Health Study Guide

#20. An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary? a) Contingent b) Irrevocable c) Revocable d) Primary

c) Revocable

#11. Which one of the following is an eligibility requirement for Social Security disability income benefits? a) Fully insured status b) Experiencing at least one year of disability c) Being at least 50 years of age d) Currently employed status

a) Fully insured status Social Security Disability benefits are available only if the worker is fully insured. Benefits are provided only after a 5-month waiting period.

#15. Under disability income policies, benefits are usually limited to approximately ___ of the total weekly benefit for time lost to minor surgery, consultations, etc. a) 10% b) 15% c) 20% d) 25%

a) 10%

#6. Under disability income policies, benefits are usually limited to approximately ___ of the total weekly benefit for time lost to minor surgery, consultations, etc. a) 10% b) 15% c) 20% d) 25%

a) 10%

#12. In a noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective? a) 100% b) 75% c) 50% d) 25%

a) 100% One hundred percent of eligible employees must participate in a non-contributory health insurance plan for the plan to become effective.

#50. An applicant for an adjuster's license can be issued a temporary license as an apprentice adjuster for how long? a) 12 months b) 30 days c) 180 days d) 3 months

a) 12 months

#48. A ___ copayment is required for mental illness treatment under Medicare Part B. a) 50% b) 40% c) 30% d) 20%

a) 50%

#1. A hospital indemnity policy will pay a) A benefit for each day the insured is in a hospital. b) Income lost while the insured is in the hospital. c) All expenses incurred by the stay in the hospital. d) Any expenses incurred by the stay in the hospital, minus coinsurance payments and deductibles.

a) A benefit for each day the insured is in a hospital.

#10. When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following? a) Consideration b) Legal purpose c) Contract of adhesion d) Acceptance

a) Consideration

under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within: 30 days of loss 60 days of loss 90 days of loss 20 days of loss

90 days of loss

#10. Which of the following options best depicts how the eligibility of members for group health insurance is determined? a) By conditions of employment, and in such a manner as to avoid individual selection b) Eligibility is not determined, but simply accepted c) By the physical conditions of the applicants at the time of employment d) In such a manner as to establish individual selection as to the amounts of insurance

A By conditions of employment, and in such a manner as to avoid individual selection

#20. A policy which covers medical costs related to a specific condition is called a a) Dread Disease Policy. b) Condition-Specific Policy. c) Specific Condition Policy. d) Limited Coverage Policy.

A Dread Disease Policy.

#22. All of the following are correct about the required provisions of a health insurance policy EXCEPT a) The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract. b) A reinstated policy provides immediate coverage for an illness. c) Proof-of-loss forms must be sent to the insured within 15 days of notice of claim. d) A grace period of 31 days is found in an annual pay policy.

A The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract.

A health insurance policy lapses but is reinstated within an acceptable timeframe. How soon after will coverage become effective? A.) immediatley B.)14 days C.)21 days D.)31 days

A.) immediately

when an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of illness or injury, this is A.)overinsurance B.)double indmenity coverage C.)fraternal coverage D.)pro-rata coverage

A.)overinsurance

#15. In an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received? a) State income tax b) No tax c) Policy tax d) Federal income tax

B No tax

#27. When Bob filled out an application for health insurance, he accidentally misstated the time period during which he was treated for acid reflux. If he had recorded this information correctly, his insurer would have charged a higher premium. When Bob is treated for erosive esophagitis 3 years after the policy's effective date, the insurer discovers the error. Which of the following is most likely true? a) Bob will be required to pay the "extra" premium that he would have been charged. b) Nothing, assuming that Bob's misstatement is found to be an honest mistake. c) Bob will be required to pay all medical bills related to erosive esophagitis. d) Bob's policy will be terminated.

