Health Insurance Final Exam A

Outpatient surgery

"Ambulatory" services are generally those that stress:

Non-payment

A Medicare Supplement policy may be cancelled by an insurer for which of the following reasons:

By either the insurer or the insured

A cancelable policy of health insurance may be cancelled:

Alcohol or narcotics

A claim filed under an individual Accident and Health policy might be denied if the loss was due to:

Comprehensive plan

A combination of a basic medical expense insurance plan and a major medical plan is known as a:

Medical Expense

A customer who wants their medical bills paid if they break their leg should buy:

Pay the claim

A health insurance claim occurs on May 30, but the policy lapses on June 1. If the claim is turned in on June 8th, the company will:

From the moment of birth

A health insurance policy providing family coverage must cover newborns:

Critical illness

A health insurance policy that pays a lump-sum if the insured suffers a heart attack, stroke or cancer and pays in addition to other types of health insurance the insured may have is known as:

Point-of-Service (POS) plan

A managed care plan that covers both in-network services in the traditional HMO manner and out-of-network services based upon a fee schedule with providers is known as a:

The loss occurred during the grace period

A premium that is due could be deducted from a claims payment under which of the following circumstances:

Stop-loss plan

A program where an employer pays employee claims up to a certain amount and insurers pay amounts above those limits, if needed, is known as a:

Medicaid

A program where the Federal government provides matching funds to the state in order to fund health care for low income individuals is known as:

Pays the hospital or doctor directly as provided by the service plan

A service plan of health insurance:

Disability benefits may be paid beyond age 65

All are true about Disability Income benefits under Social Security, EXCEPT:

It is the same with all insurers who write Disability Income insurance

All are true about the typical definition of total disability, EXCEPT:

Benefits are taxable as income to the business

All are true regarding Key Employee Disability Income insurance, EXCEPT:

Continuation requires passing a physical examination

All are true regarding continuation of health insurance after termination of employment, EXCEPT:

It is usually written on an individual basis

All are true regarding dental coverage, EXCEPT:

Employees with pre-existing conditions may be excluded from the group coverage

All are true regarding employee group health insurance, EXCEPT:

Benefits are payable from the onset of the disability

All are true regarding group Credit Disability insurance, EXCEPT:

Group coverage is subject to continuation under COBRA, but not conversion

All are true regarding group medical expense insurance, EXCEPT:

Total incontestability after the policy has been in-force for 2 years

All of the following are mandatory provisions in an individual health insurance policy, EXCEPT:

A letter of recommendation from an insurance agent

All of the following are required in the application for an insurance license, EXCEPT:

They follow the Principle of Indemnity

All of the following are true about Cancer and Dread Disease policies, EXCEPT:

They are designed to supplement Medicare Parts A, B and C

All of the following are true about Medicare Supplement policies, EXCEPT:

They cannot contain any probationary period

All of the following are true about Medicare Supplements, EXCEPT:

They must have a cash value

All of the following are true regarding "qualified" Long Term Care (LTC) insurance plans, EXCEPT:

Benefits are subject to a deductible

All of the following are true regarding Preferred Provider Organizations (PPOs), EXCEPT:

It applies to all types of health insurance sold in this state

All of the following are true regarding the Health Insurance Portability and Accountability Act (HIPAA), EXCEPT:

Insurer

All of the following must sign an application for life or health insurance, EXCEPT the:

Pay extra if the insured's other disability income benefits are reduced

An additional monthly payment rider added to a disability income policy will:

45

An individual health policy is considered reinstated after how many days following the request if the policyholder has not heard from the insurer:

100% of their deductible

An individual under age 55 can contribute a maximum of how much to a Health Savings Account (HSA):

The assignment of a caseworker to an ongoing claim

Concurrent review is defined as:

Low income and asset levels

Coverage under Medicaid for custodial care in a nursing home is conditioned upon:

Monthly payments until the insured recovers or the loan is paid off

Credit disability insurance will pay:

The various states

Eligibility for Medicaid coverage is determined by the:

May continue in the group with no change in coverage

Employees covered under a group health policy who attain age 65:

Buy all the coverage offered by the trust

Employees of small employers in the same type of business insured under a multiple employer trust must do all, EXCEPT:

18

Generally, COBRA requires an employer with 20 or more employees to allow a terminated employee to continue coverage in the group plan for up to ____ months by paying their own premiums:

It covers acute care in the hospital

Generally, all are true about Long Term Care insurance, EXCEPT:

Loss of income

Health insurance generally covers all of the following from the date of loss, EXCEPT:

The business

If a business wants to buy a disability income policy on a key employee, which of the following is considered to be the applicant:

Falling down the stairs

If a health insurance policy contains an "accidental means" clause, an insured would be covered if they broke their leg while:

Major Medical policy

If a person wishes to purchase a health policy that would pay for hospital bills in case of an accident, they would purchase a:

30

If an employee with Group medical expense insurance needs kidney dialysis due to end-stage renal disease, their group coverage will be primary for ____ months, after which Medicare will become primary:

