HEALTH: PART FOUR EXAM

2. Which of the following qualifies as a compensable injury under Workers Compensation coverage?

A. A factory worker fractures an elbow while working overtime

80. Which of the following is an example of a producer cooperative?

A. Blue Cross/Blue Shield organizations

30. What term describes a situation where a policyowner transfers a portion of his ore her rights in an insurance policy to another party in order to secure a debt to that party?

A. Collateral assignment

93. Who pays the taxes that finance Social Security benefits?

A. Employers and employees, in equal contributions

35. A Health Maintenance Organization (HMO) in a certain city contract with an independent medical group to provide services to HMO subscribers. the HMO pays the group organization, rather than paying the individual medical practitioners. What type of HMO structure is this?

A. Group model

45. Luis and Margarita Rodriguez have a family health policy that includes two riders. One rider excludes coverage for Margarita's existing diabetes. The other rider indicates that the couple may purchase additional disability income coverage at specified dates in the future without proving insurability. What two riders are attached to this policy?

A. Impairment and guaranteed insurability riders

61. Which of the following premium payment modes will result in the highest total premium?

A. Monthly

47. When may agents change a policy or waive its provisions according to Required Provision 1?

A. Never

94. What type of disability policy covers a fixed period of time and provides funds for long-term commitments if an owner or key employee of a business is disabled?

A. Reducing term disability coverage

12. Trent Bixley is named by the insured, Nancy Bixley, as the first in line to receive the death benefit provided by Nancy's accident policy. Their daughter Elaine is named as second in line to receive the benefit. Which statement is correct?

A. Trent is the primary beneficiary and Elaine is the contingent beneficiary

26. When medical expense policies do not state specific dollar benefit amounts, but instead base payments upon the charges for like services in the same geographical area, benefits are designated as which of the following?

A. Usual, customary and reasonable charges

20. Brenda names her husband as the beneficiary of the accidental death benefit in her health policy. she has relinquished her right to change the beneficiary designation. according to Required Provision 12, Brenda's husband is

A. an irrevocable beneficiary

37. In a disability income policy, there is a period during which no benefits will be paid for illness of any kind. this period usually does not apply to accidents, only to illness. The terms that describes this interim is the

A. elimination period

84. Major medical policies may include a type of deductible wherein the insured pays a new deductible amount for each different event that causes medical expenses to be incurred. This is the

A. per-cause deductible

56. A disability that is presumed to result from the same or realted cause of prior disability is called a

A. recurrent disability

14. An applicant for insurance may pay the intial premium and receive a document from the agent indicating that if the policy is issued as requested. coverage begins on the date of the document. What is this document called?

B. Conditional receipt

42. In order to obtain group insurance without providing evidence of insurability, what do eligible individuals generally have to do?

B. Enroll within a specified eligibility period

5. The type of health care provider that provides both the health care services and the health care coverage is a

B. Health Maintenance Organization

53. Which of the following waives the elimination period in a disability policy?

B. Hospital confinement rider

17. What part of Medicare requires premium payment by most eligible participants?

B. Part B, supplementary medical insurance

15. Under workers Compensation, a disability that is a permanent physical impairment leaving the individual incapable of performing the previous regular occupation, but capable of performing some other type of work is a

B. Permanent partial disability

83. Which of the following correctly describes Medicaid?

B. Provides medical benefits for certain low income people, for the disabled, and for families with dependent children.

25. Primary support for Medicare Part A comes from

B. Social Security payroll taxes

41. A health insurance policy that the insurer may choose not to renew only on the premium due date is called

B. an optionally renewable policy

43. Second surgical opinions , precertification, concurrent and retrospective reviews, and outpatient/ambulatory services are all elements of a cost-containment system commonly known as

B. case management

4. The optional short-term disability income benefit that pays a lump sim for specified injuries is called the

B. elective indemnity benefit

33. All Medicare supplement (or Medigap) policies must

B. have the same core benefits

32. A certain major medical policy states a maximum number of days for which convalescent care will be paid as well as a maximum number of X-rays that will be paid for under any one claim. These are examples of

B. inside limits

100. Required Provision 10 indicates that if the insurer wants to have an autopsy performed while claim is pending, the insurer

B. may do so if it is not forbidden by law and if the insurer pays for it.

64. When an insurer cedes part of an insured's coverage to another insurance company, retaining only part of the risk for itself, the insurer is engaging in

B. reinsurance

98. A policy that pays surgical expense benefits does not schedule the approved benefit payable for every type of surgery. Instead, surgeries not listed are paid on the basis of a commonly-performed major surgery that are scheduled. Under this arrangements, the unscheduled surgeries are paid on the basis of

B. their relative value

75. Required Provision 4 addresses reinstatement of a lapsed policy. According to this provision, when an insured applies for reinstatement and receives a conditional receipt, how long does the insurer have to approve or deny reinstatement before the policy will be automatically reinstated?

C. 45 days from the date of the conditional receipt

81. What is a cancellable policy?

C. A policy the insurer may cancel at any time by returning the unearned premium

39. Which of the following accurately describes the "free look" provision?

C. Allows the insured to look over the issued policy for a specific number of days and return it for a premium refund if desired.

10. What term describes the concept that the insurer and the insured share in the cost of medical expenses, with the insurer bearing the greater share?

C. Coinsurance

58. Some major medical policies begin with basic first dollar coverage that pays up to its limits, then the insured must pay a certain dollar amount of expenses before he major medical portion steps in. What term applies to the dollar amount the insured must pay between the basic policy and the major medical coverage?

C. Corridor deductible

57. According to Optional Provision 8, if the insurance company cancels a policy, on what basis must prepaid premiums be returned to the insured?

C. Pro raate basis, which means all unearned premium is returned to the insured.

48. Under what circumstances do major medical policies usually provide for restoration of benefits?

C. Restoration usually occurs after a specified dollar amount of benefits has been exhausted and after the insured has proved insurability

1. All of the following statements about noncancellable policies are true EXCEPT

C. The insurer may increase the premium rate after the policy is in effect provided it does so by classes of insureds.

96. Individuals covered by a group plan receive

C. certificates of insurance

22. The factor in premium computation that has to do with the recordkeeping and statistical analysis insurance companies perform is

C. experience

27. As compared to individual disability income policies, group disability income policies are generally

C. less costly and have more liberal provisions

86. Health Maintenance Organizations are required to provide for all of the following EXCEPT

C. prescription drugs

7. Which of the following are NOT eligible for Medicare coverage?

D. People with any life-threatening condition

11. With regard to group insurance, who has the responsibility to apply for coverage, provide information about the group, maintain the policy and pay premiums?

D. The master policyowner

16. A health insurance policy includes an endorsement indicating the insurer will allow the policy to continue in force without further premiums if the insured is totally and permanently disabled. What endorsement is attached to this policy?

D. Waiver of premium

89. When are disability income benefits received as nontaxable income to the recipient?

D. When the employee has paid the premium

72. For health insurance, the consideration consists of the

D. full minimum premium required and the application

44. Each of the following would be found in the insuring clause of an insurance policy EXCEPT

D. name of the insured

79. All of the following are benefits provided under Part A of Medicare EXCEPT

D. physicians' services for inpatient care.

69. In Health Maintenance Organizations, the use of a primary care physician or PCP is common as part of

D. the gatekeeper system