B Nothing, assuming that Bob's misstatement is found to be an honest

An insured pays a monthly premium, what is the duration of her grace period A.) 7 days B.) 10 days C.) 31 days D.) 60 days

B.) 10 days

most insurers issue health policies for delivery in many states. Because each state regulates differently, insurers attach a A.)Nothing B.) Conformity with States Satutes provision C.) Miscellaneous Optional Provision D.) A waiver of other states requirements

B.) Conformity with States Satutes provision

an insured owes his insurer a premium payment, since a premium. since then he incurs expenses, the insures then takes the premium out of the reimbursement. what provision is this A.) payment of claims B.) unpaid premium C.) legal action D.) proof of loss

B.) unpaid premium

#4. All of the following qualify for Medicare Part A EXCEPT a) Anyone who is at the end stage of renal disease. b) Anyone who is over 65, not covered by Social Security, and is willing to pay premium. c) Anyone who is willing to pay a premium. d) Anyone that qualifies through Social Security.

C Anyone who is willing to pay a premium.

#11. When a person applies for Medicare supplement insurance, whose responsibility is it to confirm that the applicant does not already have accident or sickness insurance in force? a) Active physician b) Agent c) Insurer d) State government

C Insurer

#7. Which type of dental care would cover operative treatment of the mouth? a) Endodontics b) Orthodontics c) Oral surgery d) Restorative

C Oral surgery

An insured loses her left arm in an accident that is covered by her Accidental Death and Dismemberment policy. What kind of benefit will she most likely recieve from this policy? A.) capital amount in monthly installments B.) Principal amount in monthly installments C.) capital amount in lump sum d.) principal amount in lump sum

C.) capital amount in lump sum

what is the purpose of the gatekeeper in an HMO?

Controlling costs Initially the member chooses a primary care physician. if they need a specialist, the gatekeeper refers the physician. this helps keep the member away from high price specialists unless its necessary.

#26. An applicant for an adjuster's license who meets all the requirements except the experience, special education, or training requirements may be issued a) A learner's permit. b) A license with limited authority. c) A regular adjuster's license. d) A temporary license as an apprentice adjuster.

D A temporary license as an apprentice adjuster.

#8. Sean has renewed his health insurance policy with Ability Insurance every year for the past 3 years. At this renewal, Sean received an extra payment from his insurer as a reward for renewing his policy and to encourage him to renew his policy again next year. What is this extra amount called? a) A supplemental benefit b) An additional benefit c) An endorsement d) An accumulation

D An accumulation

The relation of earnings to insurance provision allows the insurance company to limit the insured's benefit to his average income over the last A.) 6 months B.) 12 Months C.) 18 Months D.) 24 months

D.) 24 months

How soon after following a loss must the insured submit written proof A.) ASAP B.) 20 days C.) 60 days D.) 90 days or as soon as reasonably possible

D.) 90 days or as soon as reasonably possible

under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain A.) A statement from the insured's employer saying the insured was unable to work B.)an estimate of total expenses C.)a complete physician's statement D.) a statement that is sufficiently clear to identify the insured and the nature of the claim

D.) A statement that is sufficiently clear to identfiy the insured and the nature of the claim.

#12. In a disability policy, the probationary period refers to the time a) During which illness-related disabilities are excluded from coverage. b) Between the first day of disability and the day the disability must continue before the insured receives any benefits. c) Between the 10th day of an illness-related disability and the first payment. d) Between the first day of disability and the actual receipt of payment for the disability incurred.

a) During which illness-related disabilities are excluded from coverage.

#40. As it pertains to group health insurance, COBRA stipulates that a) Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense. b) Retiring employees must be allowed to convert their group coverage to individual policies. c) Terminated employees must be allowed to convert their group coverage to individual policies. d) Group coverage must be extended for terminated employees up to a certain period of time at the employer's expense.

a) Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense.

#13. Which of the following statements pertaining to Medicare Part A is correct? a) Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age 65. b) For the first 90 days of hospitalization, Medicare Part A pays 100% of all covered services, except for the initial deductible. c) Individuals with ESRD do not qualify for Part A. d) Each individual covered by Medicare Part A is allowed one 90-day benefit period per year.

a) Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age 65.

#7. The primary eligibility requirement for Medicaid benefits is based upon a) Need. b) Whether the claimant is insurable on the private market. c) Age. d) Number of dependents.

a) Need.

