Insurance - Week 3

Natalie currently works as an accountant for a large financial firm in New York. Her company offers wellness program opportunities and financial incentives for participation. The most recent incentive includes a $50 reward for participation in a race, such as a 5K, marathon, or related event over the next 3 months. Natalie recently broke her foot and is not currently able to participate in this incentive. What is required of the company to accommodate Natalie's situation? A. The company is not required to do anything to accommodate Natalie's situation. B. The company is required to offer an alternative method for Natalie to obtain the incentive. C. The company is required to delay the incentive to all employees until Natalie is healthy enough to participate. D. The company is required to discard the incentive all together, as this is discriminatory against Natalie and her situation.

B

Proponents of the Individual Mandate state that its implementation would reduce the occurrence of which of the following: A. Businesses that choose to make payments to the government instead of offering health insurance to their employees B. Uninsured individuals who take advantage of free emergency care services at the expense of insured individuals C. Workers who choose not to participate in employee wellness programs D. Disparities in health which exist between races

B

Research has shown that Americans want lower premiums, higher quality of care, and more choice in who their providers are. However, narrow networks, which are defined as containing a smaller number of providers than traditional networks while providing lower premiums, have grown in popularity. Why is this the case? A. Physicians are looking to decrease their patient base to provide higher quality of care B. Consumers care most about lower premiums and less about who their provider is C. Narrow networks provide less restrictions on patients and providers D. Narrow networks are most appealing to larger businesses who have to provide insurance for their large employee base E. All the above

B

The Affordable Care Act does not allow insurance companies to practice "rescission." Which of the following is an example of rescission? A. United Healthcare cancelled coverage for patient TM after the policyholder did not pay his premium for 6 months. B. United Healthcare cancelled coverage for patient TM after the policyholder was diagnosed with a chronic condition, even though he paid his premium on time each month. C. United Healthcare increased the premium for TM after he was diagnosed with a chronic condition. D. United Healthcare increased the premium for TM due to his age, geographic location and tobacco usage.

B

Which one of the following is not true about ACA? A. After ACA, among racial and ethnic groups, Hispanics and Blacks had the largest decline in uninsured rates, and all people of color generally had larger coverage gains than whites. B. Due to the growing concern in public-health, ACA made it possible for undocumented immigrants to purchase coverage from the Marketplace. C. After ACA was implemented, uninsured rates dropped across states that did and did not choose to expand Medicaid, but they dropped more in expansion states. D. Coverage gains were particularly large among low-income people living in states that expanded Medicaid. E. A and C

B

With the ACA's protection laws for consumers, insurance company "X" wanted to follow these regulations while also maintaining a balance between costs and profit. Which of the following situations does not comply with the ACA laws? A. A 38 year old Caucasian male had his coverage terminated after he failed to pay his policy premium. B. A 42 year old African American male had his premium amount increased because he was diagnosed with kidney failure. C. An 18 year old Hispanic female with diabetes receives coverage under her father's insurance policy. D. Insurance "X" spent $1,500 of the $10,000 made off of individual premiums for administrative work.

B

Debra is the owner of a small business with only 58 employees. She begins looking into insurance plans to provide to her employees. Because she knows each person on a first name basis and knows they all have specific needs of their own, Debra decides to let each employee pick an plan that works best for them instead of choosing one for them all. Under the Affordable Care Act, which of the following would occur? A. Debra does not meet the minimum person requirement to be considered a midsize or large company and is therefore not required to provide insurance through her company. B. Because Debra is not hindering her employees from choosing their own insurance plan, she cannot be legally penalized for letting her employees to decide a plan for themselves instead of providing one. C. Debra's company has met the minimum number of employees and must provide her employees with a qualified insurance plan and if not, her company is subject to a fine of almost $60,000.

