Chapter 9: Other Health Insurance Concepts
Under workers compensation, which of the following benefits are NOT included
Legal benefits
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 preventative care. What best describes the health system that the woman is using?
Managed care
Which of the following premium modes would result in the highest annual cost for an insurance policy
Monthly
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
Nonoccupational coverage
An insured has health insurance that covers them at work and at home. This policy was written on what basis
Occupational
A woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnant. Which of the following is true about coverage for pregnancy
Pregnancy will be covered immediately
Which of the following describes taxation of individual disability income insurance premiums and benefits
Premiums are not tax deductible, and benefits are not taxable
Which of the following is correct regarding the taxation of group medical expense premiums and benefits
Premiums are tax deductible and benefits are not taxed
Workers Compensation benefits are regulated by which entity
State government
The legal process that gives the insurer, after payment of a loss, the right to seek recovery from a third party that was responsible for the loss is known as
Subrogation
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,
The insurance through his company is primary
Which of the following statements regarding the Change of Beneficiaries Provision is false
The policyowner has the right to change beneficiaries in any case
Premiums paid by self-employed sole proprietors or partners for medical expense insurance are
Totally tax deductible
Under what condition are group disability income benefits received by an employee NOT taxable as income
When the benefits received are equal or less than the employee's percentage of the contribution
When may an insured deduct unreimbursed medical expenses paid under a long-term care policy?
When the expenses exceed a certain percentage of the insured's adjusted gross income
A brain surgeon has an accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for all losses
"Own occupation" - less restrictive than other definitions
An insured is 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
$3000
What percentage of individually-owned disability income benefits is taxable
0%
According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan
60%
According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?
60%
Unreimbursed Employee Expenses
7.5%
Under which condition would an employee's group medical benefits be exempt from income taxes?
An employee's group medical benefits are generally exempt from taxation as income
Disability income coverage specifies that the policy covers the insured if he is unable to perform any job for which he is qualified. In this case, total disability is defined as
Any occupation- more restrictive than other definitions
Which of the following are NOT true regarding Workers Compensation
Benefits are offered by the insurer
Which of the following is NOT true regarding Workers Compensation
Benefits are offered by the insurer
Which type of insurance provides funds for a business organization to purchase interest of a disabled partner
Disability Buy-Sell
Concerning group Medical and Dental insurance, which of the following statements is INCORRECT
Employee benefits are tax deductible the year in which they were received
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
The group plan will not pay because the employee was injured at work
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
An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay
$5,000
An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?
$500
The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT
Individual tax deduction for premiums paid
Which of the following is NOT metal level of coverage offered under the Patient Protection and Affordable Care Act
Iron
The mode of premium payment
Is defined as the frequency and the amount of the premium payment
In all health care plans under the Affordable Care Act (ACA), how many essential benefit categories are there
10
Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace
A permanent resident lawfully present in the U.S.
Which of the following would best describe total disability
A person's ability to work is significantly reduced or eliminated for the rest of his/her life
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
Disability Income
