Unit 12 - Introduction to Health Insurance
Which of the following fails under the definition fo a limited policy?
A PRESCRIPTION DRUG PLAN Prescription drug policies may be sold as supplements to individual policies or as stand-alone limited plans. LTC insurance covers a broad range of expenses involving long-term care. AD&D insurance generally also covers numerous perils related to accidental injury. A flat-benefit DI plan pays a fixed benefit for disabling accidents and injuries.
Carson is a driller on an oil rig. While coverage through his group plan is adequate, he wants an inexpensive way to continue at least some of his income and possibly pick up some of the expenses his group plan may not cover in the even the is injured. Which of the following policies would best meet his objectives?
ACCIDENT-ONLY INSURANCE The most cost-effective way for Carson to obtain the coverage he is looking for is through accident-only insurance, a limited policy that indemnifies only for injuries resulting from accidental causes. Under these types of policies, benefits may be paid for any combination of the following: death, disability, dismemberment, and hospital and medical expenses.
All of the following statements regarding a hospital indemnity plan are correct EXCEPT
ANOTHER NAME FOR THE PLAN IS A HOSPITAL EXPENSE PLAN The other name for a hospital indemnity plan is a hospital income plan. The benefits may be used any way the insured sees fit; how3ever, it is not designed to reimburse the insured for the expense of being in the hospital.
Blanket health insurance is a type of
GROUP ACCIDENT INSURANCE Blanket health insurance is a form of group accident insurance that covers accidents only under very specific conditions. Generally, these insurance policies are limited to cover passengers on a common carrier such as an airplane or train, employees at a social function such as a company picnic, members of a school's athletic team, summer camp attendees, and volunteer firefighters while on duty.
Lisa's private dental expense plan might deny a portion fo her claim for all the following reasons EXCEPT
HER CARE WAS DIAGNOSTIC Under many dental expense plans, diagnostic care is covered. A portion of claims may be denied, however, fi Lisa does not follow the predetermination (prior authorization) requirements. Also, most policies exclude costs for replacement of lost dentures.
Which of the following is the most valid reason for a person to purchase a specified (dread) disease health insurance policy?
HER FAMILY HAS A HISTORY OF CANCER, AND SHE IS CONCERNED THAT SHE MIGHT CONTRACT THE DISEASE Dread disease policies provide benefits only if the insured contracts the specific disease listed in the policy. It does not provide comprehensive coverage, nor does it cover multiple diseases. A person cannot obtain coverage if she has already been diagnosed with the disease.
Which of the following statements is CORRECT?
HOSPITAL AND MEDICAL EXPENSE COVERAGE HELSP PAY DOCTOR AND HOSPITAL BILLS. Disability income insurance pays a periodic benefit to the insured as a supplement to his salary when he is disabled and unable to work because of sickness or an accident. Medical expense insurance reimburses the insured for actual expenses incurred for medical and hospital care and related services. Long-term care insurance provides benefits to cover care for an extended period of time, usually in a nursing home, in an adult care center, or at home.
Which of the following statements concerning credit accident and health insurance is CORRECT?
IT CAN BE PURCHASED BY A DEBTOR TO COVER PAYMENTS DUE ON A SPECIFIC LOAN WHILE THE DEBTOR IS DISABLED Credit accident and health insurance coverage covers a debtor, with the creditor receiving the benefits to pay off the debt if the debtor becomes disabled. It can be sold as an individual policy covering a single debtor or on a group basis to cover more than 1 debtor. Credit accident and health insurance coverage ensures that the borrower (debtor) will cover payments due on a specific loan or other credit transaction while the borrower is disabled.
Debbie is concerned that her health insurance coverage is inadequate. Which of the following is the best reason for her to purchase an indemnity-type medical expense policy?
IT WILL PAY A SPECIFIED PER-DAY BENEFIT Indemnity-type medical expense policies pay a flat, per-day benefit for each day the insured is hospitalized This will help Debbie meet the expenses of her confinement that are not covered.
Debbie is concerned that her health insurance coverage is inadequate. Which of the following is the best reason for her to purchase an indemnity-type medical expense policy?
IT WILL PAY A SPECIFIED PER-DAY BENEFIT. Indemnity-type medical expense policies pay a flat, per-day benefit for each day the insured is hospitalized. This will help Debbie meet the expenses of her confinement that are not covered.
Which of the following is NOT a basic form of health insurance coverage?
LIMITED-PAY HEALTH Three distinct categories of basic health coverage exist: medical expense, disability income, and accident-only.
Which of the following is NOT a basic form of health insurance coverage?
LIMTED-PAY HEALTH Three distinct categories of basic health coverage exist: medical expense, disability income, and accident-only.
A health insurance plan may pay benefits for all the following EXCEPT
OVER-THE-COUNTER DRUGS Generally, nonprescription medicines are not covered by health insurance.
Which of the following is NOT a common health insurance exclusion?
PLASTIC SURGERY TO REPAIR SCAR TISSUE Elective cosmetic surgery, injuries covered by workers' compensation, and injuries sustained int eh process of committing a felony are all excluded in health insurance.
Credit health insurance
PROVIDES PAYMENTS ON LOANS THAT BECOME DUE WHILE THE DEBTOR IS DISABLED Credit health insurance and credit life insurance cover debtors of a creditor in connection with a specific loan or other credit transaction. Credit health insurance provides payments on loans that become due while the debtor is disabled, while credit life insurance covers the life of a debtor.
All of the following types of health insurance coverage can be written on an individual basis EXCEPT
SOCIAL SECURITY Disability income, medical expense, and AD&D insurance can all be written on an individual basis. Social Security is a federally administered program that provides retirement, death, and disability benefits for qualified workers.
In which of the following situations would an accidental death and dismemberment (AD&D) policy most likely NOT pay a benefit?
THE INSURED INURES A FINGER WHILE USING A CHAINSAW IN HIS WORKSHOP AD&D policies would not pay a benefit for the injury of a single finger. However, some policies may pay a reduced benefit fo rat loss of 1 limb.
Which o 4th following situations involves a loss that would typically NOT be excluded under a health insurance policy?
THE INSURED IS INJURED WHILE VACATIONING IN A STATE THA TIS NOT HER STATE OF RESIDENCE. Most health insurance policies typically exclude losses due to war and acts of war, self-inflicted injuries, military service, and overseas residence. Being injured while vacationing in a state other than one's state of residence is not something that would be excluded.
Which of the following is the best reason to purchase a vision care policy?
TO SUPPLMENT EXISTING MAJOR MEDICAL COVERAGE Vision care coverage is generally not included in major medical policies. While it pays for routine vision care, it does not pay for surgery. It pays either a scheduled benefit amount or a percentage of reasonable and customary charges; it generally does not cover 100% of costs.
Limited plans are characterized by all of the following EXCEPT
VERY BORAD OR OPEN PERILS Limited plans are characterized by limited perils, limited benefits, and notice to the insured of the limited nature of the coverage.
Benefits paid for customary charges incurred during an examination by a n ophthalmologist or optometrist are included in
VISON CARE INSURANCE Vision care coverage, normally found in a group health insurance policy, usually pays for reasonable and customary charges incurred during eye examinations by ophthalmologists and optometrists.
