Health Quiz Questions/Answers
A guaranteed renewable disability insurance policy: a. is renewable at the insured's option to a specified age. b. is renewable at the option of the insurer to a specified age of the insured. c. is guaranteed to have a level premium for the life of the policy. d. cannot be cancelled before age 65.
A
According to the prohibited policy provision, all of the following are usually excluded in health insurance policies EXCEPT: a. accidents b. mental or emotional disorders c. suicide d. war
A
All of the following are tr4ue of the Key person disability income policy EXCEPT: a. benefits are considered taxable income to business. b. premiums are not deductible to the business. c. it is typically written to protect the company in the event a key employee becomes disabled and is unable to work. d. the income may be used to find a replacement for the key employee.
A
All of the following statements about Medicare Part B are correct EXCEPT: a. it is a compulsory program. b. it covers services and supplies not covered by Part A. c. it is financed by monthly premium d. it is financed by tax returns.
A
All of the following statements about Medicare supplement insurance policies are correct EXCEPT: a. they cover the cost of extended nursing home care. b. they cover medicare deductibles and copayments. c. they supplement Medicare benefits. d. they are issued by private insureres.
A
An insured has endured multiple surgeries and hospitalizations for an illness during the summer months. Her insurer no longer bills her for medical expenses. What term best describes the condition she has met? a. Stop-loss limit b. out-of-pocket limit c. maximum loss threshold. d. maximum loss.
A
An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the Policy? a. The insured is in an accident and incurs a large claim. b. the insured does not pay the premium. c. the insured reaches the maximum age limit specified in the policy. d. within 2 years of the application, the insurer discovers a misrepresentation.
A
Following an injury, a policy owner covered under Medicare Parts A and B was treated by her physician on an outpatient basis. How much of her doctor's bill will she be required to pay out-of-pocket? a. 20% of covered charges above the deductible. b. 80% of covered charges above the deductible. c. all reasonable charges above the deductible according to Medicare standards. d. A per office visit deductible.
A
For how many days of skilled nursing facility care will Medicare pay benefits? a. 100 b. 30 c. 60 d. 90
A
If one takes Social Security retirement benefits at age 62, what needs to be done at age 65 to qualify for medicare? a. Nothing b. Apply for coverage through the state. c. appear for a physical at the Social Security office. d. apply at a local social security office.
A
In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party? a. insurer to the insured. b. insured to the insurer. c. insurer to the department of insurance. d. insured to the department of insurance.
A
Once the person meets the stringent requirements for disability benefits under social security, how long is the waiting period before any benefits will be paid? a. 5 months. b. 12 months. c. benefits will be paid immediately. d. 90 days.
A
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following? a. parts A and B of Medicare. b. all four parts of medicare. c. any private insurance policy. d. only part A of medicare.
A
The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called: a. nonoccupational coverage. b. unemployment coverage. c. occupational coverage. d. workers compensation.
A
The probationary period is: a. a specified period of time that a person joining a group has to wait before becoming eligible for coverage. b. the number of days the insured has to determine if he/she will accept the policy as received. c. the stated amount of time when benefits may be reduced under certain conditions. d. the number of days that must expire after the onset of an inllness before benefits will be earned.
A
The transfer of an insured's right to seek damages from a negligent party to the insurer is found in which of the following clauses? a. subrogation b. arbitration c. salvage d. appraisal
A
Under the mandatory uniform Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain: a. a statement that is sufficiently clear to identify the insured and the nature of the claim. b. a statement from the insured's employer showing that the insured was unable to work. c. an estimate of the total amount of medical and hospital expense for the loss. d. a complete physician's statement.
A
When John fills out his Medicare application, he intentionally omits his long-standing history of heart disease. Which of the following is most likely to happen? a. His policy will be cancelled b. his benefits will be reduced c. hear diseases losses will not be paid. d. nothing, as long as the insurer does not note the misrepresentation after two years from the effective policy date. Otherwise, his coverage will be cancelled.
