Exam Fx Health

Concerning Medicare Part B, which statement is INCORRECT?

It is fully funded by Social Security taxes (FICA).

What is another name for social security benefits?

Old Age, Survivors, and Disability Insurance

Medicare Part A services do NOT include which of the following?

Outpatient Hospital Treatment

The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health car care. is known as

Part A

All of the following are covered by Part A of Medicare EXCEPT

Physician's and surgeon's services.

Workers Compensation benefits are regulated by which entity?

State government

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.

A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their companies that also cover the other spouse. If the husband files a claim,

The insurance through his company is primary.

In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility,

The insured must have first been hospitalized for 3 consecutive days.

Which of the following statements is most correct concerning the changing of an irrevocable beneficiary?

They can be changed only with the written consent of that beneficiary.

Regarding Medicare SELECT policies, what are restricted network provisions?

They condition the payment of benefits.

A policyowner has a health insurance policy with his wife listed as the primary beneficiary. He would like to change the prim 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 any time.

An insured owes his insurer a premium payment. Since then, he incurs medical expenses. The insurer deducts the unpaic amount from the claim amount and pays the insured the difference. What provision allows for this?

Unpaid premium

Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes

Waiver of premium rider

A noncontributory group disability income plan has a 30-day elimination period and offers benefits of $2,000 a month. If an employee is unable to work for 7 months due to a covered disability, the employee will receive

$12,000, all of which is taxable.

COBRA coverage may be kept for up to how many months?

18

A 63-year-old man is planning to be employed until age 68. When will he be eligible for Medicare?

Age 65, regardless of his employment status

Which of the following is NOT among the primary ways deductibles for major medical plans can be paia

An embedded deductible

While a claim is pending, an insurance company may require

An independent examination as often as reasonably required.

How many pints of blood will be paid for by Medicare Supplement core benefits?

First 3

Medicare supplement plan must have at least which of the following renewal provisions?

Guarteed renewed

In group insurance, the underwriter will examine a group's experience rating, which is associated most closely

Claims expeirence

Which of the following programs expands individual public assistance programs for people with insufficient income and resources?

Medicaid

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 in paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, would be paid by the secondary insurer?

$500

L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay?

$900 (deductible + 20% of the bill after the deductible [20% of $2,000])

All individual insurance policies must provide the insured with the right to cancel the policy for a full refund of premium wi many days of purchase?

10

If an insured employee selects COBRA coverage after the employment is terminated, how much premium w pay?

100% of the premium paid by the employer and 2% processing fees

Following an injury, a policyowner covered under Medicare Parts A & B was treated by her physician on an outpatient basis. How muc of her doctor's bill will she be required to pay out-of-pocket?

20% of covered charges above the deductible

Which of the following must the patient pay under Medicare Part B?

20% of covered charges above the deductible

The Patient Protection and Affordable Care Act mandates that insurers provide coverage for adult children of the insured up to the

26

Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid?

5 months

If a health insurance carrier withdraws from the small employer market, how soon may they renter that market if they li to do so?

5 years

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and r policy must contain what?

A statement that is sufficiently clear to identify the insured and the nature of the claim.

Money that an individual pays for health care services after a deductible has been paid is called

Coinsurance

What is the main difference between coinsurance and copayments?

Copayment is a set dollar amount.

Which of the following is NOT covered by Medicare?

Cosmetic surgery

Which of the following types of long-term care is provided mainly for the purposes of meeting the insured's neel living?

Custodial care

The amount an individual must pay for health care services before insurance covers any of the costs is called

Deductible

Which of the following is a specified dollar amount that the insured must pay before the policy benefits begin?

Deductible

Social Security disability definition includes all of the following EXCEPT

Disability expected to last for at least 6 months.

Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amoun premium paid by the emplover?

Disability income

All of the following are advantages of an HMO or PPO for a Medicare recipient EXCEPT

Elective cosmetic procedures are covered.

An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day

Elimination period

Which of the following would not be an allowable reason for an employee's health insurance coverage to

Employee absent from work for an extended period of time because of total disability

Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it?

Free look period

A Health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective?

Immediately

The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT

Individual tax deduction for premiums paid.

In the event of a loss after your notice of claim is made To the provider who is responsible claims form parties.

Insurer to the insured

The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known

Legal actions

Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEI emergency situations?

Medicare Select

Which of the following premium modes would result in the highest annual cost for an insurance policy?

Monthly

Which of the following types of groups are formed when several similar or related small companies join forces to create a li people that the insurer will accept as a group?

Multiple-employer trusts

The primary eligibility requirement for Medicaid benefits is based upon

Need

A corporation that contracts for health services for subscribers in exchange for the periodic payment by or on behalf of the subscribers, and that does not bill the subscriber directly, but bills the service plan, is classified

Nonprofit health service plan corporation.

Premium payments for personally-owned disability income policies are

Not tax deductible.

An insured pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would

Pay the claim.

Which of the following applies to partial disability benefits?

Payment is limited to a certain period of time.

A guaranteed renewable health insurance policy allows the

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.

Which of the following is correct regarding the taxation of group medical expense premiums and benefits?

Premiums are tax deductible and benefits are not taxed.

Medicare SELECT policy does all of the following EXCEPT

Prohibit payment for regularly covered services if provided by non-network providers.

An insured has a cavity filled. His insurer covers his claim up to a predetermined amount, which is in type of dental plan does the insured have?

Scheduled

An insured has endured multiple surgeries and hospitalizations for an illness during the last few months. Her insurer no longer bills her for medical expenses. Which of the following allows for that?

Stop loss limit

Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses.

Stop-loss limit

The transfer of an insured's right to seek damages from a negligent party to the insurer is found in which of the following clauses?

Subrogation

A husband and wife are insured under group health insurance plans at their own places of employment, and as depenc their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid?

The benefits will be coordinated.

An insured submitted a notice of claim to the insurer. but never received claims forms. He later submits proof of loss, an nature and extent of loss in a hand-written letter to the insurer. Which of the following would be true?

The insured was in compliance with the policy requirements regarding claims.

long-term care insurance, what is a maximum daily benefit?

The maximum amount the insurer will pay per day for care

Which of the following will vary the length of the grace period in health insurance policies?

The mode of the premium payment payment.

All accident and health policies that provide family coverage must provide coverage for newborn children of the insured fror

The moment of birth

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

The more liberal "own occupation"

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of Payment of Claims

What is the purpose of coinsurance provisions?

To help the insurance company overutilazation to the policy.

An employee is injured in a construction accident, rendering him unable to work for a year. Which of the following plans would pro him with medical expense coverage and income assistance?

Workers Compensation