Health Exam Try 2

Hospice care is intended for

The terminally ill Under certain conditions, hospital insurance can help pay for hospice care for terminally ill insureds, if the care is provided by a medicare certified hospice.

A long-term care policyholder requests that his policy be cancelled. Which of the following is true?

a prorated premium refund will be issued

All of the following are true regarding coverage for diabetes EXCEPT

all policies must cover diabetes

An individual was involved in a head-on collision while driving home one day. His injuries were not serious, and he recovered. However, he decided that in order to never be involved in another accident, he would not drive or ride in a car ever again. Which method of risk management does this describe?

avoidance

Which of the following is NOT required to be stated in the outline of coverage provided with a long-term care policy?

basic info about supplementary policies

All of the following apply to short-term disability plans EXCEPT

both group and individual plans are renewable

If an applicant for a health insurance policy is found to be a substandard risk, the insurance company is most likely to

charge an extra premium

A health insurance plan that covers all accidents and sicknesses that are not specifically excluded from the policy is referred to as a

comprehensive plan

What process will the insurance company use to monitor the insured's hospital stay to make sure that everything is proceeding according to schedule?

concurrent review

Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as

contracts of adhesion

An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement?

cost containment

Which of the following is NOT covered by Health Maintenance Organizations (HMOs)?

elective services

How many pints of blood will be paid for by Medicare Supplement core benefits?

first 3

In the case of producer solicitation, at what point must a long-term care Shopper's Guide must be presented to the applicant?

prior to the time of the applications

Which of the following is NOT specifically prohibited by state law as an unfair trade practice?

reducing the premiums paid by employers for group insurance based on loss experience

Which type of dental care would cover the cost of fillings?

restorative

What is the shortest possible elimination period for group short-term disability benefits provided by an employer?

0 days

What is the maximum period that an insurer would pay benefits in accordance with an Additional Monthly Benefit rider?

1 year

What insurance concept is associated with the names Weiss and Fitch?

1. Guides describing company financial integrity

Which of the following is INCORRECT concerning taxation of disability income benefits?

1. If paid by the individual, the premiums are tax deductible.

For group medical and dental expense insurance, what percentage of premium paid by the employer is deductible as a business expense?

100%

An intermediary has just placed insurance on himself. He can receive compensation for this transaction only if he has placed insurance on other individuals with the same insurer within the last

12 months

The main purpose of ERISA is to ensure that

Employees receive the pension and other benefits promised by their employers.

OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage?

End-stage renal failure

In insurance transactions, fiduciary responsibility means

Handling insurer funds in a trust capacity.

The Commissioner obtains a restraining order against a person who has violated an insurance law. The person continues the violation for 10 days. The person will have to pay a fine of

$0

A noncontributory group disability income plan has a 30-day elimination period and offers benefits of $2,000 a month. If an employee is unable to work for 7 months due to a covered disability, the employee will receive

$12,000 all of which is taxable

An insured's long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged $100 per day. How much will the insurance company pay?

$120 a day

What characteristics must be met for a self-funded plan to be dependable?

. Be big enough to permit the use of a sufficiently large number of exposure units so as to make losses predictable. (The program must be based on the operation of the law of large numbers.)2. The individual units exposed to loss must be distributed in such a manner as to prevent a catastrophic loss. A loss that could affect all units at one time could cause financial failure to the program.3. The accumulation of funds must be able to meet losses that occur, with a sufficient accumulation to safeguard against unexpected deviations from predicted losses.4. All of the above

For how many days of skilled nursing facility care will Medicare pay benefits?

100

An insurer terminates an agent's appointment. Within how many days of termination must the intermediary be notified?

30 days

How long are oral contracts valid in Wisconsin?

30 days

Life settlements sold in Wisconsin must allow for the rescission of the contract within

30 days

Which of the following statements concerning Medicare Part B is correct?

4. It pays for physician services, diagnostic tests, and physical therapy.

An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action?

4. The old policy should stay in force until the new policy is issued.

What do long-term care policies offer to policyholders to account for inflation?

4. They offer the option of purchasing coverage that raises benefit levels accordingly.

The minimum number of credits required for partially insured status for Social Security disability benefits is

6 credits

Long-term care policies MUST cover

Alzheimer's disease

All of the following are requirements of eligibility for Social Security disability income benefits EXCEPT

being age 65

Which of the following changes does NOT need to be reported to the Commissioner within 30 days?

each commissoin paid to a licensee who has held a license for less than 1 year

Which of the following is NOT a characteristic of a group long-term disability plan?

the benefit can be up to 50% of ones yearly income

The period of time immediately following a disability during which benefits are not payable is

the elimination period

Which provision states that the insurance company must pay Medical Expense claims immediately?

time of payment of claims

What is the purpose of the ADEA?

to prohibit age discrimination in employement

When is the insurability conditional receipt given?

when the premium is paid at the time of the application

Federal law makes it illegal for any individual convicted of a crime involving dishonesty or breach of trust to work in the business of insurance affecting interstate commerce

without receiving written consent from an insurance regulatory authority

The Pregnancy Discrimination Act specifically prohibits pregnancy discrimination by employers with the minimum of how many employees?