A
When a disabled dependent child reaches the age limit for coverage, how long does the policy owner have to provide proof of dependency in order for the dependent to remain covered under the policy? a. 31 days. b. 60 days c. 10 days d. 15 days
A
Which health insurance provision describes the insured's right to cancel coverage? a. renewal provision b. policy duration provision. c. insuring clause. d. cancelation provision.
A
Which of the following must be present in all Medicare supplement plans? a. plan A b. foreign travel provisions. c. outpatient drugs. d. plan C coinsurance.
A
Which of the following riders would NOT increase the premium for a policyowner? a. impairment rider. b. payor benefit rider. c. waiver of premium rider. d. multiple indemnity rider
A
Which of the following statements about occupational vs. nonoccupational coverage is TRUE? a. disability insurance can be written as occupational or nonoccupational. b. group medical expense policies and individual medical expense policies always cover both occupational and nonoccupational injuries. c. individual disability policies never cover nonoccupational injuries. d. Only group disability income policies can be written on an occupational basis.
A
Which of the following statements is correct concerning taxation of long-term care insurance? a. excessive benefits may be taxable. b. benefits may be taxable as ordinary income. c. premiums may be taxable as income. d. premiums are not deductible in any case.
A
Which of the followingg statements pertaining to Medicare Part A is correct? a. Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age 65. b. for the first 90 days of hospitalization, Medicare Part A pays 100% of all covered services, except for the initial deductible. c. individuals with ESRD do not qualify for Part A. d. Each individual covered by Medicare Part A is allowed one 90- day benefit period per year.
A
Which provision states that the insurance company must pay medical expense claims immediately? a. Time of payment of claims. b. payment of claims. c. legal actions. d. relation of earnings to insurance.
A
Which type of care is NOT covered by Medicare? a. long-term care b. hospice c. respite d. hospital
A
While a claim is pending, an insurance company may require: a. an independent examination as often as reasonably required. b. the insured to be examined only within the first 30 days. c. the insured to be examined only once annually. d. an independent examination only once every 45 days.
A
A husband and wife both incur expenses that are attributed to a single major medical insurance deductible. Which type of policy do they have? a. Mutual. b. family. c. combined. d. joint.
B
A man works for Company A and his wife works for company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim: a. both plans will pay the full amount of the claim. b. the insurance through his company is primary. c. the insurance through his wife's company is primary. d. the insurance plans will split the coverage evenly.
B
A waiver of premium provision may be included with which kind of health insurance policy? a. dread disease b. disability income. c. basic medical. d. hospital indemnity.
B
All of the following are covered by Part A of Medicare EXCEPT: a. home health services. b. physician's and surgeon's services. c. in-patient hospital services. d. Post-hospital nursing care.
B
Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability? a. income replacement. b. residual disability c. recurrent disability. d. partial disability
B
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? a. 3 b. 20 c. 100 d. 80
B
How long is an open enrollment period for medicare supplement policies? a. 90 days b. 6 months c. 1 year d. 30 days
B
In a group health policy, a probationary period is intended for people: a. who want lower premiums. b. who joined the group after the effective date. c. who had a pre-existing condition at the time they joined the group. d. who have additional coverage through a spouse.
B
In which Medicare supplemental policies are the core benefits found? a. plans A-D only b. All plans c. Plans A and B only d. Plan A only
B
Insurers may change which of the following on a guaranteed renewable health insurance policy? a. no changes are permitted. b. rates by class c. coverage. d. individual rates
B
Medicare Part D provides: a. private fee-for-service plans. b. prescription drug benefit. c. hospital insurance. d. medical insurance.
B
Paula applied for a Medicare Supplement policy 1 month before her 65th birthday. The policy was issued on her birthday, Jan. 31, 1998. Her producer mailed the policy by certified mail, and paula received the policy on Feb. 5, 1998. How long does Paula have to examine the policy and decide whether or not to keep the policy? a. 30 days from the date of the application. b. 30 days from the date it was received. c. 30 days from the date it was issued. d. 10 days from the date it was received.
