Health Set
Sole proprietor of a business makes total salary of $50,000 annually. His medical expenses have reached a total of $75,000. What amount may the proprietor deduct in regards to his expenses?
$50,000
Licensed person whose activities affect interstate commerce and who knowingly makes false material statements related to the business of insurance may be imprisoned for up to
10 years
if reasonably possible, a notice of proof of loss claim must be provided to the insurer within how many days required by the policy
12 months
To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?
18 months
Every small employer carrier must actively offer to small employers at least how many health benefit plans?
2 plans
A&H policies are incontestable once they have been in force for
2 years
An insured was involved in an accident and could not perform her current job for 3 years. If the insured could reasonably perform another job utilizing similar skills after 1 month, for how long would she be receiving benefits under an "own occupation" disability plan?
2 years
If a person has a Medigap policy, and later becomes eligible for Medicaid, benefits and premiums may be suspended for up to how many years while Medicaid is in force?
2 years
An insured has Medicare Part D coverage. Upon reaching the initial benefit limit, what percentage of the prescription drug cost is the insured responsible for paying?
25%
Free look for Medicare Supplement policy
30 days
If a new individual LTC policyholder is not satisfied with a new policy, within how many days can the insured return the policy for a full premium refund?
30 days
Insurer plans to discontinue a specific type of group health insurance coverage. How much prior notice must the insurer give each employer and plan participant?
90 days
OBRA requires that large gorup health plans must provide primiary coverage for disabled individuals
Age 65 and not retired
In which Medicare supplemental policies are the core benefits found?
All plans
In reference to the Medicare Supplement benefits plans, what does the term standard mean?
All providers will have the same coverage options and conditions for each plan
What applies to defined benefit plans but not defined contribution plans?
Amount of contributions made by the employer is determined by an actuarial formula
NOT applied toward the deductible under a nonscheduled plan
Annual dental exam
An insured has a daughter who is covered as a dependent under the insured's health insurance policy, On her 17th birthday, the daughter had a babe. Which of the following is true regarding the baby's health coverage
Baby will be covered for a year
How is the amount of SS disability benefits calculated?
Based upon the worker's Primary Insurance Amount (PIA) which is calculated from their average indexed monthly earnings over their highest 35 years
Insurer offers services like preadmission testing, second opinions regarding surgery and preventative care, which term would best apply?
Case management provision
Insures may terminate or limit a contract entered into or renewed with an agent based on
Claims experience, health status, and industry
Not covered by HMO
Elective services
True or False: A disabled employee is exempt from taxation if any portion of the premium was paid by the employee.
F
True or False: Care needed because of aging is covered by Medicare
F
True or False: Disability benefits are not taxed.
F
True or False: Handicapped child is able to remain a dependent until age 30
F
True or False: Handicapped child may remain a dependent only if the child lives in an assisted living facility
F
True or False: Limited health insurance policies are limited to those enrolled in a group plan
F
True or False: Medicare does not pay for nursing home care in any care
F
True or False: Tax withholding is required if a disabled employee paid the premium.
F
True or False: care needed because of aging is covered by Medicare but not by Medicare supplements
F
True or False: handicapped child's coverage ceases when the child reaches the limited age
F
True or False: limited health policies cover all sickness or accidents that are not specifically excluded
F
True or False: limited health policies cover every need of a health insurance policy holder
F
True or false: LTC benefit can be up to 50% of one's yearly income
F
True or false: a reinstated health insurance policy provides immediate coverage for an illness
F
True or false: elimination period is the same as in the short term plan's benefit period
F
True or false: the benefit period may be to age 65
F
True or False: Groups of at least 3 employers
F - (2!)
Medicaid provides __________ EXCEPT for __________
Family planning, eyeglasses, home health care, NOT income assistance
Privacy Protection Study Commission was established to control the misuse of information and misinformation. What is the name of the act
Federal Privacy Act of 1974
What is covered under Plan A in Medigap insurance?
First three pints of blood each year, approved hospital costs for 365 additional days after Medicare benefits end, and 20% Part B coinsurance amounts for Medicare approved services
Most LTC plans have which of the following features?
Guaranteed renewability
Medicare and Choice insurance is a special arrangement between certain HMOs and what other entity
HCFA (
health care plan likely to provide comprehensive health care coverage
HMO plan
In which of the following cases would a credit disability policy be issued?
If an individual is in debt to a specific creditor, payments will be made for him/her until the return to work
In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met?
Insured must have first been hospitalized for 3 consecutive days
Who is the beneficiary in a credit health policy?