15

To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?

18 months

HIPAA applies to groups of

2 or more

An insured has Medigap insurance and later becomes eligible for Medicaid. If the person elects to receive Medicaid coverage, for how many years can Medigap benefits and premiums be suspended?

2 years

Following an injury, a policyowner covered under Medicare Parts A & 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?

2. 20% of covered charges above the deductible

All of the following statements describe a MEWA EXCEPT

MEWAs are groups of at least 3 employers. MEWAs are groups of at least 2 employers who pool their risks to self-insure. MEWAs can be sponsored by an insurance company, an independent administrator, or another group established to provide group benefits for participants.

Which of the following statements is INCORRECT concerning Medicare Part B coverage?

Part B coverage is provided free of charge when an individual turns age 65. those who want part b must enroll and pay a monthly premium participants under part b are responsibile for annual deductubiles part b will pay 80% it is a voluntary program

Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?

Part a and part B of medicare

Events in which a person has both the chance of winning or losing are classified as

Speculative risk.

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

a pre existing condition

All of the following are true regarding long-term care (LTC) policies sold in Wisconsin EXCEPT

an insurance comp can only raise LTC rates if a person has become sick

Benefit periods for individual short-term disability policies will usually continue from

6 months to 2 years

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

2. Any occupation - more restrictive than other definitions.

All of the following are true about group disability Income insurance EXCEPT

2. Coverage applies both on and off the job.

When an employee covered under a health reimbursement account changes employers, the HRA

2. Stays with the employer.

People who have been insured for how many months under a group contract must be allowed to continue group coverage or convert to an individual contract if the group coverage ends?

3

If an employer provides long-term group disability insurance for its employees, what percentage of monthly wages are lower-paid employees eligible to collect?

3. 66 and 2/3%

Which of the following does NOT qualify as a long-term care policy?

3. A disability policy that provides hospital coverage only

Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace?

3. A permanent resident lawfully present in the U.S.

Which of the following is an eligibility requirement for all Social Security Disability Income benefits?

3. Have attained fully insured status

Concerning Medicare Part B, which statement is INCORRECT?

3. It is fully funded by Social Security taxes (FICA).

When must the Medicare Supplement Buyer's Guide be presented?

At the time of application

A man bought an individual health insurance policy for himself. Which of the following roles does he now legally have?

Both subscriber and insured

Insurers may not terminate or limit a contract entered into or renewed with an agent based on all of the following EXCEPT

None of the above. All are unfair grounds of termination. Insurers may not terminate or limit a contract entered into or renewed with an agent based on the health status, claims experience, industry, occupation, or geographic location of the small employers or their employees placed by the agent with the insurer.

Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?

an individual who was previously covered by group health insurance for 6 months is eligible HIPAA requires that the individual have a previous continuous creditable health coverage for at least 18 months.

Welfare benefits include all of the following EXCEPT

holiday pay

The free-look period does NOT apply to single premium, short-term policies if the period of coverage is less than

6 months

Who must pay for the cost of a medical examination required in the process of underwriting?

insurer

In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?

2. All providers will have the same coverage options and conditions for each plan.

Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the

3. Notice Regarding Replacement.

An insurance policy is considered a "new policy" if it has been in effect for what maximum time period?

60 days

The Omnibus Budget Reconciliation Act of 1990 (OBRA) requires that large group health plans must provide primary coverage for disabled individuals under

65 who are not retired

Unreimbursed medical expenses paid for the insured may be claimed as deductions if the expenses exceed what percentage of the adjusted gross income?

7.5%

An insurance company assures its new policyholders that their premium costs will not increase for a period of at least five years. However, due to increasing financial strain, they plan to raise premium costs for all insureds by 10% over the next two years. What term best describes this act?

fraud

Which of the following programs expands individual public assistance programs for people with insufficient income and resources?

medicaid

An insurance company wants to obtain the insurance history of an applicant. Which source releases coded information to insurers regarding information included on previous insurance applications?

medical information bureau

The primary eligibility requirement for Medicaid benefits is based upon

need

Under which of the following would the Commissioner grant a requested re-hearing?

new evidence is discovered

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