NM Accident Insurance Exam Ch. 6
b
Which is not an eligible expense under a major medical policy? Select one: a. Prosthetics b. Custodial care c. Physical therapy d. Durable medical equipment
c
A major medical policy limits the dollar amount for room and board. This is an example of: Select one: a. Corridor deductible b. Maximum benefit c. Inside limit d. Exclusion
b
Adrian has a major medical policy with a $200 flat deductible and 80/20 coinsurance. If the covered loss is $5,350, how much will Adrian pay? Select one: a. $1,030 b. $1,230 c. $5,150 d. $5,350
c
At what age may funds from an HSA be withdrawn for non-medical expense purposes without incurring a penalty? Select one: a. 75 b. 62 c. 65 d. 59 1/2
b
All of the following are covered costs under a basic hospital plan, EXCEPT: Select one: a. Room and board b. Infertility treatment c. General anesthesia d. Medications
b
All of the following are limitations imposed on subscribers of HMOs to contain the cost of medical care, EXCEPT: Select one: a. Focus on preventative care b. Wide choice of medical facilities and physicians c. Physicians contract with medical facilities in an arrangement called _in-network providers_. d. Physicians are paid on a capitation basis.
d
All of the following are limited medical expense policies, EXCEPT: Select one: a. AD&D b. Travel accident c. Hospital income d. Basic hospital
d
All of the following are true regarding HMOs, EXCEPT: Select one: a. HMOs are managed care cost containment health care programs. b. HMOs provide health insurance coverage and medical services. c. HMOs are prepaid programs which focus on preventive care. d. Subscribers may see referral specialists without needing to see primary care physicians.
b
All of the following are true regarding PPOs, EXCEPT: Select one: a. PPOs are a group of medical facilities, physicians and practitioners in a designated geographic area that agree to provide medical services at a discount. b. PPO members typically pay more than non-PPO members. c. Compared to an HMO, members of a PPO have more options and choices in the medical providers from which they can utilize. d. No matter where a member under a PPO receives emergency care, it is covered by the plan.
d
All of the following are ways medical expense policies pay benefits, EXCEPT: Select one: a. Reimbursement b. Service basis c. Indemnity d. Valued
d
All of the following policies must have a prominent notice "THIS IS A LIMITED POLICY" printed on the policy face, EXCEPT: Select one: a. Blanket b. AD&D c. Vision d. HMO
b
All of the following statements are true regarding hospital income coverage, EXCEPT: Select one: a. Hospital income policies pay a dollar benefit for each day the insured is confined to a hospital. b. The insured must use the benefit to pay medical expenses. c. The benefit amount is not based on the insured's income earnings. d. Once the insured is discharged from the hospital, benefits stop.
a
All of the following statements regarding a health savings account (HSA) are true, EXCEPT: Select one: a. Funds in an HSA used for qualified medical expenses are taxed upon withdrawal. b. Both the employer and employee make contributions to an HSA. c. In order to be eligible for an HSA, an employee must not be eligible for Medicare. d. Funds in an HSA may be used by the individual, their spouse or their dependents.