C

John is a 38 year old man working in an organization in Dallas. He is married to Mary (34 years) and have twins of 7 years of age. John is insured through employer sponsored insurance, however his family income is 110% of FPL. His employer plan is comprehensive but not affordable as John pays 11% of his family income for the premiums in the employer plan. Which of the following is the most appropriate choice for John to make to cover himself and his dependents in times of illness? Also, what impact would this choice have on John's employer in terms of penalties? A. John can choose coverage in the employer plan or buy unsubsidized insurance through an exchange or in the non-group market; his employer would not be penalized for comprehensive coverage. B. John is eligible for coverage through Medicaid; his employer would be penalized for not covering John's family, and non-affordable coverage. C. John can choose coverage in the employer plan or buy insurance through an exchange and be eligible for tax credit; his employer would be penalized for non-affordable coverage. D. John's family is eligible for coverage through Medicaid; his employer would not be penalized.

C

Mark is a healthy 26-year-old male. He is starting a new job and learned that his employer offers both Health Reimbursement Arrangement (HRA) and Health Savings Account (HSA) options. As Marks decides which of the two options to choose, he needs to consider all of the following except: A. If he leaves his job, his employer will keep the funds if he enrolls in an HRA B. Funds in both accounts are considered tax-free funds C. He will be required to enroll in a high-deductible health plan if he enrolls in an HRA D. If he leaves his job, he will keep the funds if he enrolls in an HSA

C

Robby G has been living without insurance for a while now and just recently sign up for insurance coverage through the Affordable Care Act. Unfortunately, Rob has a history of anxiety and worries about being kick off his insurance plan. Which of the following could qualify him for dismissal? Robby G also lives with his 8 year old son. A. Mr. G currently makes $10,000 a year and lives with his son. B. His son, was recently diagnosis with Type 1 Diabetes. C. Recently incarcerated due to illegal activity D. Robby G likes to be proactive and decides to get a number of preventable services done, like wellness screening, physicals, etc. E. Robby G himself, has asthma.

C

Ron refuses to offer employer-sponsored insurance to his employees. His business—Very Good Building & Development Co.—employs 99 workers that qualify as full-time employees and 19 part-time employees. Which of the following statements is true due to the employer mandate from health reform? A. Since Ron's business does not employ the minimum number of full-time individuals, his company cannot be subjected to the employer penalty. B. Ron's business will be penalized $190,000 if any of this full-times employees receives subsidized coverage through the health insurance exchange. C. Ron's business will be penalized $138,000 if any of his full-time employees receives subsidized coverage through the health insurance exchange. D. Ron's business will not be penalized unless 2.5% or more of the total number full-time employees at Very Good Building & Development Co. receive subsidized coverage through the health insurance exchange.

C

The Duncan family joined an individual health insurance plan 3 years ago. Robert is a middle-aged man and the policy holder for the family insurance. Robert recently found out he accidentally made an error on the insurance application. Rebecca is a middle-aged housewife. Joel is a 27-year old studying in graduate school. Jessica is a 17-year old who was diagnosed with cerebral palsy at a young age. The insurance company has the right to remove which individual from this family's policy, under the Affordable Care Act regulations? A. Robert B. Rebecca C. Joel D. Jessica

C

David is interested in obtaining a job that provides health coverage (insurance). Which of the following firms will most likely provide health coverage and why? A. Firm with 60 full time employees; firm is required to provide coverage due to the number of workers. B. Firm with 30 full time employees; firm is required to provide coverage due to the number of workers. C. Firm with 5 full time employees; less workers means more money to allocate funds for each individual worker. D. Firm with 10 part time employees; firm will allow the employee decide on health coverage.

A

More employers are offering Consumer Direct Health Plans (CDHP). Two of the main drivers behind the rise in these plans are ____________ and _______________. However, without _____________ they are of little value to the individual because they tend to shift costs from the employer to the employee because without active prevention, many employees acquire chronic conditions such as hypertension or diabetes. A. Greater individual control, lower premiums, workplace health programs B. An increase in part-time workers, the individual mandate, governmental oversight C. The ACA, reduced healthcare costs for those enrolled in CDHPs, the individual mandate D. None of the above