B
The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as: a. Part D b. Part A c. Part B d. Part C
B
What is the purpose of coinsurance provisions? a. to share liability among different insurance companies. b. to help the insurance company to prevent overutilization of the policy. c. to have the insured pay premiums to more than one company. d. to ensure payment to the doctors and hospitals.
B
When an insurer combines two periods of disability into one, the insured must have suffered a: a. presumptive disability b. recurrent disability c. partial disability d. residual disability
B
Which of the following applies to partial disability benefits? a. benefits are reduced once an insured is no longer under a doctor's care. b. payment is limited to a certain period of time. c. an insured is entitled to a principal sum benefit for the partial loss of a limb. d. payment is based on termination of employment.
B
Which of the following entities has the authority to make changes to an insurance policy? a. producer. b. insurer's executive order. c. department of insurance. d. broker
B
Which of the following is NOT true regarding Workers Compensation? a. benefits are regulated by the state government. b. benefits are offered by the insurer. c. benefits are not regulated by the federal government. d. benefits vary from state to state.
B
Which of the following is correct regarding the taxation of group medical expense premiums and benefits? a. premiums are tax deductible and benefits are taxed. b. premiums are tax deductible and benefits are not taxed. c. premiums are not tax deductible and benefits are taxed. d. premiums are not tax deductible and benefits are not taxed.
B
Which of the following statements is NOT correct? a. medicare Part B provides physician services. b. medicare advantage must be provided through HMO's c. Medicare Advantage may include prescription drug coverage at no cost. d. Medicare Part A provides hospital care.
B
Which of the following statements is NOT correct? a. medicare part B provides physician services. b. medicare advantage must be provided through HMOs. c. medicare advantage may include prescription drug coverage at no cost. d. medicare part A provides hospital care.
B
Within how many days may a person who is being examined by the Director for nonfinancial business practices request a hearing after receiving the examination report? a. 3 days b. 10 days c. 15 days d. 30 days
B
A Medicare SELECT policy does all of the following EXCEPT: a. provide payment for full coverage under the policy for covered services not available through network providers. b. provide for continuation of coverage in the event that Medicare SELECT policies are discontinued due to the failure of the Medicare SELECT program. c. Prohibit payment for regularly covered services if provided by non-network providers. d. Make full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare SELECT policy to each applicant.
C
All of the following statements concerning workers compensation are correct EXCEPT: a. all states have workers compensation. b. benefits include medical, disability income, and rehabilitation coverage. c. a worker receives benefits only if the work related injury was not his/her fault. d. workers compensation laws are established by each state.
C
An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do? a. look at the applicant's medical history to decide what premium to charge. b. send the applicant to a doctor for a physical. Nothing can happen until they get the results. c. Offer the supplement policy on a guaranteed issue basis. d. Exclude pre-existing conditions from coverage under the supplement policies.
C
An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. This results in a long hospitalization period. Which of the following is true? a. the group plan will pay a portion of the employee's expenses. b. the group plan will pay depending on the employee's recovery. c. the group plan will not pay because the employee was injured at work. d. the group plan will pay.
C
An individual is insured under his employer's group Disability Income policy. The insured suffered an accident while on vacation that left him unable to work for 4 months. If the disability income policy pays the benefit, which of the following would be true? a. for the business, payments are not considered tax deductible as an ordinary business expense. b. the insured can deduct his medical expense benefits from his income tax. c. benefits that are attributable to employer contributions are fully taxable to the employee as income. d. the insured has to wait 2 more months to start receiving the benefits.
C
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? a. have accumulated 40 work credits. b. have reached the age of 25. c. have accumulated 6 work credits in the past 3 years. d. have accumulated 20 work credits in the past 10 years.
