Health 4 (Chapters 24, 25, & 30)

What per centage of employees must agree to a non-contributory group health plan in order for it to be approved by the state? 0% 25% 50% 75%

0%

he coordination of benefits provision, found in a health policy, was amended to require or allow a greater degree of coordination when an insured was covered by more than one policy as long as the insured is reimbursed for 100% of the covered expenses. To which of the following policies does this provision apply? 1. Between group & individual insurance 2. Hospital Indemnity type policies 3. Medicare supplement insurance 4. A.D.& D. policies 1 1 & 2 2 & 3 all the above

1

Self inflicted injuries are excluded from which of the following? 1. Medical Expense policies 2. Disability Income policies 1 only 2 only 1 and 2 Neither 1 or 2

1 and 2

A non-contributory group health plan must cover at least what percentage of eligible employees. 100% 75% 50% 25%

100%

In noncontributory group plans, the insurance company requires what per-centage of eligible employees be covered by the plan? At least 50% Usually 75% or more At least 90% 100%

100%

What is the maximum contribution limit to a Health Savings Account (HSA)? 25% of the health plan deductible 50% of the health plan deductible 75% of the health plan deductible 100% of the health plan deductible

100% of the health plan deductible

Business continuation insurance covers all of the following except: 1. Life Insurance 2. Disability Insurance 3. Group Life Insurance 4. Comprehensive Medical Insurance 1 & 3 2 & 4 2 & 3 3 & 4

3 & 4

An employee may generally convert her group health insurance to an individual policy within a maximum of how many days after her employment is terminated? 20 31 45 90

31

Employees covered under a group health plan continue to be covered after the group has terminated for how long? 15 Days 31 Days 60 Days 90 Days

31 Days

Concerning the taxation of health insurance benefits, all the following statements are true EXCEPT Personal medical expense policy benefits are not subject to taxation 5% of disability income benefits are taxable income Benefits paid for expenses deducted in a prior year are taxable Benefits received from hospital policies are not taxable

5% of disability income benefits are taxable income

Which of the following statements regarding Blanket health insurance is true? Benefits change as the group changes Persons insured are named in the policy Each policy covers a specific number of insureds A blanket policy covers a changing group of people

A blanket policy covers a changing group of people

When an employer establishes a group health insurance plan, what does each participating employee receive? An insurance notice A certificate of insurance A letter of confirmation A coverage form

A certificate of insurance

Which of the following most accurately and completely describes an application? A form furnished by the insurer requesting certain information to become part of the insurance policy A written request from an applicant to an insurer requesting the insurer to issue a policy on the basis of the information in the application An oral request from an agent to an insurer to issue an insurance policy An application can be any of the above.

A written request from an applicant to an insurer requesting the insurer to issue a policy on the basis of the information in the application

Which of the following benefits may Social Security provide Survivor income Retirement income Disability income All of the above

All of the above

June terminated her employment with the Wynot agency. She is told she will have 31 days to convert her coverage to an individual health policy. What else about conversion is true? She is still covered under the group policy for 31 days If she becomes uninsurable they might charge her a higher premium because of her health She must have been active in the group's plan for the last three months All the above are true

All the above are true

Health Maintenance Organizations (HMO): Are considered pre-paid service systems Are licensed insurance companies Reimburse the insured for his medical bills Deal with Medicare recipients only

Are considered pre-paid service systems

The transfer of the insured's rights to receive benefits of a Health Insurance policy for a particular claim is known as Facility of payment Assignment Rebating Waiver

Assignment

All of the following statements are true about the tax treatment of premiums and benefits for individually owned health insurance, EXCEPT Benefits from Individual Disability Income policies are not taxed as ordinary Income. Benefits received from Hospital & Surgical Expense policies are taxed to the extent that the benefits exceed the premiums paid Premiums paid for Accidental Death & Dismemberment (AD & D) policies are not tax deductible. Premiums paid for Individual Disability Income policies are not tax deductible.

Benefits received from Hospital & Surgical Expense policies are taxed to the extent that the benefits exceed the premiums paid

What is Business Overhead Expense insurance designed to pay? Business expenses incurred when the business owner is disabled Business expenses when the business closes due to a fortuitous loss Business expenses caused by a natural disaster Business expenses incurred when the business owner dies

Business expenses incurred when the business owner is disabled

A Business Overhead Expense policy includes all of the following except: Benefits taxable as income Tax deductible premiums Coverage for Employee's Salaries Coverage for Employer's Salaries

Coverage for Employer's Salaries

The certificate that each member receives under an employee group insurance contract is a Contract between the insurance company and the individual employee Contract between the insurance company and the employer Document that identifies the employees as an insured under the master contract Document that identifies the employees as the owner of the master contract

Document that identifies the employees as an insured under the master contract

A Health Insurance company in a certain city contracts with an independent medical group to provide services to its subscribers. The company pays the group organization, rather than paying the individual medical practitioners. What type of structure is this? Exclusive Provider Organization Network model Staff model IPA model

Exclusive Provider Organization

In using the needs approach to buying health coverages, which of the following is least important? Income needs Current group insurance plans Emergency needs Final expense funds

Final expense funds

A Business Continuation Plan may include all of the following except: Life Insurance Group Insurance Health Insurance Disability Insurance

Group Insurance

The type of health care provider that provides both the health care services and the health care coverage is a: Preferred Provider Organization. Health Maintenance Organization. Blue Cross/Blue Shield Organization. Traditional health insurance company.

Health Maintenance Organization.

