Other Health Insurance Concepts

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 occuring 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 is written on what basis?

Occupational

Which of the following applies to partial disability benefits?

Payment is limited to a certain period of time

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 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

What percentage of individually-owned disability income benefits is taxable?

0%

Under the Affordable Care Act, what percentage of preventative care must be covered without cost sharing?

100%

What is the maximum age for qualifying for a catastrophic plan?

30

When a disabled dependent child reaches the age limit for coverage, how long does the policyowner have to provide proof of dependency in order for the dependent to remain covered under the policy?

31 days

According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

60%

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

A permanent resident lawfully present in the U.S.

All of the following statements concerning workers compensation are correct EXCEPT a. Workers compensation laws are established by each state b. All states have workers compensation c. Benefits include medical, disability, income, and rehabilitation coverage d. A worker receives benefits only if the work related injury was not his/her fault

A worker receives benefits only if the work related injury was not his/her fault

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 statement accurately describes the Change of Beneficiary provision?

Any policy that has a death benefit must also have a Change of Beneficiary provision

Which of the following is NOT true regarding Workers Compensation? a. Benefits vary from state to state b. Benefits are regulated by the state government c. Benefits are offered by the insurer d. Benefits are not regulated by the federal government

Benefits are offered by the insurer

An individual is insured under his employer's group Disability Income policy. The insured suffered an accident while on vacation that left him unable to work for 4 months. If the disability income policy pays the benefit, which of the following would be true?

Benefits that are attributable to employee contributions are fully taxable to the employee as income

Alexander has a policy with his ex-wife as its beneficiary. What provision allows him to change the beneficiary to his new wife?

Change of beneficiary

The purpose of managed care health insurance plans is to

Control health insurance claims expenses

Which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner?

Disability Buy-sell

The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT a. No lifetime dollar limits b. Coverage for preventative benefits c. Individual tax deduction for premiums paid d. Right to appeal

Individual tax deduction for premiums paid

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

Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?

Metal level classification

According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10%, what type of plan is that?

Platinum

A woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out she is 3 months pregnant. Which of the following is true about coverage for pregnancy?

Pregnancy will be covered immediately

Which of the following are the main factors taken into account when calculating residual disability benefits?

Present earnings and earnings prior to disability

When an insurer combines two periods of disability into one, the insured must have suffered a

Recurrent disability

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

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

Which of the following definitions would make it easier to qualify for total disability benefits?

The more liberal "own occupation"

A policyowner names his five children as primary beneficiaries and his wife as a contingent beneficiary. If the policyowner and one of his children die, who would receive policy benefits?

The remaining 4 primary beneficiaries

Which of the following is NOT true regarding partial disability? a. Benefit of payments are typically 50% of the total disability benefit b. An insured would qualify if he couldn't perform some of his normal job duties c. This is a form of insurance that covers part-time workers d. The insured can still report to work and receive benefits

This is a form of insurance that covers part-time workers

A policyowner has a health insurance policy with his wife listed as the primary beneficiary. He would like to change the primary beneficiary to his sister. Which of the following is true?

Unless the policy designated the current beneficiary as irrevocable, the policyowner can make the change at anytime

Which characteristic does NOT describe managed care? a. High quality care b. shared risk c. Preventative care d. unlimited access to providers

Unlimited access to providers

Under what condition are group disability income benefits received by an employee NOT taxable income? a. When the employee is 59 and 1/2 b. When the amount of the benefit is equal or less than the amount of contributed by the employer c. When the benefits received are equal or less than the employee's percentage of the contribution d. When the employer makes all the premium payments

When the benefits received are equal or less than the employee's percentage of the contribution

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