Hi
Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months
30 months
To keep cobra coverage, how soon after termination of employment must an employee excervise benefits
60 days
Amount of physician or supplier bills for particular service or supply
Actual charge
What documentation, grants, espresso authority to an agent
Agents contract with the principal
Which of the following hospice events would not be covered in a cost containment setting?
Antibiotics
Which of the following describes taxation of an individual, disability, income, insurance, premiums and benefits
Are not tax deductible and benefits are not taxable
I bought an individual health insurance policy for himself which of the following roles does he now have legally
Both subscriber and insured
An insurance producer who buy contract is bound to write insurance, for only one company is classified as
Captive agent
Most scheduled plans provide first dollar benefits without
Coinsurance and deductibles
Splitting cost of premium with employer is called
Contributory plan
Gatekeeper of an HMO helps
Control specialist costs
the amount that an insured must pay on a claim before the insure will pay
Deductible
Which agreement specifies how a business will transfer when one of the owners dies or is disabled
Disability buy sell
Which of the following are not covered by health maintenance organizations HMO's
Elective services
Provision, stating both printed contract and application form between the policyholder and the insurer is called
Entire contract
The provision in a policy that ensures that the insured can't refer to any document that isn't contained in the contract is the
Entire contract clause
Denture replacement is covered how often
Every five years
What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?
Experience rating
What is the main eligibility factor for the mass health program?
Family income
How many pints of blood will be paid for by Medicare supplement core benefits
First 3 pints
In disability income insurance, the occupation, definition of disability applies
For the first two years of disability
New employee who meets HIPPA eligibility must be issued health coverage on what basis
Guaranteed
Which of the following statements is correct considering the relationship between Medicare and HMO's
HMO's may pay for services that aren't covered by Medicare
The benefits received by the business, and a disability by sell policy are
Income tax-free
Which of the following entities must approve all Medicare supplement advertisements
Insurance Commissioner or Director
The section of a policy stating causes of eligible loss, where an insured is assumed to be disabled is the
Insuring clause
All of the following statements about Medicare part B are correct except
It is a compulsory program.
Which of the following is true about PPO?
It's goal is to channel patients to providers that discount services
All of the following characteristics of a major medical expense policy, except
Low maximum limits
If an insurance company offers, Medicare policies, it must offer which plan
Part A
All of the following examples of risk retention, except
Premiums
Which disability covers conditions, such as dismemberment or total blindness
Presumptive disability
The commissioner can delay, the date of an insurance rate plan, which has been filed less than 30 additional days in order to
Properly, examine the filing and supporting info, filed as a requested or to permit a related hearing
The risk of loss may be classified as
Pure risk and speculative risk
Protection against catastrophic losses is called
Reinsurance
All of the following are ways in which a major medical policy premium is determined, except
The average age of the group
When employees are actively at work on the date coverage can be transferred to another insurance carrier what happens to coinsurance and deductibles
They carry over from the old plan to the new plan
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
Pro rata benefit reduction
ensures that insureds or beneficiaries do not profit from losses
For the purpose of insurance risk means
the uncertainty or chance of loss
What is the license renewal period for a portable electronics insurance license?
2 years
The commissioner must examine each domestic and foreign company in order to determine its financial condition, ability to fulfill its obligations complains with insurance laws and dealing with its policy holders at least once every
5 years
Difference between group, underwriting, and individual underwriting is that there is little or no medical information required, regarding regarding plan, participants in groups of
50 or more
Unreimbursed medical expenses paid for the insured may claimed as deductions in the expenses exceeding what percentage of adjusted gross income
7.5%
How many eligible employees must be included in a contributory plan?
75%
how is eligibility of members for group health insurance determined
By conditions of employment
What process will the insurance company use to monitor the insurance hospital stay to make sure that everything is proceeding according to schedule.
Concurrent review
All of the following are true about group, disability, income insurance, except
Coverage applies both on and off the job
Which of the following healthcare plans would most likely provide the insured/subscriber with comprehensive healthcare coverage?
Health maintenance organization plan
Units with the same or similar exposure to loss are
Homogenous
Rose has three policies from same insure, and her benefits have exceeded the maximum allowed what will happen
Pro rata benefit reduction
A doctor submits claimants information to patients and insurance before performing the procedure. She's doing this to check for procedure coverage. This is an example of.
Prospective review
What type of review process doing employers and insurers used to evaluate utilization review process and effectiveness of professionals involved in large insurance claims
Retrospective review
An applicant with the history of of heart disease in his family wants to buy health insurance that strictly covers heart disease what is this policy called
Specified coverage
a person has both the chance of winning or losing our classified as
Speculative risk