#9. If a member of a Blue Cross/Blue Shield (BC/BS) obtains medical treatment from a non-participating provider, the insurer will pay a) The amount that would have been paid to a participating provider. b) Nothing: BC/BS is a closed panel system. c) The entire amount billed, minus any applicable copays and deductibles. d) The entire amount billed on a 50/50 coinsurance basis.

a) The amount that would have been paid to a participating provider.

#8. When a creditor informs a debtor that he or she may be covered by a plan after a loan is closed, this is called a a) Ancillary coverage agreement b) Notice of proposed insurance. c) Coverage notification agreement. d) Corollary coverage agreement

b) Notice of proposed insurance. When a loan is closed, the creditor must inform the debtor that he or she may be covered by a plan if desired. This is called a "notice of proposed insurance." Even if the creditor pays the full cost of the coverage, the debtor must still be notified.

#2. __________ can be added to workers compensation policies in order to provide that state's mandated coverage while temporarily working outside of that state. a) The reciprocity of coverage provision b) The extraterritorial provision c) The extension of coverage provision d) The perigeographical provision

b) The extraterritorial provision An extraterritorial provision may be added to a workers compensation policy in order to provide that state's mandated coverage while temporarily working outside of that state.

#14. An insured's long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged a $100 per day. How much will the insurance company pay? a) 20% of the total cost b) $120 a day c) $100 a day d) 80% of the total cost

b) $120 a day

#44. According to OBRA, what is the minimum number of employees required to constitute a large group? a) 50 b) 100 c) 15 d) 20

b) 100

#20. If a dependent is covered under his father's health policy but then reaches the limiting age of coverage, he can convert to an individual policy within ___ days without having to provide proof of insurability. a) 20 b) 31 c) 60 d) 90

b) 31

#23. Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid? a) 90 days b) 5 months c) 12 months d) Benefits will be paid immediately. Under Social Security disability benefits, a person will have to wait five months before any benefits will be paid. Actual benefit payments start with the sixth month of disability.

b) 5 months

#42. Long-term care insurance policies must cover which of the following? a) Injuries caused by an act of war b) Alzheimer's disease c) All mental disorders d) Treatment of alcoholism

b) Alzheimer's disease

#15. Which of the following is not true of Disability Buy-Sell coverage? a) The policies provide funds for the business organization to purchase the business interest of a disabled partner. b) Benefits are considered taxable income to the business. c) It is typically written to cover partners or corporate officers of a closely held business. d) Premium payments are not deductible to the business.

b) Benefits are considered taxable income to the business`

#49. When an insurer offers services like preadmission testing, second opinions regarding surgery, and preventative care, which term would best apply? a) Claims discrimination b) Case management provision c) Cost reduction d) Claims reduction

b) Case management provision

#45. Under what type of group health plan does the insurer issue the plan on a one-year, renewable term basis, and the premium for each year only pays for that year's coverage? a) Annual fully-insured b) Conventional fully-insured c) Modified fully-insured d) Premium delay arrangement

b) Conventional fully-insured

#46. Social Security disability definition includes all of the following EXCEPT a) A physical impairment expected to result in death. b) Disability expected to last for at least 6 months. c) The inability to engage in any gainful work. d) Disability resulting from a medically determinable mental impairment.

b) Disability expected to last for at least 6 months.

#22. Concerning group Medical and Dental insurance, which of the following statements is INCORRECT? a) Employee paid premiums may be deducted if certain conditions are met. b) Employee benefits are tax deductible the year in which they were received. c) Benefits received by the employee are free from federal income tax. d) Premiums paid by the employer are deductible as a business expense.

b) Employee benefits are tax deductible the year in which they were received.

#16. All of the following statements describe a MEWA EXCEPT a) MEWAs can be self-insured. b) MEWAs are groups of at least 3 employers. c) MEWAs can be sponsored by insurance companies. d) MEWA employers retain full responsibility for any unpaid claims.

b) MEWAs are groups of at least 3 employers.

#11. A 55-year-old employee has worked part-time for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employee's eligibility? a) Income b) Number of hours worked per week c) The total amount of time worked for the company d) Age

b) Number of hours worked per week

#22. Under which type of alternative group health plan funding arrangement would the employer pay premiums 90 days past the policy's grace period? a) Flexible fully-insured b) Premium delay arrangement c) Conventional fully-insured d) Modified fully-insured

b) Premium delay arrangement

#19. When an insurer combines two periods of disability into one, the insured must have suffered a a) Presumptive disability. b) Recurrent disability. c) Partial disability. d) Residual disability.

b) Recurrent disability.

