medical expense coverage and income assistance

Workers Compensation

An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay

$5,000

An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?

$500

The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT

Individual tax deduction for premiums paid

Which of the following is NOT metal level of coverage offered under the Patient Protection and Affordable Care Act

Iron

The mode of premium payment

Is defined as the frequency and the amount of the premium payment

In all health care plans under the Affordable Care Act (ACA), how many essential benefit categories are there

10

Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace

A permanent resident lawfully present in the U.S.

Which of the following would best describe total disability

A person's ability to work is significantly reduced or eliminated for the rest of his/her life

Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer

Disability Income


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