A

Under the Affordable Care Act, all are true except A. Employers with at least 30 full time employees will have to provide qualified health insurance to their full time employees. B. If employers don't offer qualified health insurance, they will have to make a payment of up to $2000. C. Employers with more than 200 employees must automatically enroll their employees into health insurance plans. D. Employer's health plans will be assessed by its affordability relative to household income. E. All are true

A

Understanding the demographics of those for Medicaid and based on the most used modes of application among adults in Texas who signed up or attempted to sign up for Medicaid, which of the following outreach methods would be most successful in ensuring the correct information and assistance gets to the people who need it? A. Provide written information in multiple languages for distribution at government buildings, healthcare centers, and through mailings to people who have used programs that assist low income and elderly populations. B. Set up a website in English that includes information on how to apply for coverage, contact information for each state's Medicaid program, and Frequently Asked Questions (FAQ) section. C. Create a social media outreach program that includes publicizing information via Twitter and Facebook about how to sign up for the program and answering questions asked by followers.

A

Which of the following candidate is likely to be coved by Medicaid? A. 16 year old hispanic female, who is 6 months pregnant without medical insurance and she does not have a job B. A 35 year old male who make an income of 60000 dollars yearly C. A 65 year old female retired registered nurse D. A 45 year old caucasian male with chronic hypertension but he is an engineer and he makes approximately 70000 dollars yearly E. A 75 year old male with Diabetes, Congestive Heart Failure and chronic hypertension

A

You are operating a home health agency in the State of Texas with branches in some major cities of the state. You have more than 300 employees and because of the affordable care act; you know you have to do one of the following to extend health care coverage to all your employees. A. Automatically enroll all workers. B. Do not allow workers to opt out of coverage. C. Do not enroll workers automatically. D. None of the above.

A

A healthy 26 year-old Caucasian female student is in excellent health. She sees her doctor once a year in September for an annual check-up. During her annual check-up each time, she receives the influenza vaccine and any other necessary immunizations. In a year, she gets sick about 1 to 2 times, which required a doctor visit. The doctor gave her a prescription on both occasions, and those were the only times she filled a prescription at the pharmacy. During those times that she used healthcare, she did not have insurance, and paid everything out of pocket. Her yearly income is $19,500, and she is currently borrowing loans to help pay for her school and apartment. Her school initiated a new law requiring students to be enrolled in a health plan. She wants to enroll in a health plan that will cover her previous healthcare expenses and satisfy the school's requirement, but she worries about the cost and requests for any financial help, especially with deductibles and co-payments. Which of the following health plan is the best for her? A. Low premiums, high deductibles of a bronze plan B. Low premiums, high deductibles of a silver plan C. High premiums, low deductibles of a gold plan or platinum plan D. Low cost of a catastrophic plan

B

After the Affordable Care Act was implemented many American were able to be eligible for insurance. However, Texas still has the highest percent of uninsured residents in the country. Which of the following is not a contributing factor to the high amount of uninsured Texans? A. Texas decided not to expand its Medicaid program, leaving many low income adults ineligible. B. Many Texans are ineligible for insurance coverage due to pre-existing conditions C. Texas has a large immigrant population D. Lack of information about new health insurance options

B

An employer who offers a consumer directed health plan also invests heavily in an employee wellness program. Which of the following is not a potential benefit of implementing this wellness program? A. The wellness program should reduce employer healthcare costs B. The program will keep the employer legally compliant with federal HIPAA regulations C. The wellness program should increase employee productivity D. The wellness program will help prevent healthcare costs from shifting to the employee

B

Captain America, an employee at the S.H.I.E.L.D, is enrolled in a high-deductible insurance plan. His current plan has a deductible of $1,600. This year he had multiple doctors' visits and exams (due to his injuries from work) but not his annual physical exam, totaling charges of $1,000. Captain America is scheduled for his annual physical and looking to estimate the cost for the visit. If the physical exam costs $250, what portion is Captain America expected to pay during the visit? A. $250 because he has not yet reached his deductible. B. $0 since annual physical exams are covered as preventative medicine C. $600 because he needs to reach his deductible before he goes for annual physical exam D. Unknown

B

James, a 67 years old disabled man without a job lives in Irving, Texas. Once he had severe chest pain and needed to go to the Emergency Room. After observing, the doctor said the patient needs to do an angiogram and some related tests to identify the cause of chest pain. James does not have enough money and cannot afford the expenditure of the bill. Now which insurance he is eligible for. A. Medicaid -Medicaid will cover the bill. B. Medicare - Medicare will cover the bill C. Affordable Care Act (ACA)-will cover the bill.

