Health Simulate Exam

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?

$50,000

which statement best defines a multiple employer welfare arrangement (MEWA)

A joining together by employers to provide health benefits for employee

a 63 year old man is planning to be employed until the age 68 when will he be eligible for medicare?

Age 65, regardless of his employment status

what documentation grants express authority to an agent

Agent's contract with the principal

An insured is the recipient of an Accidental Death and Dismemberment (AD&D) policy purchased by his employer. The policy pays triple indemnity in case of accidental death. If the insured died as a result of an accident stipulated in the policy, how will the benefits paid be taxed?

Benefits received are considered income tax free.

A man is still employed at age 65 and is now eligible for Medicare. He wants to know what health insurance coverage he is eligible to receive. Which of the following options are available to him?

Both group health and Medicare

After a person's employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true?

By law, the new, individual policy must provide the same benefits as the group insurance policy.

When an insurer offers services like preadmission testing, second opinions regarding surgery, and preventative care, which term would best apply?

Case management provision

which of the following provisions must be included on the first page of a medicare supplement policy, which states the insurers right to change premium amounts?

Continuation Provision

group disability income insurance premiums paid by the employer are...

Deductible by the employer as an ordinary business expense

which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner?

Disability Buy-Sell

what type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?

Experience rating

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the

Insuring clause

in which of the following situations is it legal to limit coverage based on marital status?

It is never legal to limit coverage based on marital status

which of the following is true regarding a term health policy?

It is nonrenewable

in franchise insurance, premiums are usually

Lower than individual policies, but higher than group policies.

which of the following is NOT the purpose of HIPAA?

To provide immediate coverage to new employees who had been previously covered for 18 months

which of the following are characteristics of a successful self funded plan?

a. A group large enough to reasonably predict future loss experience b. A stop-loss contract to assume losses beyond the insured's retention c. A third party administrator who services claims **d. All of the above

if an insurance company wishes to order a consumer report on an applicant to assist in the underwriting process, and if a notice of insurance information practices has been provided, the report may contain all of the following information except the applicants

ancestry

how often must health insuring corporations, other than specialty health care insurers, provide current company information, providers list, methods of operation and other reports to its insured?

annually

on a major medical insurance policy, the amount that an insured must pay on a claim before the insurer will pay is known as...

deductible

If an insured worker has earned 40 quarters of coverage, the worker's status under Social Security disability is...

fully insured

Which of the following expenses is not covered by health insurance policy?

funeral

Regarding long-term care coverage, as the elimination period gets shorter, the premium...

gets higher

a health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective?

immediately

According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

60%

According to the telemarketing sales rules, what are the permissible calling hours for telemarketing calls?

8am until 9pm (Permissible calling hours for telemarketers are between 8am and 9pm.)

If an insurance company makes a statement that its policies are guaranteed by the existence of the Insurance Guaranty Association, that would be considered

An unfair trade practice.

what document describes an insureds medical history, including diagnoses and treatments?

Attending Physician's Statement

all of the following could be considered rebates if offered to an insured in the sale of insurance except

Dividends from a mutual insurer.

Which types of insurance companies marketing long-term care insurance coverage must establish procedures to assure that any comparison of policies by its agents will be fair and accurate?

Every company is required to establish marketing procedures.

a life insurance policy has a legal purpose if both of which of the following elements exist?

Insurable interest and consent

which of the following is incorrect concerning medicaid?

It is solely a federally administered program

all of the following statements describe a MEWA except

MEWAs are groups of at least 3 employers.

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?

Medicare SELECT

on a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are

Not taxable since the IRS treats them as a return of a portion of the premium paid

when an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called

Overinsurance

which of the following provisions is mandatory for health insurance policies?

Physical examination and autopsy

which of the following must be present in all medicare supplement plans?

Plan A

According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10%, what type of plan is that?

Platinum

a guaranteed renewable health insurance policy allows the...

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.

underwriting is a major consideration when an insured wishes to replace her current policy for all of the following reasons except

Premiums always stay the same

a long term care shoppers guide must be presented at what point?

Prior to the time of application

A medicare Select Policy does all of the following except

Prohibit payment for regularly covered services if provided by non-network providers

what method do insurers use to protect themselves against catastrophic losses?

Reinsurance

what provision can reduce the disability benefit based upon the insureds current income?

Relation of earnings to insurance

which of the following would an accident only policy not cover?

Surgery to repair a wrist damaged by tendonitis.

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?

The insured is in an accident and incurs a large claim

in terms of parties to a contract, which of the following does not describe a competent party?

The person must have at least completed secondary education.

how are employer contributions to health reimbursement accounts treated in regards to taxation?

They are tax deductible

in a replacement situation, all of the following must be considered except

assets

Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?

attending physician

The First Street Church plans to sponsor a summer camp for the youth of their congregation. They would like to purchase insurance that would pay benefits should one of the youth get injured while participating in the camp activities. The type of policy they would likely need is a/an

blanket

a children's group is planning a summer camp. what kinda of accident and health policy could cover all of the participants without requiring individual applications and identifying each of the children attending the camp?

blanket policy

Jason is insured under his employer's group health insurance. He splits the cost of the premiums with his employer. This is an example of

contributory plant

which of the following best describes an insurance company that has been formed under the laws of this state?

domestic

Under a typical health insurance policy, claims that result from injuries while the insured was intoxicated or under the influence of drugs are generally

excluded

The authority granted to an agent through the agent's contract is referred to as

express authority

which of the following coverages is not monitored by the employee retirement income security act (ERISA)?

golden parachutes

A new employee who meets HIPAA eligibility requirements must be issued health coverage on what basis?

guaranteed

in long term care (LTC) policies, as the benefit period lengthens, the premium...

increases

when compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is...

lower

Under most dental plans, what limitations are posed for denture replacement?

once every 5 years

Which renewability provision are you most likely to see on a travel accident policy?

period of time

which of the following occupations would have the lowest disability insurance premiums?

personal trainer

which of the following losses will be covered by a group medical expense policy?

pre-existing condition

Rose bought three policies from the same insurer. Her benefits have exceeded the maximum allowed by the insurer. Which of the following will happen?

pro rata benefit reduction

which of the following is not provided by an HIC?

reimbursement

which of the following insurers are owned by stockholders who have the usual rights of ownership, including the right of voting?

stock

which type of medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), except in emergency situations?

to select

in insurance policies, the insured is not legally bound to any particular action in the insurance contract, but the insurer is legally obligated to pay losses covered by the policy. what contract element does this describe?

unilateral

an employee is injured in a construction accident, rendering him unable to work for a year. which of the following plans would provide him with medical expense coverage and income assistance?

workers compensation