Lending institution
What is made up of four parts. The first part is paid for FICA and the second is financed by premiums and payroll taxes
Medicare
Who picks the primary care physician in HMO
Member
LTC care insurance shopper's guide must be provided in the format developed by
NAIC (National Association of Insurance Commissioners)
Coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called
Nonoccupational coverage
Premium payments for personally-owned disability income policies are
Not tax dedeuctible
Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. Where could the insured find this information
Notice Regarding Replacement
Which part of Medicare must be part of all supplement plans
Part A
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?
Parts A and B Medicare
Metal plan that covers 90% and insured is responsible for 10%.
Platinum
An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true?
Pre-existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one picking up where the old one left off
Any occupation typically means that an individual is unable to perform the duties of the occupation for which he/she is suited by all of these EXCEPT
Preference
Underwriting is a major consideration when an insured wishes to replace her current policy for all of the following reasons exceot
Premiums always stay the same
Health care provider is paid a regular fixed amount for providing care to insured and does not receive additional amounts of compensation dependent upon procedure
Prepaid plan
What is NOT a goal of a Medicare supplement application?
Presuming the applicant is eligible for Medicaid based on the nature of the policy
Under a disability income policy, the insurer does not pay a monthly benefit that is equal to the insured's previous income. The reason for paying a benefit amount that is less than the insured's income is to
Prevent over utilization and malingering
What is included in a certificate of insurance?
Procedures for filing a claim, length of coverage, policy benefits and exclusions
When an employee is still employed upon reaching age 65 and eligible for Medicare, which of the following is the employee's option?
Remain on the group health insurance plan and defer eligibility for Medicare until retirement
Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering form total disability. What is the benefit that is based on the loss of earnings after recovery called?
Residual Disability
What is covered by HMOs
Routine physicals, immunizations, elective services
Your client has a social insurance supplement rider on his disability policy. After he becomes disabled, he receives payments form the company. Shortly thereafter, he also begins receiving SS benefit payments. What will happen?
SIS payment will be reduced dollar for dollar by the SS benefit benefit
All of the following ways are included when determining the premium for a major medical policy
Stop-loss, deductible, coinsurance
True or False: A disabled employee may be subject to taxation if the premium was paid by the employer.
T
True or False: HMO coverage is based on geographic location
T
True or False: Handicapped child may remain a dependent for as long as he/she is incapable of self-sustaining employment and is chiefly dependent upon the insured under the policy for support and maintenance
T
True or False: Limited health policies only cover specific accidents or diseases
T
True or False: MEWA employers retain full responsibility for any unpaid claims
T
True or False: can be self-insured
T
True or False: medicare will cover nursing home care if it is part of the treatment for a covered illness
T
True or false: A grace period of 31 days is found in an annual pay health policy
T
True or false: LTC benefit can be up to 66 and 2/3% of one's month income
T
True or false: MEWAs can be sponsored by insurance companies
T
True or false: The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract?
T
True or false: proof-of-loss forms must be sent to the insured within 15 days of notice of claim
T
What does not have to be disclosed a LTC policy?
The aggregate amount of premiums due
Which statement accurately describes group disability income insurance?
The extent of benefits is determined by the insured's income
Which state has jurisdiction over a group policy that covers individual that reside in more than one state?
The state in which the policy was delivered
When Mark fills out his health insurance application, he accidentally forgets to include the face that he was once diagnosed with high blood pressure. He is then rediagnosed 1.5 years after policy begins. What is true?
Treatment costs can be denied
When does a person qualify to receive disability-related income?
When the insured is unable to perform his or her job duties
Under age discrimination in employment act, if the obligation of the employer to provide retiree health benefits, what will an individual younger than 65 receive in benefits each year
at least the value of SS benefits
Which of the following is NOT true of Disability Buy-Sell coverage
benefits are considered taxable income to the business
If the head of the Department of Insurance has ruled a group can apply for group health, it is considered
discretionary group
What is the name of the statement which says "This is a limited policy" on the first page?
limited policy notice
Prescription contraceptives in disability insurance policies in this state
mandatory coverage
When does Medicare cover nursing home care?
only if it is part of treatment for a covered illness or injury
Operative treatment of the mouth
oral surgery
Type of dental care covering extraction of wisdom teeth
oral surgery
Part A
pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice
Under the AD&D coverage, what benefit will be paid to the beneficiary in the event of the insured's accidental death?
principal sum
Care that re-establishes functional use to natural teeth
restorative
Premiums paid by self-employed sole proprietors or partners for medical expense insurance are
totally tax deductible
HIPPA includes protecting individually identifiable health information
transmitted in any form
Policies that cover hospital expenses must provide at least how much coverage per year for hospital inpatient and outpatient treatment of kidney disease?
$30,000
