Life Insurance Exam 5

Group health plans obligated by the consolidated omnibus budget reconciliation act (COBRA) cover groups of at least

20 employees

After the deductible is satisfied, what percentage of a reasonable charge does medicare part B pay?

20%

As established by PPACA, an adult child may be covered by a parent's health insurance plan until what age?

26 years old

After the deductible, what portion does a patient pay for covered expenses under medicare part B?

80%

Regarding the health benefit exchanges, as created by PPACA, all of the following statements are true EXCEPT

An individual enrolling in a bronze level plan is not eligible for reduced cost-sharing

Which plan covers the medical expenses that are not covered by medicare?

Medicare supplement

What is the cost of service from the health insurance counseling advocacy program (HICAP)?

No charge

In health insurance the coinsurance is

A percentage paid for covered expenses by the insured and insurer after the deductible is satisfied

The most common type of specified disease insurance policy is

Cancer

In California, a child may obtain individual health coverage through all of the following EXCEPT

Healthy family

Part-time nursing that follows a hospitalization and can be provided in a patient's home is covered under

Home health care benefit

A long-term care insurance rider can include coverage for all of the following EXCEPT

Hospital acute care

An example of a third-party administrator is an

Outside organization that processes claims for an employer's self-funded group plan

The adult day care coverage level of long-term care policy provides for

Part-time nursing at a facility for elderly who live at home

Under group disability insurance an employee is eligible for a partial disability benefit when they can

Perform some of their job activities on a part time basis injury

Which health insurance provision protects an insured from the expense of a catastrophic illness?

Stop-loss

A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ratio (MLR) is less than what percentage?

80%

The type of health care provider that provides both the health care services and health care coverage is called

A health maintenance organization

According to the California insurance code, all of the following long-term care (LTC) insurance sales are considered unnecessary EXCEPT

A replacement LTC policy with equal benefits for a lower premium

Vision insurance usually limits coverage in all of the following ways EXCEPT

A specific dollar amount for examination

In the absence of a coordination of benefits clause, all of the following circumstances might result in recovery of more than 100% of actual health care expenses EXCEPT:

A worker's medical plan includes a carryover deductible provision

All of the following statements are true regarding health insurance counseling advocacy program (HICAP) counselors EXCEPT HICAP counselors

Are qualified to give legal advice

During the solicitation of a long term care insurance rider, a life agent must consider all of the following EXCEPT the applicant's

Attending physician statement

The insurer can do which of the following under a noncancelable health insurance policy?

Cancel the policy for nonpayment of premium

Health insurance counseling and advocacy program (HICAP) counselors can do all of the following EXCEPT

Charge for their services

Which of the following is not an example of costs sharing in a health insurance policy?

Coordination

The group medical plan provision that applies when a claimant has coverage under more than one plan is known as

Coordination of benefits

Which health insurance contract provision addresses the problem of overinsurance?

Coordination of benefits

A commonly used cost containment measure for emergency hospital care under a major medical expense plan is the

Deductible

In medical expense insurance, what serves the same purposes as the elimination period in disability income insurance

Deductible

Provisions in a disability income policy include all of the following EXCEPT

Deductible and coinsurance amounts

The employee retirement income security act of 1974 (ERISA) regulates group insurance in the area of

Disclosure and reporting

Two of the long-term care chronically ill activities of daily living (ADLs) are

Eating and dressing

The premium of a proposal disability income policy could be lowered by increasing the

Elimination period

In order to obtain group insurance without providing evidence of insurability, what do eligible individuals generally have to do?

Enroll within a specified eligibility period

Vision care insurance usually covers all of the following EXCEPT

Eye surgery

Traditional comprehensive major medial plans include all of the following EXCEPT

First-dollar coverage

Benefits under social security are available only for workers who are

Fully insured

For social security purposes, a person with 40 quarters of coverage is considered

Fully insured

Under the PPACA, which medical enrollment tire is 80% actuarial value?

Gold

A supplemental insurance policy that pays a set amount for each day that an individual is hospitalized is known as

Hospital confinement indemnity

All of the following may opt for a self insured medical and disability plan EXCEPT

Individuals

What happens if an insurer violates the medical loss ratio rule and spend too much money on administrative costs?

Insurers that do not meet the medical loss ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs

Why is an injury caused by an accident at an employee's workplace excluded from individual health insurance coverage?

It is covered by the state worker's compensation program

Providers of coverage for all of the following types of care are subject to the jurisdiction of the California department of insurance (CDI) EXCEPT

Lasik

All of the following are optional group medical coverage EXCEPT

Maternity

Which program pays the cost of nursing home care for people who cannot afford it themselves?

Medi-cal

Which program is designed to provided medical assistance to people with low incomes

Medical

All of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT

Medical expense

Which statement about medicare is not correct?

Medicare part C covers long-term care

A medicare coverage

Part B provides benefits for diagnostic tests and X-ray performed on an outpatient basis

Medicare part A provides coverage for all of the following EXCEPT

Physician services

Which health plan pays more for care received from a network provider than it pays for care from a non-network provider?

Preferred provider organization (PPO)

Characteristics of preferred provider organizations (PPOs) include all of the following EXCEPT

Primary physicians serve as gatekeepers

Residual disability income insurance payments are based on

The amount of the insured's income is reduced by the disability

What is the first step in submitting medicare claims?

The medical provider submits expenses to medicare

Which group provides information about health-related issues to the elderly in California

The national health care anti-fraud association. The health insurance counseling and advocacy program (HICAP)

What rights do individuals have if they disagree with a decision on the amount medicare will pay?

They can ask a medicare carrier to review the decision

The initial enrollment period for medicare part B ends how many months after the 65th birthday month?

Three months

What is the purpose of social insurance?

To protect certain vulnerable segments of the population

Under a disability income insurance policy with an own occupation clause, an individual who can no longer perform the tasks of the job held at the time of injury is considered

Totally disabled

Which type of insurance can be purchased at airport, bus terminals and railroad stations?

Travel accident insurance

The family and medical leave act (FMLA) covers all of the following EXCEPT

Traveling with a spouse who has been transferred overseas

When medical expense policies do not state specific dollar benefit amounts, but instead base payment upon the charges for like services in the same geographical are, benefits are designated as

Usual, customary, and reasonable charges

Which of the following statement concerning the usual coordination of benefits provisions is correct?

When two plans both have the provision, coverage as an employee is primary to coverage as a dependent

An individual is allowed to enroll in individual health insurance under the following circumstances EXEPT

Within 30 days of being diagnosed with an illness