Chapter 9: Helath and Disability Income Insurance
What is a typical copayment amount for indiciduals?
$20 - $30
The average per employee cost for health care in 2008 was more than
$8,000
How much income is usually replaced with a private income insurance program for a disability?
40 - 60 percent, with some plans paying up to 74 percent
How many people in the United States do not have health insurance?
48 million
Which of the following is INCORRECT?
A bad disability policy pays you if you cannot work at your regular job.
Which of the following is most likely to use a health maintenance organization?
A family with teenagers who need annual check-ups for sports at school
Most people receive health insurance form
A plan offered by their employer
A policy that pays you back for actual expenses is called
A reimbursement plan
Which of the following about individual health insurance policies is NOT correct?
All insurance companies that offer this type of policy are required to charge the same rates.
All of the following are sources of disability incoem exept
All of the above are sources of disability income. (Worker's compensation, Disability benefits form an employer, Social security, Private income insurance programs)
Which of the following activities is NOT a step being taken to reduce health care costs?
All of the activities can reduce health care costs (Community health education programs motivate people to take better care of themselves, Physicians encourage patients to pay cash for routine medical care and lab tests, Programs to review health care fees are available, Community health planning can help achieve a better balance between health needs and health care resources)
Who is most likely to use a home helath care agency?
An elderly neighbortn
This health insurance provision lets your insurer make direct payments to yor doctor or hospital.
Assigned benefits
Rising health costs are due to all except
Baby boomers using fewer health care services
Brittany and Brandon are both charged $250 for an office visit to the same specialist. Brittany's reimbursement policy has a deductible of $300. Once she has met the deductible, the policy will cover the full cost of her visits. Brandon's indemnity policy will pay him $150, the maximum amount his plan provides for a visit to any specialist. Which of the following is correct?
Brittany will pay more because she must pay the entire bill since she has not met her deductible while Brandon will have part of his bill paid by his policy.
Nancy is studying the health insurance plan options offered by her employer. She wants a policy that will have the insurance pay a percentage of her medical expenses. She should review the
Coinsurance
Coordination of benefits (COB) applies to
Combining two insurance policies issued for a married couple
The insurance that helps pay extensive hospital, surgical, medical, and other bills with a low deductible is known as a
Comprehensive major medical policy
COBRA stands for
Consolidated Omnibus Budget Reconciliation Act
Jenny wants health insurance that limits the amount that she must pay before the insurance starts paying benefits. She is concerned about a
Deductible
The set amount that you must pay toward medical expenses before the insurance company pays benefits is called
Deductible
Miguel is concerned that the health insurance option he is considering plays upon unrealistic fears. He is most concerned about
Dread disease policy
Which of the following is INCORRECT about dread disease policies?
Each policy covers a wide range of conditions
Anna contributes pre-tax dollars to an account managed by her employer for her health care expenses. If she does not spend all of her money by the end of the year, she may forfeit it. What kind of plan does she have?
FSA
Disability incoem insurance plans offer benefits
For only a few years, Until age 65, For life
If you are concerned that our disability insurer may try to cancel your coverage if your health becomes poor, you should look for a plan that offers
Guaranteed renewability
Monica's employer offers a health insurance plan with a very high deductible. In addition, her employer provides a fund for her to spend specifically on health care. What kind of plan does she have?
HRA
Jacob is concerned that his out-of-pocket health care expenses will be quite high, so he is considering adding contributions to a tax-free account that he can use with his high-deductible policy to cover catastrophic expenses. What kind of plan does he have?
HSA
Cameron, age 25, sustained a debilitating hand injury and was unable to perform his job as viola player in the local orchestra for 45 days. His employer has a disability income insurance policy that pays 70 percent of take-home pay with an elimination period of 60 days and coverage to age 65. Given this information, which of the following is true for Cameron?
He will not be eligible for any disability income because his disability ended before the elimination period ended.
Xavier's employer offers a health plan that stresses preventative services and covers routine immunizations and checkups, screening programs, and diagnostic tests. What kind of plan does his employer offer?
Heath maintenance organization (HMO)
Blue Cross and Blue Shield are
Hospital and medical service plans
The type of health insurance coverage that pays for some or all of the costs of room and board is
Hospital expense
Medicare covers
Impatient hospital care
A health insurance policy that will cover only a fixed amount of an expense is called
Internal limit
The health insurance provision sets limits on the amount of repayment for certain services.
Internal limits
Medicaid covers
Lab services, Skilled nursing and home health services, Prescription drugs, Eyeglasses
The type of health insurance coverage that takes up where basic health insurance coverage leaves off is
Major medical expense
Jack needs comprehensive medical coverage, however, his income is quite low. What plan should he investigate?