C
An insured covered by a partially contributory group disability income plan that pays benefits of $4,000 a month. If the insured pays 25% of the monthly premium, how much of the monthly benefit would be taxable? a. none b. $1,000 c. $3,000 d. $4,000
C
An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own? a. medicare supplement. b. medicare advantage. c. medicare select. d. Medicare part A
C
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? a. 6 credits b. 40 credits c. 12 credits. d. 20 credits.
C
If an insured is receiving a transplant, which of the following must the insured do for a live donor? a. offer a free policy b. nothing c. provide coverage d. provide monetary compensation.
C
In which of the following situations would social security disability benefits NOT cease? a. the individual dies. b. the individual has undergone therapy and is no longer disabled. c. the individual's son gets a part-time job to help support the family. d. the individual reaches age 65.
C
Individuals who itemize deductions can claim deductions for medical expenses not covered by health insurance that exceed what percent of their adjusted gross income? a. 5% b. 7% c. 10% d. 15%
C
Medicaid provides all of the following benefits EXCEPT: a. eyeglasses b. family planning services. c. income assistance for work-related injury. d. home health care services.
C
The mode of premium payment: a. is the method used to compute the cash surrender value of the policy. b. does not affect the amount of premium paid. c. is defined as the frequency and the amount of the premium payment. d. is the factor that determines the amount of dividends.
C
The part of Medicare that helps pay for inpatient hospital care, inpatient care in skilled nursing facility, home health care and hospice care, is known as: a. part C b. Part D c. Part A d. part B
C
The sole proprietor of a business makes a total salary of $50,000 a year. This year, his medical expenses have reached a total of $75,000. What amount may the sole proprietor deduct in regards to his medical expenses? a. $10,000 b. $25,000 c. $50,000 d. $75,000
C
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in: a. medicare parts A and C b. medicare part D c. medicare part A d. medicare part B and C
C
Under what condition are group disability income benefits received by an employee NOT taxable as income? a. when the employee is 59 1/2 b. when the amount of the benefit is equal or less than the amount of contributed by the employer. c. when the benefits received are equal or less than the employee's percentage of the contribution. d. when the employer makes all the premium payments.
C
Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer? a. dental expense b. basic medical expense c. disability income d. major medical
C
When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent that she was 30 years old, when in fact, she was 37. If the policy contains the optional misstatement of age provision: a. the elimination period will be extended 6 months for each year of age missstatement. b. because the misstatement occurred more than 2 years ago, it has no effect. c. amounts payable under the policy will reflect the insured's correct age. d. the contract will be deemed void because of the misstatement of age.
C
Which characteristic does NOT describe managed care? a. shared risk. b. preventative care c. unlimited access to providers. d. high-quality care.
C
Which of the following are the main factors taken into account when calculating residual disability benefits? a. Employee's full-time status and length of disability. b. Present earnings and standard cost of living. c. Present earnings and earnings prior to disability. d. earnings prior to disability and the length of disability.
C
Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policy owner? a. entire contract clause. b. proof of loss c. payment of claims d. change of beneficiary.
C
Which of the following statements concerning Medicare Part B is correct? a. it pays on a first dollar basis. b . it pays 100% of medicare's standards for reasonable charges. c. it pays for physician services, diagnostic tests, and physical therapy. d. it is provided automatically to anyone who qualifies for Part A.
C
Which of the following statements is NOT true concerning Medicaid? a. it is funded by state and federal taxes. b. it is intended to provide medical assistance for certain categories of people who are needy. c. it consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income. d. it is a state program.
C
Worker's compensation insurance covers a worker's medical expenses resulting from work related sickness or injuries and covers loss of income from: a. Plant or office closings b. temporary job layoffs. c. work-related disabilities. d. job termination.
C
all of the following qualify for medicare Part A EXCEPT: a. anyone who is at the end stage of renal disease. b. anyone who is over 65, not covered by Social Security, and is willing to pay premium. c. anyone who is willing to pay a premium. d. anyone that qualifies through Social Security.