B

Monica and Rachel both work at a large firm that recently implemented a workplace wellness program. Though voluntary, the firm has been encouraging employees to participate in an attempt to reduce both absenteeism and expenditures for employee's health care. Monica has recently been struggling with obesity so she signs up but Rachel decides NOT to participate. Which of the following statements is FALSE? A. Monica could be eligible to pay a reduced copayment when using health services in the future B. Rachel's health begins to worsen because she did not participate in the program C. Monica could will a small prize or a cash value for participating D. Rachel might be offered a less comprehensive health plan or have to pay a higher premium as a 'penalty' for not participating E. Monica will now have access to programs such as weight management and health education

B

Mr. Correa, a 21 year old hispanic male, is looking to enroll in a health insurance plan offered by his employer Astros Inc. His job requires him to be on the road frequently, and he often sees a specialist for injuries suffered through work. He is looking for an insurance plan that is the most cost-effective. There are several plans offered by his employer, including a Health Maintenance Plan (HMO), a Preferred Provider Organization (PPO), and an Exclusive Provider Organization (EPO). Unsure of which health plan to select, Mr. Correa calls you, his good friend who recently enrolled in a class in Health Management and Policy. Which insurance plan would you recommend to Mr. Correa? A. You recommend that Mr. Correa select the EPO Plan. B. You recommend that Mr. Correa select the PPO Plan. C. You recommend that Mr. Correa select the HMO Plan. D. You would recommend that Mr. Correa buy individual health insurance, being that it would be more cost effective.

B

Ms. Sharon Lesters is a 67-year-old widowed woman, who is slowly developing early stages of dementia. She and her deceased husband have one son, whom lives far away from her and is taking care of his own family. She recently lost her health coverage due to the passing of her husband, and she is in need of a new healthcare plan. One of the options given to her was Long Term Care Insurance (LTCI) - a relatively new insurance that can help her pay for long-term care, lessening the impact of any health crisis. The other options include Medicare or private insurance. Which of the three insurance options is appropriate for Ms. Lesters? A. Under the ACA, Ms. Lesters is eligible to apply for the program because she is above 65. Under this plan, Ms. Lesters will receive most of the preventive care. B. LTCI, since Ms. Lesters shows sign of a chronic condition, which makes this plan most appropriate for her. The cost of her possible long-term health care will be less than signing up for other plans. C. Ms. Lesters should be able to afford private insurance from inheriting what her husband left for her. D. None of the plans listed above is beneficial for Ms. Lesters

B

According to a 2010 survey, less than 1% of U.S. adults were able to answer 10/10 basic facts correctly about the health reform law. Which one of the statements is NOT a product of the health reform law? A. The existing Medicaid program is to expand to cover low-income, uninsured adults regardless of whether they have children. B. The health reform law provides financial help to low and moderate income Americans who don't get insurance through their jobs to help them purchase coverage. C. The health reform law will cut benefits that were previously provided to all people on Medicare. D. Insurance companies are prohibited from denying coverage because of a person's medical history or health condition.

