Practice Health Insurance Questions
A woman's health insurance policy dictates which doctors she is allowed to see. her health providers share an assumed risk for their patients and encourage preventive care. What best describes health system that the woman is using?
Managed Care
NOT CORRECT regarding Medicare
Medicare Advantage must be provided through HMOs
In an individual long-term care insurance plan, the insured is able to deduct premiums from taxes. what income taxation will be imposed on the benefits revived
No tax
The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insureds employment is called?
Nonoccupational Coverage
All individual and group health insurance policies providing medical, surgical, or hospital expenses in Kansas, must provide reimbursement or indemnity for treatment of alcoholism, drug abuse or nervous or mental conditions. Such coverage may be limited to
Not less than 30 days per year when the person is confined in a properly licensed facility
An insured has health insurance that covers them at home and work. this policy was written on what basis?
Occupational
What is a defined version of unilateral contract
One-sided: only one party makes enforceable promise
What part of Medicare is known as hospital insurance?
PART A
MUST be presented in all medicare supplements
PLAN A
Who qualifies for Medicare?
Persons 65 years or older, people with permanent kidney failure, person who has been on some social security program for at least 24 months
NOT COVERED by PART A Medicare
Physician and surgeon services
A woman obtains health insurance coverage through the Marketplace on October 1. Two weeks later she finds out she is pregnant 3 month
Pregnancy will be covered immediately
Regarding the taxation of Business Overhead policies,
Premiums are deductible and benefits are taxed
This describes taxation of individual disability income insurance premiums and benefits
Premiums are not tax deductible, and benefit are not taxable
What type of care is Respite care?
Relief for a major care giver
What is another name for OLD AGE, SURVIVORS, and DISABILITY INSURANCE BENEFITS?
Social Security
Which of the following is correct regarding selecting a primary care physician in a PPO plan
THE INSURED MAY CHOOSE MEDICAL PROVIDERS NOT FOUND ON THE PERFFERED LIST
Hospice care is intended
Terminally ill
which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial information?
The Fair Credit Act Reporting
The annual Contribution limit of a dependent care flexible spending account is set by
The IRS
NOT covered by under PLAN A in a MEDIGAP insurance
The Medicare Part A deductible
Whose responsibility is it to determine that all the questions on an insurance application are answered?
The agent
Which of the following is true about the requirement regarding HIV exams?
The applicant must give prior informed written consent
Which statement accurately describes group disability income insurance?
The extent of benefits is determined by the insureds income
Which statement is not true regarding underwriting group health insurance?
The group is assed individually for insurability
NOT TRUE about qualifications for Social Security disability benefits?
The individual must be at least 65 years old
The following situtation would Social Security Disability Benefits NOT cease
The individual son gets a part time job to help support the family
In order for an insured under Medicare part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met?
The insured must have been in the hospital for 3 consecutive days
Which of the following definition would make it easier to quality for total disability benefits?
The more liberal "own occupation"
Hospital indemnity/hospital confinement intimately policy will provide payments based on
The number of days confined to a hospital
Whish of the following is true regarding optional benefits with long-term care polices
They are available for additional premium
NOT CORRECT about Medicare supplement policies
They cover the cost of extended nursing home care
A characteristic that DOES NOT describe managed care:
Unlimited access to providers
When may an insured deduct unreimbursed medical expenses paid under a long-term care policy?
When the expense exceed a certain percentage of the insureds adjusted gross income
What are the most common variations in a Long Term Care policy?
number of days in confinement, home health visits, The amount paid for nursing home care
What is the entire contract in health insurance underwriting?
the application and the policy issued
in comparison to consumer reports, which of the following describes a unique characteristic of the investigative consumer reports?
the costumers associates, friends, and neighbors provide the reports data
If a person is disabled at age 27 and meets Social Security's definition of total disability, how many work credits must he/she have earned to receive benefits?
12 credits
If an employee has been continuously insured under a group health policy for at least 3 months prior to termination, the employee will be entitled to how many months of coverage (maximum)
18 months
Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days?
20
Following an injury, a policyowner covered by Medicare part A & B was treated by her physician on an outpatient basis. How much of her doctors bill will she have to pay out of pocket?
20% of covered charges above the deductible.
A medicare Supplement policy must have a free-look period of at least?
30 Days
Within how many days must an insured notify the insurer of a child's birth and pay any required fees?
31 days
The classification Small Employer means any person actively engaged in a business that on at least 50% of its working days during the preceding year employed no more than how many eligible employees?
50
Individual who itemize deductions can claim deductions for medical expenses not covered by health insurance that exceed what percentage of their gross adjusted income?
7.5%
All health insurance policies issued in this state must provide coverage for maternity services. How many hours of inpatient care must be provided to a mother after a delivery by caesarian section?
96 hours
In which Medicare supplements polices are the core benefits found?