C
which of the following entities keeps a file of all of an insurer's advertisements? a. director b. state government c. the insurer d. state insurance board.
C
A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as: a. relative-value schedule. b. benefit schedule. c. gatekeepers. d. usual, customary and reasonable.
D
According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT: a. the insurer must provide the insured a written notice of the cancellation. b. claims incurred before cancellation must be honored. c. an insurance company may cancel the policy at any time. d. unearned premii
D
An insurance agent proposed an individual health policy that is guaranteed renewable. If the applicant accepts this policy, the insurer agrees that: a. the company will change the premium rate based upon the insured's health only. b. the premium rate cannot be changed for any reason. c. the insured will always be able to pay the premiums. d. the company will continue to renew the policy until the insured has reached age 65.
D
Hospice care is intended for: a. people in need of acute care. b. home health visits from a participating home health agency. c. the caregiver. d. the terminally ill.
D
If an employee has been previously covered under a prior group policy immediately prior to joining a new group, how many months of creditable service must the employee have for there to be no applicable pre-existing conditions under the new path? a. 18 months b. 24 months c. 6 months d. 12 months
D
In an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received? a. policy tax b. federal income tax c. state income tax. d. no tax
D
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? a. the insured must have a medicare supplement insurance policy. b. there is no benefit provided under medicare part A for skilled nursing care. c. the insured must cover daily copayments. d. the insured must have first been hospitalized for 3 consecutive days.
D
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean? a. coverage options and conditions comply with the law, but will vary from provider to provider. b. all plans must include basic benefits A-N. c. coverage options and conditions are developed for average individuals. d. all providers will have the same coverage options and conditions for each plan.
D
Regarding Medicare SELECT policies, what are restricted network provisions? a. they determine who can be insured. b. they determine premium rates. c. they help avoid adverse selection. d. they condition the payment of benefits.
D
S is a sole proprietor who owns a medical expense plan. What percentage of the cost of the plan may he deduct? a. 25% b. 50% c. 75% d. 100%
D
The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as: a. time limit on certain defenses. b. payment of claims. c. proof of loss d. legal actions.
D
Which of the following applies to partial disability benefits? a. an insured is entitled to a principal sum benefit for the partial loss of a limb. b. payment is based on termination of employment. c. benefits are reduced once an insured is no longer under a doctor's care. d. payment is limited to a certain period of time.
D
Which of the following is NOT a factor in determining qualifications for Social Security disability benefits. a. worker's PIA b. worker's age. c. number of work credits earned. d. worker's occupation.
D
Which of the following programs expands individual public assistance programs for people with insufficient income and resources? a. medicare. b. social security. c. unemployment compensation. d. medicaid.
D
Which of the following statements is INCORRECT concerning Medicare Part B coverage? a. participants under part B are responsible for an annual deductible. b. Part B will pay 80% of covered expenses, subject to Medicare's standards for reasonable charges. c. it is a voluntary program designed to provide supplementary medical insurance to cover physician services, medical services and supplies not covered under Part A. d. Part B coverage is provided free of charge when an individual turns age 65.
D
Which of the following statements is correct? a. medicare advantage is medicare provided by an approved Health Maintenance Organization only. b. HMO's do not pay for services covered by Medicare. c. All HMOs and PPOs charge premiums beyond what is paid by Medicare. d. HMOs may pay for services not covered by Medicare.
D
Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals, EXCEPT in emergency situations? a. medicare advantage. b. medicare part A c. preferred. d. Medicare Select.
D
Workers Compensation benefits are regulated by which entity? a. employer b. insurer c. federal government. d. state government.
D
which of the following statements is true regarding coinsurance? a. the larger the percentage that is paid by the insured, the higher the required premium will be. b. The smaller the percentage that is paid by the insured, the lower the required premium will be. c. the smaller the percentage that is paid by the insured, the more consistent the required premium will be. d. the larger the percentage that is paid by the insured, the lower the required premium will be.
D