#43. The ________ is designed to encourage employers to hire people who are partially disabled. a) Injury reimbursement fund b) Second injury fund c) Reinjury fund d) Insurance guaranty fund

b) Second injury fund

#43. Which of the following is a health care program funded by the federal government for the retirees and spouses of the military services? a) Federal Plan for Retired Uniformed Servicemen (FEDPRUS) b) TRICARE c) Federal Retired Soldiers Health Care Program d) Uniformed Services

b) TRICARE

#8. An insured loses her left arm in an accident that is covered by her Accidental Death and Dismemberment policy. What kind of benefit will she most likely receive from this policy? a) The principal amount in monthly installments b) The capital amount in a lump sum c) The principal amount in a lump sum d) The capital amount in monthly installments

b) The capital amount in a lump sum

#13. Which statement accurately describes group disability income insurance? a) Short-term plans provide benefits for up to 1 year. b) The extent of benefits is determined by the insured's income. c) In long-term plans, monthly benefits are limited to 75% of the insured's income. d) There are no participation requirements for employees.

b) The extent of benefits is determined by the insured's income.

#16. Which of the following is NOT a feature of a noncancellable policy? a) The insured has the right to renew the policy for the life of the contract. b) The insurer may terminate the contract only at renewal for certain conditions. c) The premiums cannot be increased beyond the amount stated in the policy. d) The guarantee to renew coverage usually applies until the insured reaches certain age.

b) The insurer may terminate the contract only at renewal for certain conditions.

#24. Which of the following is true regarding underwriting for a person with HIV? a) A person may be declined for HIV but not AIDS. b) The person may be declined. c) The person may only be declined if he/she has symptoms. d) The person may not be declined.

b) The person may be declined.

#48. What is another name for an Administrative-Services Only arrangement? a) Self-funding b) Third-party administrator c) A modified fully insured plan d) Modified endowment contract

b) Third-party administrator

#16. Randy has an infectious disease that is highly contagious and disabling. He is required to stay indoors in a medical facility for the vast majority of the time. Randy has a _____ disability. a) Partial, nonconfining b) Total, confining c) Total, nonconfining d) Partial, confining

b) Total, confining

#31. Bob's legs were injured in an accident, and he must use a wheelchair for the rest of his life. What type of disability does this describe? a) Total, confining b) Total, nonconfining c) Partial, confining d) Partial, nonconfining

b) Total, nonconfining

#38. Insurers set aside certain funds when a policy is issued. Which fund category would be used if the insured cancels the policy? a) Complaint Reserves b) Unearned Premium Reserves c) Claim Reserves d) Accumulation Reserves

b) Unearned Premium Reserves

#19. When may an insured deduct unreimbursed medical expenses paid under a long-term care policy? a) Only if the insured does not itemize the expenses b) When the expenses exceed a certain percentage of the insured's adjusted gross income c) Only if the insured is age 65 or older d) All LTC expenses are tax deductible.

b) When the expenses exceed a certain percentage of the insured's adjusted gross income

#13. Group policy types are determined by two factors, whether the policy is contributory or noncontributory and a) The size of the group. b) Whether the policy is occupational or nonoccupational. c) Whether the policy is paid by annual premiums or monthly premiums. d) Whether or not the policy will be covering dependents.

b) Whether the policy is occupational or nonoccupational.

#3. Which clause stipulates that life insurance premiums can be paid in advance of policy issuance? a) Policy Issuance Clause b) Prepayment Clause c) Payment of Premium Clause d) Premium Prepayment Clause

c) Payment of Premium Clause The clause that allows for life insurance premiums to be paid in advance is called the Payment of Premium Clause.

#35. A credit life insurance policy may include a provision excluding or denying a claim for death in the event of suicide within what time limit? a) There is no time limit. b) 10 months. c) 6 months (12 months for contracts of more than 3 years) after purchase of the policy. d) 3 months.

c) 6 months (12 months for contracts of more than 3 years) after purchase of the policy.

