215 (Part 2) - Intro to Health Insurance
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a Primary Care Physician.
What is issued to each employee of an employer health plan?
Certificate
Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?
Entire Contract
Which of these is considered a true statement regarding Medicaid?
Funded by both state and federal governments
How does group insurance differ from individual insurance?
Group insurance differs from individual insurance in that it provides coverage at a lower cost.
Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?
HMO
A medical care provider which typically delivers health services at its own local medical facility is known as a
Health Maintenance Organization
J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to?
Health Maintenance Organization
Which type of provider is known for stressing preventative medical care?
Health Maintenance Organizations (HMO's)
A medical care provider which typically delivers health services at its own local medical facility is known as a
Health Maintenance Organizations (HMO's) traditionally provide services to its members at its own local health care facilities.
A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?
Her group health plan
Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?
If the employee paid for qualified medical expenses, the reimbursements may be tax-free
Which of the following statements BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that used the "accidental means" definition?
Less restrictive
Which of the following statements BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that uses the "accidental means" definition?
Less restrictive
An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses?
Loss of eyesight due to an accidental injury
The health insurance program which is administered by each state and funded by both the federal and state governments is called
Medicaid.
______________ is a hospital and medical expense insurance program
Medicare
According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?
Monthly
Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?
More physicians to choose from
Which of the following statements is true about most Blue Cross/Blue Shield organizations?
Most Blue Cross/Blue Shield organizations are considered to be nonprofit.
Which of the following BEST describes a short-term medical expense policy?
Nonrenewable
J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's ages as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?
The insurer will adjust the benefit to what the premiums paid would have purchased at the time the insured's actual age
Which statement is TRUE regarding a group accident & health policy issued to an employer?
The employer is the policyowner and each employee receives a certificate of coverage
Which type of provider is known for stressing preventative medical care?
The health provider that stresses preventive medical care is known as a Health Maintenance Organization.
Which of the following statements is true about most Blue Cross/Blue Shield organizations?
They are nonprofit organizations
Medicare is intended for all of the following groups EXCEPT
Those enrolled as a full-time student
A Business Overhead Expense policy would cover which of the following if a business owner becomes disabled?
Utilities and office rent
The provision in a Group Health policy that allows the insurer to postpone coverage for aa covered illness 30 days after the policy's effective date is referred to as the
Waiting Period
Medicaid was designed to assist individuals who are
below a specific income limit
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)
closed panel
Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business?
Business owner becoming disabled
The benefits under a Disability Buy-Out policy are
payable to the company or another shareholder
T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. When T submits a claim, his employer's plan is considered what type of carrier under the Model Group Coordination of Benefits provision?
"Primary carrier".
B has a $100,000 Accidental Death and Dismemberment policy that pays triple indemnity for common carrier death. If B is killed from an accident on a commercial flight, what will the policy pay B's beneficiary?
$300,000
XYZ Company pays the entire premium for its group health plan. The MINIMUM percentage of eligible employees that must be covered is
100%
An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?
31
S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations?
36
M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force?
45 days
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)
A closed panel is when an HMO is represented by a group of physicians who are salaried employees and work out of the HMO's facility.
Which of the following statements BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that uses the "accidental means" definition?
A policy that uses the "accidental bodily injury" definition of an accident is less restrictive than the one that uses the "accidental means" definition.
Which of the following statements describes what an Accident and Health policyowner may NOT do?
Adjust the premium payments
Under which of the following circumstances do the benefits under COBRA continuation coverage expire?
All group health plans are eliminated by the employer
Which of the following statements BEST describes what the Legal Actions provision of an Accident and Health policy requires?
An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed
Which of the following is the MOST important factor when deciding how much Disability Income coverage an applicant should purchase?
Applicant's monthly income
Accidental Death coverage is provided to commercial airline passengers in which of the following types of policies?
Blanket Accident policy
Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is
Business Overhead Expense
Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident and out of work for six weeks?
Business Overhead Expense
Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is
Business Overhead Expense Insurance.
For what circumstance is a Business Disability Buy-Sell policy designed to help in the sale of a business?
Business owner becoming disabled
A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The orginal neck injury occurred before the application. How will the insurer handle this claim?
Claim will be paid and coverage will remain in force
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
Commercial insurer
Which of the following reimburses its insureds for covered medical expenses?
Commercial insurers
An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?
Consideration clause
When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans?
Contributory
Medicare Part A and Part B do NOT pay for
Dental services are not covered by Medicare Part A or B.
Which contract permits the remaining partners to buy-out the interest of a disabled business partner?
Disability Buy-Sell
K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income?
Disability Income
What accurately describes the tax treatment of premiums and benefits of individual Accident and Health insurance?
Disability income policy premiums are not tax-deductible
The federal income tax treatment of employer-provided group health insurance can be accurately described as
Employee's coverage paid for by the employer is tax-deductible to the employer as a business expenditure
Under which of the following circumstances do the benefits under COBRA continuation coverage expire?
One of the disqualifying events that can result in the termination of continuing coverage under COBRA is when the employer terminates all group health plans.
Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?
PPO
Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?
PPO's are NOT a type of managed care systems
Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?
PPO's normally provide a wider choice of physicians and hospitals.
Which of the following best describes a contingent beneficiary?
Person designated by the insured to receive policy proceeds in the event that the primary beneficiary dies before the insured
What health insurance provider normally has more providers to chose from, prices are negotiated in advance, In-network providers offer members better coverage of incurred expenses, and is a type of managed care systems?
Preferred Provider Organization (PPO)
How does group insurance differ from individual insurance?
Premiums are lower
Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy?
Premiums are waived after the insured has been totally disabled for a specified time period
What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?
Premiums may increase at time of renewal
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a
Primary Care Physician
T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. When T submits a claim, his employer's plan is considered what type of carrier under the Model Group Coordination of Benefits provision?
Primary carrier
Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy?
Reimbursement
R had received full disability income benefits for 6 months. when he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity?
Residual Disability
P is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period?
Sign an enrollment card
The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs?
Social Security Disability Income
What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision?
Submit the claim in any form
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers (and their families) whose employment has been terminated the right to
continue group health benefits
A Business Overhead Expense policy
covers business expenses such as rent and utilities
Medicare Part A and Part B do NOT pay for
dental work
M becomes disabled and is unable to work for six months. M dies soon after from complications arising from his disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?
earned, but unpaid benefits
The Health Insurance Portability and Accountability Act (HIPAA) gives privacy protection for
health information
What is also called a short term medical policy?
interim coverage
If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best describes this policy is called
noncancellable
The Notice of Claims provision requires a policyowner to
notify an insurer of a claim within a specified time
The Coordination of Benefits provision
prevents an insured covered by two health plans from making a profit on a covered loss
With Optionally Renewable Health policies, the insurer may
review the policy annually and determine whether or not to renew it
An individual Disability Income insurance applicant may be required to submit all of the following EXCEPT
spouse's occupation
Which of the following statements is correct regarding an employer/employee group health plan?
the employer receives a master policy and the employees receive certificates
The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the
waiting period.