Medicaid
A Medigap policy fills the gap between medical costs and payments from
Medicare
Which of the following is NOT a private health care plan?
Medicare
Individuals over the age of 65 who are eligible for federal government health plan coverage may also be interested inpurchasing
Medigap
Which of the following is NOT a type of health insurance available to individuals or employees?
Minor medical idemnity insurance
Which of the following is correct?
Most medical expense plans reimburse an individual for hospital stays, doctors' visits and medications.
After you have reached a certain limit, the insurance company covers 1000 percent of any additional cost. This is called
Out-of-pocket limit
What is the primary purpose of medical expense insurance?
Pay medical costs for illness or injury
The type of health insurance coverage that may cover routine doctor visits, X-rays, and lab tests is
Physician expense
This type of plan combines features of HMOs and PPOs. It uses a network of participating physicians and medical professionals who have contracted to provide services for certain fees. What kind of plan does his employer offer?
Point-of-service plan
Yvonne's employer offers a health plan that has a group of doctors and hospitals that agree to provide specified medical services to members at prearranged fees. This health plan offers some flexibility since members can either visit a physician from a list or go to their own doctors. What kind of plan does her employer offer?
Preferred provider organization (PPO)
Which of the following is true about the elimination period?
Premiums for a plan with an elimination period of 90 days will be less than the premiums for a plan with an elimination period of 60 days
A quality health insurance plan should do all of the following except
Provide a lifetime maximum level of coverage of up to $50,00
A health insurance policy with this provision lists coverage in terms of service, not dollar amounts.
Service benefits
The Health Insurance Portability and Accountability Act of 1996
Sets federal standards to ensure that workers would not lose their health insurance if they changed jobs
Mark was severely injured and expects to be unable to work for at least 12 months. Because of his injury, he should expect to be eligible for disability income from
Social Security
Fran is interested in purchasing health insurance that limits the total out-of-pocket amount that she will have to pay. She should consider a
Stop-loss provision
The type of health insurance coverage that may cover a specific amount for an operation is
Surgical expense
Which of the following is TRUE about long-term care insurance?
The older you are when you enroll, the higher the annual premium.
Which of the following about individual health insurance policies is correct?
They are available for the self-employed or others who are dissatisfied with the coverage that their group plan provides.
Which of the following is NOT correct?
Victims of accidents and crimes require less emergency medical services than in the past
Katrina was injured in an accident at work. The benefits she will receive to cover part of her income will come from
Worker's compensatio
A Flexible Spending Account is funded by an employer.
false
A PPO is another name for an HMO.
false
A good disability income insurance plan will provide benefits if you cannot work at any job.
false
A health insurance policy that pays you back for actual expenses is acalled an indemnity policy.
false
Administrative cost in the United States consume half of the health care dollars spend.
false
All group health insurance plans provide the same level of protection.
false
An employer self-funded health plan requires a low level of financial assets.
false
Blue Cross and Blue Shield are two types of HMOs.
false
Disability income insurance covers your medical expenses when you are disabled.
false
Disability income insurance policies are required to provide benefits for disabled policyholders until age 65.
false
Health care costs have decreased because of aging baby boomers using fewer health care services.
false
Health insurance is a form of protection that eases the financial burden people may experience as a result of someone's death.
false
Long-term care insurance is used to pay for a stay in a nursing home but not for help at home.
false
Medicare is offered to certain low-income individuals and families.
false
Medicare typically covers routine checkups.
false
Some policies consider the average fee for a service in a particular geographical area then use that amount to set a minimum payment for policyholders.
false
The United States has the fifth highest per capita medical expenditures in the world.
false
The benefit limits provision identifies the minimum benefits that will be paid for days spent in the hospital.
false
The copayment provision deals with the amount that someone will pay for a bill such as 20 percent coinsurance.
false
The financial problems caused by death are greater than those caused by disability.
false
The period before you can receive benefits in a disability plan is called the probationary period.
false
A Health Reimbursement Account is an employer-funded plan.
true
A PPO is a type of managed care plan.
true
A deductible is the amount you must pay before benefits become payable by the insurance company.
true
A disability policy with a longer elimination period typically charges lower premiums than a policy with a short elimination period.
true
A health insurance policy that pays you back for actual expenses is called a reimbursement policy.
true
COBRA and The Health Insurance Portability and Accountability Act of 1007 have improved health insurance coverage options for individuals and families.
true
FSAs, HRAs, and HSAs all provide tax advantages for health expenses.
true
If you have Medicare Part A and Medicare Part B, you should not need Medicare Part C.
true
Surgical expense coverage for health insurance includes surgeon's fees in a doctor's office.
true
The definition for Disability is stricter for Social Security than for employer plans.
true
With a guaranteed renewable health insurance policy, the insurer is permitted to raise premiums for all members of a group.
true