Health practice final
A physician opens up a new practice and qualifies for a $7000/month disability income policy. What rider would the physician add if he wants the ability to increase his policy benefits as his practice and income grow?
Guaranteed insurability option rider
PPO's
are a considered to be a managed health care system
In order to establish a health reimbursement arrangement (HRA), it must:
be established by the employer
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n):
closed panel
M completes an application for life insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect EXCEPT
free-look period has expired
The health insurance portability and accountability Act (HIPAA) gives privacy protection for:
health information
With a Basic Medical Expense policy, what does the hospitalization expense cover?
hospital room & board
An insurer receives proof of loss for an acceptable medical expense claim under an Individual Health Insurance Policy. Under the Time of Payment of Claims provision, the insurer MUST pay the benefits
immediately
the first portion of a covered major medical insurance expense that insured is required to pay is called the?
initial deductible
Medicare Part B does NOT cover
inpatient hospital services
Information obtained from a phone conversation to the proposed insured can be found in which of these reports?
inspection report
Which health policy clause specifies the amount of benefits to be paid?
insuring
the clause identifying which losses resulting from an accident or sickness are insured by the policy bis the called the:
insuring clause
which of the following claims are typically excluded from medical expense policies?
intentionally self-inflicted injuries
Which type of plan normally includes hospice benefits?
managed care plans
what is not a managed care organization?
medical information bureau
The document that describes policy features, benefits, exclusions and riders in a long term care policy is known as?
outline of coverage
Deductibles are used in health policies to lower
overuse of medical services
Deductibles are used in health policies to lower?"
overuse of medical services
Under what system 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?
preferred provider organization (PPO)
A lapsed health insurance policy has recently been reinstated. how long after reinstatement must an insured wait before coverage for a sickness is available?
10 days
coverage for sickness is available how many days after reinstatement?
10 days
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.
15 days
An insurer must send notice of appointment how many days?
15 days
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?
31 days
An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?
31 days
new born additional premium
31 days
Under which of the following circumstances will the benefits under COBRA continuations coverage end?
All group health plans are terminated by the employer
what does a medicare supplement policy cover?
Allowable amounts under medicare Part B
All of the following statements regarding group health insurance is true, EXCEPT?
An individual policy is given to each member
When is a Group Health policy required to provide coverage for a newborn child?
At the moment of birth
When does a Probationary Period provision become effective in a health insurance contract?
At the policy's inception
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 is
Business overhead expense
organization that would make reimbursement payments directly to the insured?
Commercial insurer
what best describes a hospital indemnity policy?
Coverage that pays a stated amount per day of a covered hospitalization
K completes an application for a disability policy but does not pay the initial premium. The company approves the policy standard and the agent delivers the policy. K then pays her initial premium 3 days later. At what point does K's policy take effect?
Date the initial premium is collected
M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?
Determined by the terms of the policy
Characteristic of preferred provider organizations (PPO's) would be:
Discounted fees for the patient
which of the following statements BEST describes the intent of a coinsurance clause in a major medical policy?
Discourages over-utilization of the insurance coverage
M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?
Earned, but unpaid benefits
From what authority derives the requirement that an insurance application contains a disclosure stating that an investigative consumer report may be obtained on an applicant?
Fair credit reporting act
When determining the monthly benefit amount for a disability income policy, the factor that limits the amount a prospective insured may purchase is?
Income
The health insurance program which is administered by each state and funded by both the federal law and state government is called:
Medicaid
The provision that defines to whom the insurer will pay benefits to is called?
Payment of claims
The insuring clause
States the scope and limits of the coverage
Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party?
Subrogation
an assignment of benefits of a health policy:
Transfers payments to someone other than the policyownwer
describe how pre-admission certifications are used?
Used to prevent nonessential medical costs
A foreign insurance company?
a company formed under the laws of another state
Social Securtiy does NOT provide benefits for?
dismemberment
Benefits NOT covered due to an act of war are:
excluded by the insurer in the contract provision
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?
file written proof of loss
A major medical policy typically?
provides benefits for reasonable and necessary medical expenses, subject to policy limits
percentage of PIA determines?
social security disability income
Insured losses are covered immediately after a health policy is reinstated when:
the losses result from accidental injuries
A disability period is best described as a:
time deductible
elimination period?
time period a disabled person must wait before benefits are paid
Disability policies do NOT normally pay for disabilities arising from which of the following?
war
