Chapter 29 Quiz

A health insurance company can refuse coverage solely for which of the following reasons? A.Applicant's past medical history B.Sickle-cell trait in applicant C.Sex of applicant D.Marital status of applicant

A.Applicant's past medical history

Which of the following is considered a "cost containment" measure of health policies? A.Coordination of benefits B.Duplication of benefits C.Full coverage for inpatient treatment D.Elimination of all deductibles

A.Coordination of benefits

All of the following statements regarding group health insurance are correct EXCEPT A.Coordination of benefits is required between group policies and Medicare supplements B.Coordination of benefits helps to reduce costs C.Duplication of benefits result in overpayment D.Coordination of benefits is permitted so long as the insured is completely reimbursed for covered expenses

A.Coordination of benefits is required between group policies and Medicare supplements

All of the following provisions are required by the Florida Employee Health Care Access Act EXCEPT A.Coverage must always be renewed by carriers B.Carriers must use a "modified community rating" methodology C.All small group health benefit plans must be issued on a "guarantee-issue" basis D.Preexisting exclusions are limited to 12 months for conditions manifested during the previous six months for small employers with 2-50 employees

A.Coverage must always be renewed by carriers

Which of the following applies to the 10-day free-look privilege in a health insurance contract? A.It permits the insured to reject the policy within 10 days of policy delivery and receive a full refund. B.It allows the insured 14 days to pay the initial premium. C.It can be waived only by the insurance company. D.It is granted only at the option of the agent.

A.It permits the insured to reject the policy within 10 days of policy delivery and receive a full refund.

Which of the following statements is correct about coverage for a handicapped family member who reaches adulthood? A.Coverage ceases for the family member at the limiting age in the policy B.Coverage continues if the member is chiefly dependent on the policyholder C.Group health policies must continue coverage unlike individual policies D.Coverage automatically ceases when the family member obtains employment

B.Coverage continues if the member is chiefly dependent on the policyholder

All of the following are eligible for group health insurance EXCEPT A.Any group eligible for group life insurance B.Employees of members under an association plan C.Group established by labor unions and associations D.The employees of one employer and their dependents

B.Employees of members under an association plan

The notice to the insurance company of a health insurance claim must include all of the following EXCEPT A.Name of the policy owner B.Estimated amount of claim C.Nature of sickness or injury D.Name of the person receiving treatment

B.Estimated amount of claim

A health maintenance organization(HMO) provides which of the following? A.Free health care for Medicare patients B.Preventative health care for its members C.A program of "pay as you go" medicine D.An extension of VA hospital treatment for veterans

B.Preventative health care for its members

Individual and group health insurance policies and HMO contracts can be canceled for all of the following reasons EXCEPT A.Failure to pay premiums B.The insured develops a serious illness C.The insurer ceases to offer coverage in the market D.Fraud or intentional misrepresentation of a material fact

B.The insured develops a serious illness

All of the following statements about the Outline of Coverage for health insurance policies are correct EXCEPT A.it must be provided at the time of application or delivery of policy B.principal benefits also shown on the policy need not be included C.it is to include a summary statement of principal exclusions D.it must include any right the insurer reserves to change premiums

B.principal benefits also shown on the policy need not be included

At what point in time can a policyholder file suit against a health insurance company for failure to pay a claim? A.60 days from date of loss B.120 days from date of loss C.60 days after filing proof of loss D.120 days after filing proof of loss

C.60 days after filing proof of loss

All of the following are correct about the required provisions of a health insurance policy EXCEPT A.A grace period of 31 days is found in an annual pay policy B.The entire contract clause means the policy, endorsements and attachments constitute the entire contract C.A reinstated policy provides immediate coverage for an illness D.Proof-of-loss forms must be sent to the insured within 15 days of claim

C.A reinstated policy provides immediate coverage for an illness

Which of the following is NOT provided in a proof-of-loss form? A.A statement of the occurrence of accident of sickness B.The extent of the loss for which the claim is made C.A statement from the attending physician D.Information that identifies the claimant

C.A statement from the attending physician

All of the provisions are required by Florida law for group health insurance policies EXCEPT A.Coverage for mental and nervous disorders must be available to the group policyholder B.A newborn child is to be provided coverage from the moment of birth C.Coverage must continue until age 25 for a handicapped child that is a family member D.A newborn child of a covered family member is to be provided coverage for 18 months

C.Coverage must continue until age 25 for a handicapped child that is a family member

All of the following provisions are mandatory in health insurance policies EXCEPT A.Time limit on certain defensesB.Grace period C.Misstatement of age D.Time of payment of claims

C.Misstatement of age

All of the following statements about health insurance application are correct EXCEPT A.the application may request health history B.the application becomes a part of the insurance contract C.the agent can correct and sign an application form for the client D.the insurer can contest the application only when it is attached to the policy

C.the agent can correct and sign an application form for the client

All of the following statements regarding maternity benefits are correct EXCEPT A.Hospital expenses are usually covered up to ten times the room and board benefit B.Individual health insurance policies can be written to include maternity benefits C.Maternity benefits are optional to the policyholder of group insurance D.All health insurance policies must provide maternity benefits

D.All health insurance policies must provide maternity benefits

If a health insurance policy owner changes jobs to a more hazardous occupation, which of the following could apply? A.Benefits could be reduced if the policy so provides B.Coverage would not change if all insureds are charged the same rate C.Coverage would not change if the insured has given notice and paid a higher premium D.All of the above could apply

D.All of the above could apply

Group health insurance policies are required to provide all of the following EXCEPT A.Coverage for hospitalization during disability B.Coverage for a newborn child of a family member C.Coverage for a newborn child from the moment of birth D.Coverage for dental expenses

D.Coverage for dental expenses

Which of the following statements is correct about a group health insurance policy? A.It cannot exclude coverage from an occupational accident B.It can exclude newborn children from coverage C.It cannot exclude coverage for VA hospital treatment D.It can provide coverage for handicapped children

D.It can provide coverage for handicapped children

Which of the following practitioners is NOT defined as a "physician" under Florida law? A.Surgeon in an ambulatory surgical center B.Dentist performing surgery in a office C.Optometrist rendering services at an eye clinic D.Sports therapist performing services in a health club

D.Sports therapist performing services in a health club

In which of the following situations is a group health insurance policy NOT required to provide coverage? A.Qualified services performed in an ambulatory surgical center B.Outpatient services that would have been paid if rendered for an inpatient C.Specified services by a licensed podiatrist D.Treatment for an occupational illness or injury

D.Treatment for an occupational illness or injury