C

Congratulations! You have just graduated from the UNTHSC and you were recently offered four different positions across the country with relatively the same pay. While making a final decision on which job to pursue, you read further into each position's health benefits, because you want to make sure you'll be in the best hands. Background: You're a 26-year-old single female with asthma and reoccurring flare-ups of Lupus. Various types of cancer run in your family and your mother is a Type 1 Diabetic. Your father has begun to show early signs of Parkinson's Disease. You exercise about 3 times a week for about 40 minutes each workout. You are a social smoker and drinker, but go out more often than you should. You eat fast food almost 4 times a week, causing your cholesterol and blood pressure to constantly be off the charts. Although after getting the results back on your most recent physical exam, you decide that you must do something about your health. Which of the following companies will offer you the BEST health insurance plan, considering your background? A. A small company with 42 full-time employees that does not provide you with any health insurance benefits. B. A small company with 47 full-time employees that offers health insurance incentives for maintaining a healthy lifestyle by providing bonuses instead of providing full health coverage. These bonuses can be in the form of cash, vouchers, or prizes. C. A large company with 238 full-time employees that offers a few wellness programs with incentives for maintaining a healthy lifestyle (such as lower deductibles and premiums) and penalties (such as higher deductibles and premiums) for not doing so. D. A large company with 240 full-time employees that requires you to pay the high deductibles and premiums and then offers full coverage once the threshold is met. E. B or C

C

"Most employers who provide health insurance also provide some type of wellness benefit." Which of the following workplace wellness programs would fall into the category referred to as "participatory wellness program"? A. Employee with high cholesterol would receive a discount on his/her health insurance premium if they enroll in wellness program and reduce his/her total cholesterol to less than 200. B. Employee would receive a rebate for participating in a smoking cessation program and can certify they have quit smoking within 6 months. C. Employee who is overweight would receive a discount on his/her health insurance premium if he/she enrolls in the company's fitness program and reduces his/her BMI by a specified number of points within 6 months. D. Employee is offered a discount on his/her health insurance premium for obtaining a gym membership but does not have to provide proof of weight loss.

D

An organization that consists of more than 1000 employees has recently implemented a wellness program for its employees. Which of the following cannot occur as a result of implementing the wellness programs in this organization? A. Reduction in sick leave B. Reduction in employer medical cost C. Reduction in worker compensation and disability costs D. Reduction in the percentage of employer-provided premium coverage by 43%

D

As a new screening officer for Medicare eligibility, your job is to review patient profiles and determine if they qualify for receiving Medicare benefits. Which of the following patients is most likely to receive Medicare? A. Patient #1 is a 45 year old female who has been receiving disability benefits from the Allied Pilots Association retirement board for 24 months. B. Patient #2 is a 59 year old widow who is currently receiving a monthly social security check from her recently deceased husband. C. Patient #3 is a 63 year old male who has been receiving Medicaid for more than 10 years. D. Patient #4 is a 12 year old male who has recently been diagnosed with stage 5 CKD.

D

Jackson is a 46-year-old male who is a CEO of a company of about 250 full-time employees and 30 part-time employees. The company's insurance follows the qualifications stated within the Affordable Care Act (ACA). Which of the following is true about insurance status of Jackson's full-time employees due to the ACA? A. The employees are not offered insurance, and must get their own private insurance. B. Due to ACA, employees are required to get only the insurance offered by the company and are unable to obtain private health insurance. C. The company is required to have their own clinics and is free-of-charge to employees D. Employees are automatically enrolled to the company's insurance and may opt out, should they choose to get private insurance. E. Employees are required to obtain private insurance within 90 days of being hired.

D

Nearly all US residents are required to maintain coverage, but exceptions for not having coverage are occasionally given. Which group of people are NOT given exceptions? A. People in financial hardships or with religious objections B. American Indians C. People who have been uninsured for less than 3 months D. Veterans of any branch of the Untied States Military E. People who's lowest cost health plan exceeds 8% of their income

D

Robert Angier, a 57 year-old male, is looking to purchase an insurance plan to tailor his needs. He comes to you for help and you start asking him some specific questions about his health. Mr. Angier reveals that he visits his physician's office monthly to have labs taken because he suffers from asthma, osteoporosis, and heart disease. Due to these chronic health conditions, he is required to take multiple medications, some of which are very expensive because they are brand-name only. He has also been hospitalized twice in the past 6 months. The plans offered are platinum, gold, silver, or bronze but he's not sure which one to choose. Based on Mr. Angier's health, what 'medal' level(s) would be the best and most cost efficient? A. Silver B. Platinum C. Gold D. Bronze E. Both B and C are correct answer choices

E