health insurance
continue group health benefits
(COBRA) gives workers (and their families) whose employment has been terminated the right to
health information
(HIPAA) gives privacy protection for:
interim coverage
Short term medical policy
Insuring Clause
States the scope and limits of the coverage
medical history gross income occupation
individual disability income insurance applicant may be required to submit:
deductible can be expressed as a fixed dollar amount the benefit period begins only after a specified amount of expenses have accrued benefits are generally expressed as a percentage of eligible expenses
major medical benefits:
provides benefits for reasonable and necessary medical expenses, subject to policy limits
major medical policy typically:
Those enrolled as a full-time student
medicare is NOT for:
"Normally, a guardian is required to be appointed in the Beneficiary clause of the contract
minor beneficiary statement:
Policyowner
on an accidental death and dismemberment (AD&D) insurance policy, who is qualified to change the beneficiary designation ?
Guaranteed Renewable
renewability that best describes a disability income policy that covers an indiviual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class:
36 months
s is employed by a large corporation that provides group health coverage for its employees and their dependents. if S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations?
survivorship disability retirement
social security provides benefits for:
the employer receives the policy and each employee is issued a certificate
statement regarding a group accident & health policy issued to an employer:
Initial Deductible
the first portion of a covered major medical insurance expense that the insured is required to pay is called:
Medicaid
the health insurance program which is administered by each state and funded by both the federal and state governments called:
68-year old male covered by medicare
the individual most likely to buy a Medicare supplement policy would be:
notify an insurer of a claim within a specified time
the notice of claims provision requires a policyowner to:
Social security disability income
the percentage of an individuals primary insurance amount (PIA) determines the benefits paid in which of the following programs?
social security disability income
the percentage of an individuals primary insurance amount (PIA) determines the benefits paid in which of the following programs?
hospitalizations skilled nursing care physical therapy
Medicare part a and b pays for:
Actual covered expenses up to the daily maximum
A "reimbursement policy" pays what amount of covered Long-Term Care expenses?
experimental investigative services
A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered EXCEPT for
time deductible
A disability elimination period is best described as a
off-the-job accident
An accident policy will most likely pay a benefit for a(n)
$300,000
B has a $100,000 accidental death and disemberement policy that pays TRIPLE indemnity for common carrier death. if b is killed from an accident on a commerical flight, what will the policy pay b's beneficary?
Services are reimbursed after insurer receives the invoice
BEST describes dental care indemnity coverage?
residual benefit clause
D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits?
Overuse of medical services
Deductibles are used in health policies to lower
Business Overhead Expense
G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern:
Premiums are lower
How does group insurance differ from individual insurance?
medicare supplement
If a retiree on Medicare required five hospital stays in one year, which policy would provide the best insurance for excess hospital expenses?
$25,000
J has an Accidental Death and Dismemberment policy with a principal sum of $50,000. While trimming the hedges, J cuts off one of his fingers. What is the MAXIMUM J will receive from his policy?
Health Maintenance Organization
J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price, this plan is:
internal limit
J was reviewing her health insurance policy and noticed the phrase "this policy will only pay for a semi-private room" :
expense incurred
Long Term Care policies will usually pay for eligible benefits using which of the following methods?
earned, but unpaid benefits
M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a disbility income policy that pays $2,000 a month. What is owed to her estate?
$1,600 because 2,200-200 x 80%
M has a major medical insurance policy with a $200 flat deductible and an 80% coininsurance clause. if m incurs a $2,200 claim for an eligible medical expense, how much will m receive in payment for this claim?
determined by the terms of the policy
M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?
revocable beneficiary designation
M purchased an accidental death and dismemberment (AD&D) policy and named his son as beneficiary. M has the right to change the beneficiary designation at anytime because his son is:
Below a specific income limit
Medicaid was designed to assist individuals who are
$2,100 because 10,000 x20% + 100
Q is hospitalized for 3 days and receives a bill for $10,100. Q has a major medical policy with a $100 deductible and 80/20 coininsurance. How much will Q be responsible for paying on this claim?
upon satiifsying the elimination period
R becomes disabled and owns an individual disability income policy. when is R eligible to receive disability benefits?
increase the premium do not cover the substandard condition limit the type of coverage
an insurer may legally take all these actions to provide disability income coverage
$0 because T is still alive and the sole primary beneficiary
T and S are named co-primary beneficairies on a $500,000 accidental dealth and dismemberment policy insuring their father. their mother was named contingent beneficary. 5 years later S, dies of natural causes and the father is killed in a scuba accident shortly afterwards. How much of the death benefit will the mother reciceve?
Less than $5,000 per month benefit regardless of the cause
T has disability income policy that pays a monthly benefit of $5,000. if T becomes partially disabled, what can he likely expect?
Insurer will likely treat as a pre-existing condition which may not be covered for one year
T was treated for an ailment 2 months prior to applying for a health insurance policy. this condition was noted on the application and the policy was issued shortly afterwards. How will the insurer likely consider this condition?
payable to the company or another shareholder
The benefits under a Disability Buy-Out policy are
buy additional coverage at a later date
The guarantee of insurability option provides a long-term care policyowner the ability to
closed panel
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)
30 days
how long is the typical free look period for long term care insurance policies?