Which of the following statements about the role of the agent in completing Health Insurance applications is true? I. The agent must understand the importance of Moral Risk. II. Problems with claims will probably occur if the agent fails to include all pertinent facts and medical history on forms. I only II only I and II Neither I nor II

I and II

An insured purchased group Credit Disability insurance to cover a loan. He was injured and disabled for 7 months. What benefits were paid under his policy? I. The insured received Disability Income benefits II. The insured's creditor received the equivalent of the monthly payment owed by the insured I only II only I and II Neither I nor II

II only

Which of the following about group health insurance is (are) true? I. Insurance company underwriting practices are generally less liberal for groups than for individuals. II. Claim experience is often utilized in large groups. I only II only I and II Neither I and II

II only

HMO services are paid: In advance of any treatment After treatment is complete During the treatment By the HMO & the subscriber

In advance of any treatment

Which of the following statements concerning the Health Care & Insurance Reform Act of 1993 is true? It governs group and individual health insurance provisions It governs group health insurance provisions It governs individual health insurance provisions

It governs group health insurance provisions

Disability Buy-Out plans feature: Long elimination plans up to two years Short elimination periods Short elimination periods and benefits up to 10 years Long elimination periods and benefits up to 10 years

Long elimination plans up to two years

Which of the following would not be considered a qualified health care expense for a Health Savings Account? Prescription and non-prescription medicines Medicare expenses Medigap policies Long Term Care services

Medigap policies

If an employer pays the premiums for an insurance plan that automatically covers all eligible employees, the plan is known as Salary savings insurance Contributory group insurance Noncontributory group insurance Franchise group insurance

Noncontributory group insurance

Rute Canal, a dentist is disabled. His disability overhead expense policy will cover all the expenses below EXCEPT: Electricity Leased X-ray equipment Payments to the doctor Uniforms for the staff

Payments to the doctor

All of the following characteristics apply to a Partnership disability buy-sell agreement except: Having a lengthy elimination period Setting forth the terms for buying the partners share Providing for lump sum payments of benefits Providing for a death benefit

Providing for a death benefit

If an insurance company has rejected an applicant for coverage on the basis of a Medical Information Bureau (MIB) report, the MIB will release medical information contained in the report to which of the following, if any? The applicant The applicant's physician The agent of record None of the above; the report is strictly confidential

The applicant's physician

With regard to group insurance, who has the responsibility to apply for coverage, provide information about the group, maintain the policy, and pay premiums? The agent that wrote the group coverage The insurer that provides the group coverage The individuals that make up the group The master policyowner

The master policyowner

Which of the following statements about health service organizations is true? They provide Loss of Income benefits to policyowners. They provide benefit payments directly to the hospitals and physicians providing service. They reimburse policyowners directly for physicians' fees. They reimburse policyowners directly for all medical expenses.

They provide benefit payments directly to the hospitals and physicians providing service.

Which of the following represents certain consumer safeguards enacted by states and patterned after a model act developed by NAIC? Fair Credit Reporting Act The MIB Unfair Trade Practices Act COBRA

Unfair Trade Practices Act

When applying for a health policy, Chester Crook stated that he had never had heart trouble even though he suffered a heart attack. Two months after the policy's effective date, Chester suffered a second heart attack. The insurance company will probably take which of the following actions? Void the policy and refund the premiums paid. Pay him reduced benefits according to the policy's Recurrent Disability provision. Pay the claim and increase his future premiums. Pay the claim and add an exclusion for heart ailment to the policy.

Void the policy and refund the premiums paid.

Coverage under COBRA terminates When the employee becomes eligible for Medicare When the employee becomes eligible for Medicaid When a dependent child no longer qualifies as a "dependent child" When a worker was terminated for gross misconduct

When a worker was terminated for gross misconduct

The type of health insurance policy most likely to cover all students attending a large university is: a blanket policy a franchise policy an ASO a self-insured plan

a blanket policy

The type of health insurance policy most likely used to cover all students attending a large university is: a blanket policy. a franchise policy. an ASO. a self-insured plan.

a blanket policy.

A company that is licensed to sell insurance in a particular state is a domestic company an alien company a nonadmitted company an authorized company

an authorized company

For group insurance, employees may be classified in all the following ways EXCEPT: by type of payroll by duties by length of service by age

by age

Regarding dental insurance, deductibles and co-insurance typically do not apply to which of the following? oral surgery root canals cleaning & exams all the above

cleaning & exams

The purpose of the COBRA requirements concerns: coordination of health benefits. continuation of health insurance. Medicare supplement coverage. nondiscrimination in group health plans.

continuation of health insurance.

The Primary Insurance Amount, (P.I.A.), as defined under Social Security, is: amount of insurance available to a surviving spouse amount of insurance payable at death on the primary bread winner amount of disability insurance payable to a disabled worker equal to the full retirement benefit at age 65

equal to the full retirement benefit at age 65

With regard to group health insurance policies, pre-existing conditions are generally: excluded permanently excluded for a limited time covered for up to 80% of the policy limit covered immediately

excluded for a limited time

The Internal Revenue Service (IRS) considers Disability Income benefits paid under an employer-paid group Disability Income policy to be: taxable for 13 weeks only nontaxable for 26 weeks only fully taxable as ordinary income exempt from taxation

fully taxable as ordinary income

In group health insurance, unlike most personal insurance, Maternity expenses are treated as any other claim. true false

true

Answers given by Health Insurance applicants are considered to be the absolute truth warranties representations negotiable

representations

From a legal standpoint, Constructive Delivery of a policy is accomplished when the company sends the policy to the agent with instructions to obtain a statement attesting to the Insured's continued good health. the agent delivers the policy for inspection but the initial premium has not yet been paid. the company relinquishes all control over the policy and turns it over to someone acting for the policyowner including the company's agent. the agent mails a policy to the policyowner with a note that he or she will stop by later to collect the first premium.

the company relinquishes all control over the policy and turns it over to someone acting for the policyowner including the company's agent.