800

If an insured with a major medical policy with a $100 deductible and 80/20 co-insurance has a $1,100 claim, how much will the insurer pay:

$200

If an insured with a major medical policy with no deductible and 80/20 co-insurance has a $1,000 claim, the insured must pay:

Usual, customary and reasonable

If no provider agreement exists between a provider and an insurer, the insurer will pay for medical services rendered on a ______________ basis:

The amount paid will be reduced

If the client goes out of network for services on a PPO:

Employer and the insurance company

In group health insurance, the contract is between the:

10%

Individuals may be able to tax deduct their premiums for medical expense insurance if they exceed ____ % of their adjusted gross income:

Only the insurer makes an enforceable promise

Insurance contracts are considered to be "unilateral" because:

Acute care

LTC insurance covers all of the following, EXCEPT:

Alzheimer's disease

LTC policies may exclude coverage for all of the following, EXCEPT:

Premiums

Medicare Part B is financed mainly by:

Part C

Medicare Part ____ is also known as the "managed care" option:

60

Most insurers will not write individual disability income coverage in excess of ____% of an insured's gross monthly income:

Sleeping

On Long Term Care (LTC) insurance, all of the following are considered to be "activities of daily living" (ADLs), EXCEPT:

90

On an individual health insurance policy, the insured must render proof of loss within ____ days of the loss:

Any occupation

On disability income insurance, if an insured is considered to be disabled if they cannot perform any job they are suited for by prior education, training or experience, they have the ________ definition of total disability:

Elimination period

On disability income insurance, the time between the onset of an injury or sickness and the time benefits begin is known as the:

Common accident deductible

On medical expense insurance, if several members of the same family are injured in the same accident, the insured should have carried a:

Part C

Persons seeking the managed care option for Medicare should enroll in Medicare:

Sickness you had prior to the effective date of the policy

Pre-existing conditions are defined as:

Fully deductible

Premiums paid by sole proprietors for individual health insurance coverage are:

Not tax deductible

Premiums paid for individual Disability Income policies are:

It usually covers you, both on and off the job

Short Term Disability Income insurance has the following characteristics, EXCEPT:

After two years of benefits

The "any" occupation definition in disability income policies is especially important:

Regulates consumer reports

The Federal Fair Credit Reporting Act:

30 days

The free-look when replacing Long Term Care insurance is:

Coordination of Benefits

The group insurance provision that prevents two insurers from paying more than the actual loss is called:

Five months

The waiting period before a qualified person can receive Social Security disability benefits is:

Countersignature

To be valid, an insurance policy must have all of the following, EXCEPT:

12 months

To qualify as disabled under the provisions of Social Security, your disability must be expected to last at least:

12

To qualify for disability income benefits under Social Security, an individual's disability must be expected to last at least ____ months or result in death:

Principle of Indemnity

To restore you financially after a claim is known as the:

Primary

Under a Group medical expense plan's Coordination of Benefits (COB) provision, when an insured is covered by more than one policy, the policy that covers them as an employee is considered to be:

The claim will be paid on a pro-rata (proportionate) basis

Under the "other insurance" clause, if two policies cover the same disability income claim:

The claim will be paid, but the overdue premium will be subtracted

Under the "unpaid premium" provision of a health insurance policy, if the insured has a claim in the grace period:

Give the insurer time to investigate the claim

Under the Legal Actions Provision, the insured cannot sue for non-payment of a valid claim until after 60 days in order to:

Hospital indemnity

What type of health insurance will pay the insured a specific benefit for each day that the insured is confined to the hospital:

Orthodontics

When a dentist uses mechanical devices to straighten teeth, it is known as:

Sudden and unforeseen

When a person jumps off a street car and breaks their ankle, this injury is considered to be:

Automatically at age 65

When a person takes early retirement under Social Security at age 62, when does coverage for Medicare Part A begin?

Prospective review

When a provider submits a claim for prior approval before performing medical services, the provider is using a utilization management technique known as:

Optionally renewable

When an insurance company may or may not renew an individual health policy, the policy would be considered:

Date of hospitalization

When does a Part A Medicare claim begin:

Coordination of benefits (COB)

Which group medical expense policy provision is designed to provide uniformity in claim payments when an employee is covered by more than one policy:

An insurance agent with Social Security withholding taken out of their paycheck

Which of the following is most likely to be considered an employee:

Adhesion

Which of the following is not a requirement of a legal contract:

Workers' Compensation

Which of the following is not considered to be a medical expense plan:

Prior informed written consent is required from the applicant

Which of the following is true about the requirements regarding HIV exams:

They must be renewed if the insured pays the premium

Which of the following is true regarding Guaranteed Renewable health insurance policies:

risk

Which of the following terms is defined as the chance, uncertainty or possibility of loss:

Premiums are deductible, benefits are taxed

Which statement best describes the tax implications of a Business Overhead policy:

Non-cancellable

Which type of health insurance policy does not allow premiums to be changed:

Long Term Care

Which type of individual health insurance policy might have tax deductible premiums:

Your Workers' Compensation benefits may be inadequate

You might consider buying Disability Income insurance to cover occupational injury because: