XCEL Chapter 11

According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied? A. There have been too many claims in the previous year B. The size of the group has increased by more than 10% C. Participation or contribution rules have been violated D. Participation or contribution rules have been changed

Participation or contribution rules have been violated

Which of the following would evidence ownership in a participating health insurance contract? A. Stock ownership B. Irrevocable beneficiary status C. Policy ownership D. Collateral assignment

Policy ownership

Coordination of Benefits regulation applies to all of the following plans EXCEPT? A. Group vision plan B. Preferred Provider Organization plan C. Self-funded group health plan D. Group health plan

Preferred Provider Organization plan

When are group disability benefits considered to be tax-free to the insured? A. When the recipient pays the premiums B. When the employer pays the premiums C. When both the employer and recipient pay the premiums D. When benefits paid are equal to or lower than the recipient's salary

When the recipient pays the premiums

The purpose of the Coordination of Benefits provision in group accident and health plans is to? A. avoid overpayment of claims B. reduce out-of-pocket costs C. reduce adverse selection D. lower the cost of premiums

avoid overpayment of claims

Susan is insured through her Group Health Insurance plan and changed her coverage to an individual plan with the same insurer after her employment was terminated. This change is called a(n) A. crossover B. conversion C. exchange D. extension of benefits

conversion

A group Disability Income plan that pays tax-free benefits to covered employees is considered? A. non-contributory B. partially contributory C. group contributory D. fully contributory

fully contributory

According to HIPAA, when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual? A. is eligible for coverage upon hire B. must wait 360 days to be eligible for coverage C. must continue coverage with the previous employer D. is eligible for only health insurance, not life or dental insurance

is eligible for coverage upon hire

The election of COBRA for continuation of health coverage will? A. increase the coverage and lower premium B. maintain the same coverage and increase premium C. increase out-of-pocket costs and lower premium D. decrease out-of-pocket costs and maintain same premium

maintain the same coverage and increase premium

Health insurance involves two perils, accident and ____. A. death B. sickness C. disability D. liability

sickness

An insurer has the right to recover payment made to the insured from the negligent party. These rights are called? A. contributory B. indemnity C. estoppel D. subrogation

subrogation

Continued coverage under COBRA would be provided to a(n) A. former dependent of employee no longer of dependent status B. terminated employee C. divorced spouse of employee D. employee reaching full retirement

terminated employee

Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of? A. costs that exceed 7 1/2 % of AGI B. costs that exceed 10% of AGI C. 100% of costs D. no deduction permitted

100% of costs

How many employees must an employer have for a terminated employee to be eligible for COBRA? A. 20 B. 30 C. 40 D. 50

20

Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his pre-existing health condition applies, Ron cannot have more than a ___ day gap without previous health insurance. A. 45 B. 63 C. 75 D. 90

63

Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental? A. Presumptive disability provision B. Absolute accidental provision C. Accidental death benefit provision D. Accidental bodily injury provision

Accidental bodily injury provision

The policyholder for a group health benefit plan is considered to be the A. Employee B. Employer C. Liaison D. Insurer

Employer

Which of the following would be considered a possible applicant and contract policyholder for group health benefits? A. Human resource department B. Employer C. Insured employee D. Insurance company

Employer

A master contract and certificate of coverage can be found in which type of policy? A. Long-term B. Medicaid C. Group D. Medicare

Group

What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do? A. In the event of employment termination, group health insurance can be kept if the employee pays the premiums B. Receive a tax credit to help offset the cost of health insurance C. Remain on their current coverage for 30 months D. In the event of employment termination, group health insurance can be kept if the employer pays the premiums

In the event of employment termination, group health insurance can be kept if the employee pays the premiums

Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA? A. It would be considered taxable income to the employee B. The employee would not be allowed to an HSA C. The employer would pay payroll tax and FICA on the contribution amount D. The employer would not be allowed to deduct the contribution from the employee's pay

It would be considered taxable income to the employee

What is the contract called that is issued to an employer for a Group Medical Insurance plan? A. Master policy B. Certificate of coverage C. Provisional policy D. Document of coverage

Master policy

Sonya applied for a health insurance policy on April 1. Her agent submitted the information to the insurance company on April 6. She paid the premium on May 15 with the policy indicating the effective date being May 30. On which date would Sonya have coverage? A. April 1 B. April 6 C. May 15 D. May 30

May 30

Which of the following is typically NOT eligible for coverage in a group health policy? A. Full-time employee B. Temporary employee C. Business owner D. Partner in a partnership

Temporary employee

Under the subrogation clause, legal action can be taken by the insurer against the? A. responsible third party B. beneficiary C. policyowner D. State

responsible third party

A common exclusion with Vision plans is A. eyeglass frames B. the examination C. contact lenses D. lasik surgery

lasik surgery

Which of the following does Coordination of Benefits allow? A. Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid B. Allows both a group health plan and individual health plan to coordinate their benefit payments C. Allows the deductible to be spread out between all the health providers D. Allows each health provider to pay 100% of the claim

Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid

Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled? A. Disability overhead policy B. Business continuation policy C. Disability buy-sell policy D. Business overhead expense policy

Business overhead expense policy

Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the A. employee's benefits still owed can be claimed B. employee cannot be excluded from the new employer's health plan C. employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan D. new health insurance carrier will have a clear record of any chronic conditions that exist

employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan

Credit Accident and Health plans are designed to? A. permit creditors the ability to require that coverage be purchased through insurers of their choice B. provide permanent protection C. help pay off existing loans during periods of disability D. not permit free choice of coverage selection

help pay off existing loans during periods of disability