ALL PLANS
Which of the following reports will provide the underwriter with the information about an insurance applicant's credit
Consumer Reports
All health insurance policies issued in this state must provide all the same benefits to adopted children Except
Coverage for children maybe excluded at the discretion of the insurer
A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as?
Critical Illness
In the definition of Social Security it DOES NOT INCLUDE:
Disability expected to last for at least 6 months
TRUE about occupational vs. nonoccupational coverage?
Disability insurance can be written as occupational or nonoccupational
Which of the following is considered a qualifying event under COBRA
Divorce
Who can provide skilled nursing care?
Doctor
The insurance policy, together with the policy application and any additional riders form is know as
Entire Contract
What benefits are provided by Medicare Part C?
Expanded benefits for a fee through private insurance programs such as HMO's or PPO's.
How many pints of blood will be paid for by Medicare Supplement core benefits?
First 3
What is the phase that begins after a new policy has been delivered?
Free Look
A Medicare Supplement Plan must have this renewal provision
Guaranteed Renewable
An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits?
Have accumulated 6 credit work hours in the past 3 years
Before an agent delivers a policy, the insurer makes a last-minute change to the policy. The agent informs the insured of this change, and he accepts it. In response, the agent must
Have the insured sign a statement acknowledge that he is aware of the change
Medicaid does not cover this benefit?
Income assistants for work-related injury
Regarding long-term care coverage, as the elimination period gets shorter, the premium
Increases
Underwriting a group health insurance plan that is paid for by the employer requires all of the following EXCEPT
Individual members of the group may select the level of benefits for their own coverage
The Patient Protection and Affordable Cares Act includes all of the following EXCEPT
Individual tax deduction and premiums paid
IS CORRECT pertaining toward Medicare PART A
Individual who have ALS automatically qualify for Medicare A, regardless of age
The Medical Information Bureau (MIB) was created to protect
Insurance companies from adverse selection by high risk persons
A TRUE STATEMENT regarding medicare supplement insurance:
It CANNOT duplicate benefits provided by medicare
What is not a benefit of a POS plan?
It allows guaranteed acceptance of all applicants.
NOT TRUE about Medicaid
It consist of 3 parts hospitalization, doctors, services, disability income
Which of the following best describes MIB?
It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance.
Is INCORRECT about PART B
It is fully funded by Social Security Taxes (FICA)
Which of of the following statements is NOT true regarding the COBRA Act of 1985?
It requires all employees, regardless of the number or age of employees to provide extended group health coverage
Under workers compensation, which of the following benefits are NOT included?
Legal benefits
How many consecutive months of coverage (other than in acute care unit of a hospital) must LTC insurance provide in this state?
12
S is a sole business proprietor who owns a medical expense plan. What percentage of the cost of the plan may he deduct?
100%
Company C is developing its own advertising script to be used on their radio advertising campaign for their LTC policies. which of the following or phrases would be allowed?
"Benefits paid directly to you"
A brain surgeon has an accident and develops tremors on her right arm. which of the following income policy definition of a total disability will cover for all of her losses
"Own Occupation"- less restrictive than other definitions
A noncontributory group disability income plan has a 30 day elimination period and offers benefits of $2,000 a month. if an employee is unable to work for 7 months due to a coved disability, the employee with receive
$12,000 all oof which is taxable
The sole proprietor of a business makes a total salary of $50,000 a year. this year, his medical expense have reached a total of $75,000
$50,000
In all health care plans under the Affordable Care Act (ACA), how many essential benefit categories are there?
10
An individual is approaching retirement age and is concerned about having the proper coverage should he have been placed in a Long-Term Care Facility. His agent told him that LTC polices would be provide nessary coverage at all of following levels EXCEPT:
Acute
At what age do individuals quality for Medicare?
Age 65
A 63 year old man is planning to be employed until the age of 68. When will he be eligible for medicare?
Age 65, regardless of his employment status
In reference to the standard Medicare supplement benefits plan, what does the term standard mean?
All providers will have the same coverage options and
In a replacement situation, all of the following must be considered EXCEPT
Assets
To comply with the Fair Credit Reporting Act, when must a producer notify an applicant that a credit report may be requested?
At the time of the application
An insurance contract must contain all of the following to be considered legally blinding EXCEPT
Beneficiary Consent
An insurance contract must contain all of the following to be considered legally blinding EXCEPT?
Beneficiary Consent
How is PART B MEDICARE funded?
By monthly premiums and from the general revenues of the federal government
The proposed insured makes the premium payment on a new insurance policy. if the insured should die, the insurer will pay the death benefit to the beneficiary if the policy is approved. This is an example of what kind of contract?
Conditional
Because an insurance policy is a legal contract, it must conform to the state laws governing contracts which require all of the following elements EXCEPT
Conditions