c
Barbara is looking at both individual and group medical coverages - for herself and her company. She has learned that medical expense plans may be offered as: Select one: a. Individual coverages only b. Group coverages only c. Individual or group coverages d. None of the above
a
Base plans: Select one: a. Offer first-dollar coverage b. Have deductibles and coinsurance c. Do not cover catastrophic medical costs d. Are identical to managed care plans
d
Compared to basic medical expense plans, coverage for medical expenses under major medical is: Select one: a. Narrower b. The same c. Nonexistent d. Broader
d
Compared to basic medical expense plans, major medical policies have: Select one: a. No catastrophic coverage b. The same limits for catastrophic coverage c. Lower limits for catastrophic coverage d. Higher limits for catastrophic coverage
a
Donald has an AD&D policy and names his sister Maxine as the primary beneficiary, and his daughter Julie as the contingent beneficiary. If Donald and Maxine are killed simultaneously in the same car wreck, who will receive the policy proceeds? Select one: a. Julie b. Maxine c. Donald's estate d. Donald's wife's estate
c
Which medical savings plan is a combination of a savings account and a high deductible, where contributions are made by the plan participants and funds from the prior year may be rolled over into the following year? Select one: a. HRA b. FSA c. HSA d. All of the above
b
Frank has a major medical policy with a $300 deductible and 80/20 coinsurance. The policy has $10,000 stop-loss coverage. How much is paid by the policy on a covered loss of $7,500? Select one: a. $2,160 b. $5,760 c. $6,000 d. $7,500
d
Funds in this special savings medical plan do not rollover from year to year: Select one: a. Group health insurance b. HRA c. HSA d. FSA
b
Gerald has a major medical policy with a $500 deductible and 80/20 coinsurance. He incurs a $20,000 covered loss. How much does Gerald pay on the claim? Select one: a. $500 b. $4,400 c. $16,100 d. $19,500
d
HMOs are required to provide all of the following basic hospital services EXCEPT: Select one: a. Room and board b. General nursing care c. X-rays and other diagnostic tests d. Dental
d
How do managed care plans control medical care costs? Select one: a. Requiring plan participants to obtain second surgical opinions b. Precertification c. Emphasizing preventative care d. All of the above
b
How is the miscellaneous expenses coverage under basic hospital medical expenses paid? Select one: a. A fraction of the room and board benefit b. A multiple of the room and board benefit c. the room and board benefit d. None of the above
b
In what plan arrangement(s) can Consumer Driven Health Plans (CDHPs) be offered? Select one: a. FSA or HSA b. HRA or HSA c. HSA only d. HRA only
c
Mary is in a car accident and requires surgery to repair her fractured leg. Which policy will not pay for her hospital expenses? Select one: a. Medicare Advantage b. Medicare Supplement c. Disability income d. Major medical
a
Most medical expense plans have: Select one: a. Coinsurance and deductibles b. Copayments only c. Coinsurance only d. Deductibles only
a
POS plans are a mix of: Select one: a. HMOs and PPOs b. Base plans and comprehensive plans c. Major medical and base plans d. Open and closed panel
c
Precertification of medical services is used in which of the following medical care arrangements? Select one: a. Medicare b. Workers_ Compensation c. Managed care d. PPO
c
Rachel is in a devastating car accident and loses both legs. Her $200,000 AD&D policy will pay: Select one: a. $50,000 b. $100,000 c. $200,000 d. $400,000
c
Susan has a major medical policy with $200 flat deductible and 70/30 coinsurance. If the covered loss is $3,200, how much will Susan pay? Select one: a. $200 b. $900 c. $1,100 d. $2,100
c
Which is not a limited medical expense policy? Select one: a. Hospital income b. AD&D c. Basic hospital expense d. Dental
b
The stop-loss feature in a major medical policy: Select one: a. Occurs before the out-of-pocket limit is reached b. Applies after coinsurance is paid c. Pays the deductible d. Pays the coinsurance
c
The two categories of basic hospital medical expense coverage are: Select one: a. Surgical and recovery room b. Physician's fees and disability income c. Room and board and miscellaneous expenses d. Physician's fees and nursing fees
c
The two types of flexible spending accounts are: Select one: a. MSAs and HSAs b. HRAs and HSAs c. Qualified medical expense account and dependent care expense account d. None of the above
d
Vision plans cover all of the following, EXCEPT: Select one: a. Annual eye exams b. Eyeglasses c. Contact lenses d. Eye surgery
c
What is the purpose of coinsurance in major medical policies? Select one: a. For risk selection b. For rating risks c. To prevent overutilization d. To exclude certain medical conditions
d
What policy feature in major medical policies allows the maximum lifetime benefit to be restored to its original amount after a large portion of the benefits have been used? Select one: a. Out-of-pocket limit b. Stop-loss c. Deductible d. Restoration of benefits