4 months
V is insured under an individual disabilty income policy with a 30 day elimination period. on july 1, he is involved in an accident and temporaily disabled. he returns to work on december 1. How many months are benefits payable?
Residual Disability
When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called which of the following?
Recurrent Disability
When a second disability is suffered due to the same cause within a certain period of time (usually 6 months), the elimination period will not apply and the disability will be considered continuous.
Normally includes an Elimination period
Which of these statements concerning an individual Disability Income policy is TRUE?
business overhead expense
Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident and out of work for six weeks?
Gross income at the time of purchase
With Disability Income Insurance, an insurance company may limit the monthly benefit amount a prospective policy holder may obtain because of the insured's
Noncanellable
if an insurance company issues a disability income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best describes this policy is called:
Coinsurance
a major medical policy typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insurer. this provision is called:
irrevocable
a policyowner's rights are limited under which beneficary designation?
Continue coverage but exclude the heart condition
a prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. the company issues the policy. two months later, the insured suffers a heart attack and submits a claim. while processing the claim, the company discovers the pre existing condition, the company will:
disability income policy are NOT tax-deductible major medical policy benefits are normally not taxed disability income policy benefits are normally not taxed
accurately describes the tax treatment of premiums and benefits of indivual accident and health insurance?
Carryover Provision
allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible. The major medical deductible carryover period normally applies to expenses incurred during the last three months of the plan year.
Consideration Clause
an insurance company receives E's application for an indivual health policy- didnt complete health form and suffers from a heart attack
Proceeds will go to the contingent beneficiary
an insured covered by (AD&D) insurance has just died. What will happen if the primary beneficary had already died before the insured and contingent beneficary?
$3,000 because 1,000+ 20%
an insured covered by a group major medical plan is hospitalized after sustaining injuries that resulted from an automoblie accident. assuming the plan had a $1,000 deductible and an 80/20 coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?
20 days
an insured must notify an insurer of a medical claim within _____ days after an accident
$720 because 400 + 20%
c was injured while deep sea diving and requires a hosptial stay. c has a major medical policy with a 80/20 coininusrance clause and a $400 deductible. what is the MAX c will pay if the covered medical expenses are $2000?
arthritis
cancer insurance does not cover:
dental care other prescription drugs
common exclusions to continuation of group coverage include:
Major Medical with Basic Hospital/Surgical coverage
comprehensive major medical policies usually combine:
disability buy-sell
contract that permits the remaining partners to buy-out the interest of a disabled business partner?
oral surgery preventive care orthodontia
dental care coverage
hospital room and board
for which of the following expenses does a basic hospital policy pay?
avoid the duplication of benefit payments
group health plans typically contain a coordination of benefits (COB) provision and the purpose is:
daily room and board miscellaneous expenses intensive care
hospital expense coverage
waiting period
the provision in a group health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as:
Common Accident Deductible
this type of deductible provision states that should more than one family member be involved in a common accident, or suffer the same illness, one one individual deductible amount shall be applied:
hospital room and board
under a basic medical expense policy, what does the hospitalization expense portion cover?
Alcohol rehabilitation
under a long term care policy, which benefit would be typically excluded or limited?
PPO
under what systems do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?
Part A covers hospitalization; Part B covers doctor's services
what does medicare parts a and b cover?
Time period a disabled person must wait before benefits are paid
what is the elimination period of an individual disability policy?
100% of the insured's Primary Insurance Amount (PIA)
what is the maximum social security disability benefit amount an insured can receive?
wages
what is the primary factor that determines the benefits paid under a disability income policy?
contributory
when an employee is required to pay a portion of the premium for an employer/ employee group health plan, the employee is covered under which of the following plans?
income
when determining the monthly benefit amount for a disability income policy, the factor that limits the amount a prospective insured may purchase is:
less restrictive
which of the following BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that uses the "accidental means" definition?
More physicians to choose from
which of the following BEST describes how a preferred provider organization (PPO) is less restrictive than a health maintenance organization (HMO)
No medical underwriting
which of the following characteristics is associated with a large group disability income policy:
leukemia
which of the following does a critical illness plan cover?
probationary period
which of the following is considered to be the time period after a health policy is issued, during which no benefits are provided for illness?
usual, customary and reasonable expenses
which of the following phrases refers to the fees charged by a health care professional?
Commerical Insurers
which of the following reimburses its insureds for covered medical expenses?
major medical policy
which of the following types of health coverage frequently uses a deductible?
HMO
which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements
home health care
which of the following will a long term care plan typically provide benefits for?
precription drugs
which of these options can an individual use their medical flexible spending account to pay for?
Restoration of Used Benefits
which provision allows a portion of any used medical benefits to be restored following a particular amount of benefit has been used, or after the policy has been in effect for a particular period of time?
Health Maintenance Organization (HMO)
which type of provider is known for stressing preventative medical care and routine physical examinations?
