Health Insurance Exam 1

Group underwriting criteria includes all of the following EXCEPT

insurability of individual group members

The longer the benefit period of a disability income policy

the higher the policy's premium

Skilled nursing care means

nursing and rehabilitative care that is required daily and can be performed only by skilled medical practitioners on a doctor's orders.

The Fair Credit Reporting Act

obligates insurers that use a third-party source to acquire credit information to inform applicants who have been denied coverage of the identity of that source

Preferred provider organizations (PPOs) are typically

open-panel entities

The chief officer of an insurance department may issue all of the following penalties to licensees who engage in unfair or deceptive practices EXCEPT

order imprisonment for willful violators

In an HMO, the role of the gatekeeper is performed by the insured's

primary physician

In major medical policies, the coinsurance provision

requires the insured to pay a percentage of medical expenses

The purpose of a health savings account (HSA) is to

serve as a tax-favored way to accumulate funds to cover medical expenses

A medical expense policy's coinsurance provision

specifies the percentage of costs that will be paid by the insured and the insurer

Group health insurance premiums paid by the employer are

tax deductible as a business expense

When a group disability insurance plan is paid entirely by the employer, benefits paid to disabled employees are

taxable income to the employee

Changes to a written application for a life or health insurance policy can only be made by

the applicant

The period in which an insured must pay long-term care expenses before the policy benefits begin is called

the elimination period

The waiting period before benefit payments begin from a disability policy is called

the elimination period

All of the following are covered by Medicare Part A EXCEPT

the first 3 pints of blood

The maximum out of pocket cost for an insured is equal to

the insured's deductible times the coinsurance percentage minus the stop-loss limit

A distinguishing feature of a stock insurer is that

the issued policies are called non-participating policies

With a conditional receipt, coverage may become effective as early as the date

the policy is delivered to the owner

In a contributory plan, where the premium is paid by both the sponsor and the insured, what percentage of eligible employees must participate in the plan

75%

Which of the following must an individual have in order to establish a health savings account (HSA)

High-Deductible Health Plan (HDHP)

Which of the following policies pays a fixed hospital benefit directly to the insured, regardless of the actual hospital expenses incurred

Hospital indemnity policy

Under COBRA, the right to continue existing group health coverage is NOT available to an individual who

is terminated due to gross misconduct

In a noncontributory plan, when the premium is paid by the sponsor (employer), what percentage of eligible employees must participate in the plan

100%

The time limit on certain defenses provision (incontestability period) is usually how long in most states

2 years

The waiting period to qualify for Social Security disability benefits is

5 months

What is the definition of a fiduciary

A person in a position of trust and confidence who handles the affairs and funds of others

Which type of health insurance policy prevents the insurer from changing the premium rate of modifying the coverage in any way

Noncancelable policy

Which definition of total disability is most favorable to the insured

Own occupation

Who are the owners of a mutual insurance company

Policyowners

Joe offers a pair of tickets to the sold-out basketball game in exchange for the person to purchase her insurance with him. This is known as

Rebating

Julia's semiannual premium on her health insurance policy was due August 1. She forgot to pay the premium and suffers a loss on August 22, for which she files a claim. How will the insurer handle the situation?

The claim will be paid after Jackie pays her premium

In which type of contract is only one party's promises enforced

Unilateral contract

Medicare Part D provides coverage for

prescription drugs

Which of the following health insurance providers is most commonly associated with prepaid plans for subscribers

Health maintenance organizations

Which of the following situations described an instance of unfair discrimination

An insurer refuses to issue a policy to an applicant who works in an industry that is assumed to be at higher risk for HIV

The entire contract in a health insurance policy includes all of the following EXCEPT

Buyer's Guide

Major medical policies that pay 100% of covered expenses above a specifies amount contain what kind of provision

Stop loss provision

The expense that must be incurred before major medical benefits begin to be paid is

The deductible

If an employee of a large employer is over age 65 and is eligible for both Medicare and group health insurance, which will be the primary payor

The group policy will be primary.

Dwayne becomes disabled and is forced to leave his job for 4 months, during which time he received benefits under his disability income policy. Three months after returning to work, he is disabled again from the same cause. Which of the following statements is CORRECT

The original benefit period will resume as if Dwayne had not returned to work.

Which of the following most accurately described the probationary period in a health insurance policy

The period of conditional coverage after an application for coverage is submitted

An insurer's license to transact insurance business in the state is called

a certificate of authority

ABC Insurance Company's health insurance contract contains a 2-year time limit on certain defenses provision. This means that

after the policy has been in force for 2 years, ABC cannot deny claims on the basis of misinformation given in an application for insurance

All of the following would be eligible for Medicare EXCEPT

an individual with liver failure

All of the following would be considered activities of daily living (ADLs) for the purpose of a long-term care policy EXCEPT

cleaning

The Health Insurance Portability and Accountability Act (HIPAA) imposes requirements on health care providers with respect to

disclosure of protected health information

Which of the following actions may result in license suspension or revocation.

disobeying a cease and desist order

All of the following are processes within utilization management EXCEPT

financial planning certification

When conducting hearings, the Commissioner of Insurance may do all of the following EXCEPT

impose criminal penalties