d
What term best describes a dollar limit placed on the room and board of a major medical policy? Select one: a. Exclusion b. Optional benefit c. Corridor deductible d. Inside limit
a
What type of health insurance policy is intended to insure a debt? Select one: a. Credit health b. Blanket insurance c. Dread disease d. Critical illness
b
What type of insurance plan covers medical care costs, such as physician's fees, surgical fees, and prescription drugs? Select one: a. Life insurance b. Medical expense insurance c. Property insurance d. Disability income insurance
b
Which basic plan covers costs an insured incurs while confined to a hospital, including room and board, nursing care, X-rays, lab fees, operating and treatment room, oxygen, blood, medications and general anesthesia? Select one: a. Medical b. Hospital c. Surgical d. Medical, hospital and surgical
C
Which basic plan covers surgical costs including surgeon fees, anesthesia, and post-surgery recovery? Select one: a. Medical b. Hospital c. Surgical d. Medical, hospital and surgical
c
Which health insurance contract pays a death benefit? Select one: a. Long-term care b. Medigap c. AD&D d. Hospital income
b
Which health insurance policy requires the insured name a beneficiary? Select one: a. Long-term care insurance b. Travel accident c. Medigap d. Student health insurance
a
Which is not a characteristic of basic medical plans? Select one: a. Coinsurance b. First-dollar coverage c. Dollar maximum benefit per visit d. Low limits for catastrophic coverage
d
Which of the following is a managed care plan? Select one: a. HMO b. PPO c. POS plan d. All of the above
b
Which of the following is false regarding flexible spending accounts? Select one: a. Withdrawals from a flexible spending account can be made through a flexible spending account debit card. b. Flexible spending account funds are not subject to the use-it or lose-it rule. c. Flexible spending accounts are tax-advantaged savings accounts in which funds are used for qualified medical expenses and dependent care. d. Flexible spending accounts can be offered with an employer cafeteria plan.
d
Which of the following is not a managed care plan? Select one: a. Point of Service b. Health Maintenance Organization c. Preferred Provider Organization d. Accidental death and dismemberment
d
Which of the following is not characteristic of hospital indemnity coverages? Select one: a. The coverage pays a stated amount per day the insured is confined to the hospital. b. Premiums are low. c. Benefits can be used for non-medical purposes. d. The benefit amount is based on the insured's income earnings.
c
Which of the following is true regarding taxation of medical expense plans? Select one: a. Benefits are only taxable for individual policies. b. Benefits are only taxable for group policies. c. Benefits are not taxed. d. Benefits are taxable as ordinary income.
c
Which of the following medical plans has essentially replaced the outdated base plans? Select one: a. Major medical b. Comprehensive c. Managed care d. Limited policies
b
Which of the following plans covers non - surgical physician's fees? Select one: a. Basic hospital b. Basic medical c. Basic surgical d. All base plans
a
Which of the following statements regarding PPOs is false? Select one: a. If PPO members use non-preferred medical providers, coverage is not provided. b. PPOs cover the cost of emergency care no matter where it is received. c. Medical facilities, physicians and practitioners are paid on a fee-for-service basis. d. PPO members choose medical providers from a list provided by the PPO _ these providers are termed _preferred._
a
Which of the following terms is an amount of the claim the insured must pay before the health insurance policy will pay benefits? Select one: a. Deductible b. Coinsurance c. Copayment d. Inside limit
b
Which peril is covered by AD&D policies? Select one: a. Premature death b. Accident c. Sickness d. Accident and sickness
c
Which plan covers physician's fees? Select one: a. Basic surgical expense b. Basic hospital expense c. Physician's nonsurgical expense d. All of the above
a
Which policy combines a base plan with major medical coverage? Select one: a. Comprehensive major medical b. AD&D c. Basic hospital d. All of the above
d
Which special savings medical plan combines high-deductible coverage with a savings account in which contributions are made by the plan participant, and funds roll over from year to year? Select one: a. HRA b. Group health insurance c. FSA d. HSA
a
Which term correctly describes a nonscheduled plan of charges for basic surgical plans? Select one: a. Usual, customary and reasonable b. Relative value c. Absolute value d. None of the above
c
teven has a major medical policy with a $350 flat deductible and 80/20 coinsurance. If the covered loss is $5,500, how much will the insurer pay? Select one: a. $1,030 b. $1,100 c. $4,120 d. $4,400