#36. A tornado that destroys property would be an example of which of the following? a) A loss b) A physical hazard c) A peril d) A pure risk

c) A peril

#34. The full premium was submitted with the application for life insurance, and the policy was issued two weeks later as requested. When does the policy coverage become effective? a) As of the first of the month after the policy issue b) As of the policy issue date c) As of the application date d) As of the policy delivery date

c) As of the application date

#23. Prior to issuance of a Long-Term Care policy to an applicant age 80 or older, the insurer must obtain all of the following EXCEPT a) Attending physician's report. b) Copies of medical records. c) Date of previous doctor visit. d) Report of a physical examination or assessment of functional capacity.

c) Date of previous doctor visit.

#32. Which of the following is correct about a group health insurance policy? a) It can exclude newborn children from coverage. b) It cannot exclude coverage for VA hospital treatment. c) It can provide coverage for handicapped children. d) It cannot exclude coverage from an occupational accident.

c) It can provide coverage for handicapped children.

#26. Which of the following programs expands individual public assistance programs for people with insufficient income and resources? a) Social Security b) Unemployment compensation c) Medicaid d) Medicare

c) Medicaid

#5. Which clause allows both the insured and dentist to know in advance which benefits will be paid? a) Advanced Benefit Notification b) Fixed Rate c) Precertification d) Preadmission

c) Precertification

Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's accidental death? a) Double the amount of the death benefit b) Refund of premiums c) Principal sum d) Capital sum

c) Principal sum

A Medicare SELECT policy does all of the following EXCEPT a) Provide payment for full coverage under the policy for covered services not available through network providers. b) Provide for continuation of coverage in the event that Medicare SELECT policies are discontinued due to the failure of the Medicare SELECT program. c) Prohibit payment for regularly covered services if provided by non-network providers. d) Make full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare SELECT policy to each applicant.

c) Prohibit payment for regularly covered services if provided by non-network providers.

#47. Giving a client an inducement to a sale not stated in the policy is an unlawful practice known as a) Unlawful distribution of dividends. b) Coercion. c) Rebating. d) Twisting.

c) Rebating.

#13. An insured loses her left arm in an accident that is covered by her Accidental Death and Dismemberment policy. What kind of benefit will she most likely receive from this policy? a) The capital amount in monthly installments b) The principal amount in monthly installments c) The capital amount in a lump sum d) The principal amount in a lump sum

c) The capital amount in a lump sum

#32. Which of the following is NOT a feature of a guaranteed renewable provision? a) Coverage is not renewable beyond the insured's age 65. b) The insured's benefits cannot be reduced. c) The insurer can increase the policy premium on an individual basis. d) The insured has a unilateral right to renew the policy for the life of the contra

c) The insurer can increase the policy premium on an individual basis.

#31. What is the purpose of the rehabilitation benefit in disability insurance? a) To refund the insured's premium paid during the disability b) To help the insured recover from a disability c) To cover the expenses of retraining the insured to return to work d) To compensate the insured for the lost income

c) To cover the expenses of retraining the insured to return to work

#34. For how many days during a patient's lifetime will Medicare Part A cover mental health care in a psychiatric facility? a) 365 b) 90 c) 100 d) 190

d) 190

#15. In underwriting a substandard risk, which of the following is INCORRECT? a) The policy could be modified in the coverage or amount of coverage requested. b) The applicant could be rejected for coverage. c) Additional exclusions could be included to modify the underlying policy coverage. d) A discounted premium would be charged.

d) A discounted premium would be charged.

#10. All of the following are correct about the required provisions of a health insurance policy EXCEPT a) Proof-of-loss forms must be sent to the insured within 15 days of notice of claim. b) A grace period of 31 days is found in an annual pay policy. c) The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract. d) A reinstated policy provides immediate coverage for an illness.

d) A reinstated policy provides immediate coverage for an illness.

#43. Under which condition would an employee's group medical benefits be exempt from income taxes? a) An employee's group medical benefits are never exempt from taxation as income. b) When the premiums and other unreimbursed medical expenses exceed 5% of the employee's adjusted gross income c) When the premiums and other unreimbursed medical expenses exceed 10% of the employee's adjusted gross income d) An employee's group medical benefits are generally exempt from taxation as income.

d) An employee's group medical benefits are generally exempt from taxation as income.

