Health Insurance Chapter 1

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

Group

Credit Accident and Health plans are designed to? Permit creditors the ability to require that coverage be purchased through insurers of their choice Provide permanent protection Help pay off existing loans during periods of disability Not permit free choice of coverage selection

Help pay off existing loans during periods of disability

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

Health insurance will typically cover which of the following perils? Death due to illness Injury due to accident Death due to accident Dismemberment

Injury due to accident

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? Is eligible for coverage upon hire Must wait 360 days to be eligible for coverage Must continue coverage with the previous employer Is eligible for only health insurance, not life or dental insurance

Is eligible for coverage upon hire

A person covered with an individual health plan? Is issued a policy Is issued a certificate of medical costs Does not contract directly with the insurance company Is not subject to medical underwriting

Is issued a policy

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

It would be considered taxable income to the employee

A common exclusion with Vision plans is? Eyeglass frames The examination Contact lenses Lasik surgery

Lasik surgery

The election of COBRA for continuation of health coverage will? Increase the coverage and lower premium Maintain the same coverage and increase premium Increase out-of-pocket costs and lower premium Decrease out-of-pocket costs and maintain same premium

Maintain the same coverage and increase premium

An employer is issued a group medical insurance policy. The single contract is known as a(n)? Entire contract Master Policy Certificate of coverage Employer contract

Master policy

What is the contract called that is issued to an employer for a Group Medical Insurance plan? Master policy Certificate of coverage Provisional policy 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? April 1 April 6 May 15 May 30

May 30

Mark continues working after the age 65 and is covered through his employer's group health plan. Which of the following statements is TRUE? He's not eligible for Medicare His group health plan and Medicare pay 50/50 Medicare is the secondary payer Medicare is the primary payer

Medicare is the secondary payer

Under which criteria may a group health plan exclude participation? Member's claims history Member's current age Member's pre-existing condition Member's part-time employment status

Member's part-time employment status

Under which criteria may a group health plan exclude participation? Member's claims history Member's current age Member's preexisting condition Member's part-time employment status

Member's part-time employment status

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

Participation of contribution rules have been violated

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

Policy ownership

Coordination of Benefits regulation applies to all of the following plans EXCEPT? Group vision plan Preferred provider organization plan Self-funded group health plan Group health plan

Preferred provider organization plan

Under the subrogation clause, legal action can be taken by the insurer against the? Responsible third party Beneficiary Policyowner State

Responsible third party

Health insurance involves two perils, accident and ___________. Death Sickness Disability Liability

Sickness

An insurer has the right to recover payment made to the insured from the negligent party. These rights are called? Contributoy Indemnity Estoppel Subrogation

Subrogation

Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes? Partially taxable income Non-taxable income Taxable income Conditionally taxable income

Taxable income

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

Temporary employee

Continued coverage under COBRA would be provided to a(n)? Former dependent of employee no longer of dependent status Terminated employee Divorced spouse of employee Employee reaching full retirement

Terminated employee

Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make? The amount contributed by the employer The amount contributed by the owner The underlying account investments used The medical expenses paid for by the HSA

The amount contributed by the employer

In an employer-sponsored contributory group Disability Income plan, the employer pays 60% of the premium and each employee pays 40% of the premium. Any income benefits paid are taxed at the employee at? Employee has no tax liability 40% of the benefit 60% of the benefit 100% of benefit

60% of the benefit

Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his preexisting health condition applies, Ron cannot have more than a ______ day gap without previous health insurance. 45 63 75 90

63

What is issued to each employee of an employer health plan? Provision Receipt Policy Certificate

Certificate

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)? Crossover Conversion Exchange Extension of benefits

Conversion

When can a group health policy renewal be denied according to the HIPAA? When a change of management has occurred within the group When the annual number of claims has increased by 25% When contribution of participation rules have been violated When group participation has increased by 25%

When contribution or participation rules have been violated

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

When the recipient pays the premiums

The limited period of time given to all members to sign up for a group health plan is called the? Enlistment period Sign-up period Probationary period Enrollment period

Enrollment period

A group disability income plan that pays tax-free benefits to covered employees is considered? Non-contributory Partially contributory Group contributory Fully contributory

Fully contributory

If an employee contributes 50% toward the disability plan premium provided by an employer, what would be considered the taxable income of a $1,000 monthly disability benefit? $100 $250 $500 $1,000

$500

Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of? Costs that exceed 7 ½ % of AGI Costs that exceed 10% of AGI 100% of costs No deduction permitted

100% of costs

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

20

HIPPA considers which of the following as "individually identifiable health information?" A person's employment history A person's net income A person's hire date A person's health claim information

A person's health claim information

Which of the following would be considered a possible applicant and contract policyholder for group health benefits? HR department Employer Insured employee Insurance company

Employer

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

Accidental bodily injury provision

Which of the following does Coordination of Benefits allow? Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid Allows both a group health plan and individual health plan to coordinate their benefit payments Allows the deductible to be spread out between all the health providers 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 of the following is INELIGIBLE to participate in a Section 125 plan? Key employee in a C-Corp Highly compensated employee in an S-Corp A C-Corp owner with a greater than 2% share An S-Corp owner with a greater than 2% share

An S-Corp owner with a greater than 2% share

The purpose of the Coordination of Benefits provision in group accident and health plan is to? Avoid over payment of claims Reduce out-of-pocket costs Reduce adverse selection Lower the cost of premiums

Avoid over payment of claims

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must? Be less extensive and premium cannot exceed 102% Be the same and the premium cannot exceed 102% Be more extensive and the premium cannot exceed 102% Be the same as well as the premium

Be the same and the premium cannot exceed 102%

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

Business overhead expense policy

In an employer-sponsored group accident and health plan, a master contract is issued to the? TPA Employees Administrative Services Organization Employer

Employer

The policyholder for a group health benefit plan is considered to be the? Employee Employer Liaison Insurer

Employer

Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the Employee's benefits still owed can be claimed Employee cannot be excluded from the new employer's health plan Employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan 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