#9. What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application? a) 90 days after the effective policy date b) 6 months after the effective policy date c) 1 year after the effective policy date d) As long as the policy is in force

d) As long as the policy is in force

#1. Which of the following is not true of Disability Buy-Sell coverage? a) It is typically written to cover partners or corporate officers of a closely held business. b) Premium payments are not deductible to the business. c) The policies provide funds for the business organization to purchase the business interest of a disabled partner. d) Benefits are considered taxable income to the business.

d) Benefits are considered taxable income to the business. The buy-sell coverage benefits are tax free.

#18. Don was born in March 1973 and got his license in February 2008. When would he have to complete continuing education requirements? a) By the end of February 2010 b) By the end of February 2009 c) By the end of March 2011 d) By the end of March 2009

d) By the end of March 2009

#40. Which of the following is NOT true regarding Basic Surgical Expense coverage? a) There is no deductible. b) Contracts include a surgical schedule. c) It is commonly written in conjunction with Hospital Expense policies. d) Coverage is unlimited.

d) Coverage is unlimited.

#18. All of the following are requirements for insurance license applicants EXCEPT a) Be of good character and reputation. b) Have not committed any criminal acts. c) Fulfill the residency requirement. d) Fulfill post secondary education requirements.

d) Fulfill post secondary education requirements.

#42. Events or conditions that increase the chances of an insured loss occurring are referred to as a) Exposures. b) Risks. c) Perils. d) Hazards.

d) Hazards.

#26. Where are the execution agreements found in a health insurance application? a) At the very end b) Before the section to be filled in by the soliciting agent c) At the very beginning d) Immediately preceding the applicant's signature

d) Immediately preceding the applicant's signature

#11. Which of the following is NOT true of a major-medical health insurance policy? a) It usually has a maximum benefit amount. b) The benefits are subject to deductibles. c) It is designed to cover hospital and medical expenses of a catastrophic nature. d) It is designed to pay on a first dollar of expense basis.

d) It is designed to pay on a first dollar of expense basis.

#9. In an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received? a) Policy tax b) Federal income tax c) State income tax d) No tax

d) No tax

#17. What term is used to describe when a medical caregiver contracts with a health organization to provide services to its members or subscribers, but retains the right to treat patients who are not members or subscribers? a) Closed panel b) Restrictive rights c) Indemnity contract d) Open panel

d) Open panel

#47. Which of the following provisions is mandatory for health insurance policies? a) Free-look b) Unpaid premiums c) Intoxicants and narcotics d) Physical examination and autopsy

d) Physical examination and autopsy

#5. When the insured initiates the cancellation of a policy, the unearned premium will be refunded on a a) Extended term basis. b) Pro rata basis. c) Per occurrence basis. d) Short rate basis.

d) Short rate basis.

#20. Bob is admitted into a nursing home, leaving his wife Sarah to pay the bills. The _________ will allow her to keep a portion of the couple's income and assets equal to a percentage of the federal poverty line. a) Medicaid income rule b) Standard of living rule c) Cost of care rule d) Spousal impoverishment rule

d) Spousal impoverishment rule

#45. How does a member of an HMO see a specialist? a) The insurer chooses the specialist. b) HMOs do not cover specialists. c) The member is allowed to choose his or her own specialist. d) The primary care physician refers the member.

d) The primary care physician refers the member.

#22. What is another name for an Administrative-Services Only arrangement? a) A modified fully insured plan b) Modified endowment contract c) Self-funding d) Third-party administrator

d) Third-party administrator

#5. An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss? a) Incontestability b) Physical Exam and Autopsy c) Legal Actions d) Time of Payment of Claims

d) Time of Payment of Claims

which of the following terms is related to disability income insurance residual benefit coinsurance deductibles insurable interest

residual benefit a residual benefit amount is based on the proportion of income lost to disability

an insured is anxious to get treatment and wants a specialist. if they have a PPO Plan, which is true

the insured can select any specialist, but non network specialists have a higher cost