ExamFX - MS Health Quiz Questions with Complete Solutions., Exams of Health sciences

Download ExamFX - MS Health Quiz Questions with Complete Solutions. and more Exams Health sciences in PDF only on Docsity! ExamFX - MS Health Quiz Questions with Complete Solutions. Which of the following statements is NOT correct concerning the COBRA Act of 1985? - Correct Answer It requires all employers, regardless of the number or age of employees, to provide extended group health coverage - only applies to employers with 20 or more employees How does a member of an HMO see a specialist? - Correct Answer The primary care physician refers the member Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives? - Correct Answer None, since GD does not cover war, military service, intentional injuries, overseas residence, or felony injuries Under a credit disability policy, until what point will payments to the creditor be made for the insured? - Correct Answer Until the disability ends or the debt is satisfied, whichever is sooner Insurers usually do not remiburse claimants for 100% of income lost due to disability. What is the reason for insurer limitations on coverage amounts? - Correct Answer To provide an incentive for the insured to return to work In long-term care insurance, what type of care is provided with intermediate care? - Correct Answer Occasional nursing or rehabilitative care Which type of hospital policy pays a fixed amount each day that the insured is in a hospital? - Correct Answer Indemnity Can a group that is formed for the sole purpose of obtaining group insurance qualify for group insurance? - Correct Answer No, the group must be formed for a purpose other than obtaining group insurance Which of the following does NOT describe hospice care? - Correct Answer It provides care to people with life expectancies of 1 to 2 years. (6 months or less) All of the following statements concerning Accidental Death and Dismemberment coverage are correct EXCEPT - Correct Answer Death benefits are paid only if death occurs within 24 hours of an accident (90 days) An insured's long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged $100 per day. How much will the insurance company pay? - Correct Answer $120 per day A hospital indemnity policy will pay - Correct Answer A benefit for each day the insured is in a hospital What is a penalty tax for non-qualified distributions from a medical savings account? - Correct Answer 20% A disability income policy is written with a 10-month benefit period, a 30-day elimination period, and a 30-day probationary period. If the insured becomes disabled due to illness 9 days after the effective date, the policy will pay benefits for a maximum of - Correct Answer 10 months Most LTC plans have which of the following features? - Correct Answer Guaranteed renewability Occasional visits by which of the following medical professionals will NOT be covered under LTC'S home health care? - Correct Answer Attending physician Qualified medical expenses paid for participants in a Medical Savings Account (MSA) are - Correct Answer Not taxable Which of the following would be a qualifying event as it relates to COBRA? - Correct Answer Termination of employment due to downsizing (termination of an employee for reasons other than misconduct) Which of the following is another name for a primary care physician in an HMO? - Correct Answer Gatekeeper How many hours of inpatient care for childbirth must be offered by health insurance plans for women after a vaginal delivery? - Correct Answer 48 hours Who can provide skilled nursing care? - Correct Answer Doctor Which of the following is NOT covered by Health Maintenance Organizations (HMOs)? - Correct Answer Electiveservices The primary purpose of disability income insurance is to - Correct Answer Replace income lost due to a disability Which of the following is NOT an advantage of an HRA for an employer? - Correct Answer HRAs are defined benefit programs Your client wants to know what the tax implications are for contributions to a Health Savings Account. You should advise her that the contributions are - Correct Answer Tax deductible A small company offers group health insurance to its employees, but recently has decided to terminate the health insurance contract, leaving the workers without insurance. What can the employees do regarding the insurance? - Correct Answer Convert to an individual health policy All of the following would be qualified as a dependent under a Dependent Care Flexible Spending Account, EXCEPT - Correct Answer Jeremy had to have both legs amputated, but has learned how to take care of himself and get around in a wheelchair Which is NOT a characteristic of group health insurance? - Correct Answer A policy is insured to each insured individual ("master contract" is issued to group sponsor only) A typical Accidental Death & Dismemberment policy covers all of the following losses EXCEPT - Correct Answer Income The HMO Act of 1973 required employers to offer an HMO plan as an alternative to regular health plans if the company had more than 25 employees. How has this plan since changed? - Correct Answer Employers are no longer forced to offer HMO plans A guaranteed renewable disability insurance policy - Correct Answer is renewable at the insured's option to a specified age Which of the following does the insuring clause NOT specify? - Correct Answer A list of available doctors Which of the following will vary the length of the grace period in health insurance policies? - Correct Answer The mode of the premium payment (grace period = 7 days on a weekly premium mode; 10 days on monthly premium mode; 31 days on other premium modes) Which premium states the insurance company must pay Medical Expense claims immediately? - Correct Answer Time of Payment Claims When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should - Correct Answer Adjust the benefit in accordance with the decreased risk Which of the following is NOT a feature of a guaranteed renewable provision? - Correct Answer The insurer can increase the policy premium on an individual basis (GRP is only increased on a class basis) While a claim is pending, an insurance company may require - Correct Answer An independent examination as often as reasonably required Insurers may change which of the following on a guaranteed renewable health insurance policy? - Correct Answer Rates by class (not on an individual policy) Which of the following is NOT an exclusion in medical expense insurance policies? - Correct Answer Which of the following riders would NOT increase the premium for a policyowner? - Correct Answer Impairment rider (includes a specified condition for coverage and reduces benefits. Insurer will not charge extra for riders that reduce benefits) Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss? - Correct Answer Notice of Claim Which statement best describes the free look provision? - Correct Answer It allows the insured to return the policy within 10 days for full refund of premiums if dissatisfied for any reason Which of the following provisions is mandatory for health insurance policies? - Correct Answer Physical examination and autotopsy (optional provisions include (1) illegal occupation, (2) unpaid premiums, and (3) intoxicants and narcotics) An insured submitted a notice of claim to the insurer, but never received claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insuer. Which of the following statements would be true? - Correct Answer The insured was in compliance with the policy requirements regarding claims Which of the following is NOT a feature of an noncancellable policy? - Correct Answer The insurer may terminate the contract only at renewal for certain conditions Which of the following is true regarding elimination periods and the cost of coverage? - Correct Answer The longer the elimination period, the lower the cost of coverage When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent she was 30 years old, when in fact she was 37. If the policy contains the optional misstatement of age provision - Correct Answer Amounts payable under the policy will reflect the insured's correct age. The insuring clause of a disability policy usually states all of the following EXCEPT - Correct Answer The method of premium payment An insured misstated her age on an application for an individual health insurance policy. he insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued? - Correct Answer Adjust the claim benefit to reflect the insured's true age Under the Physical Exam and Autopsy provision, how many times can an insuer have the insured examined, at its own expense, while a claim is pending? - Correct Answer Unlimited What is the main difference between coinsurance and copayments? - Correct Answer Copayment is a set dollar amount (conisurance is a percentage) The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the - Correct Answer Insuring Clause (states the coverage and when it applies) According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT - Correct Answer Unearned premiums are retained by the insurance company (unearned premium is returned to the policyholder on a pro rata basis) An insurance agent proposed an individual health insurance policy that is guaranteed renewable. If the applicant accepts this policy, the insurer agrees that - Correct Answer The company will continue to renew that policy until the insured has reached age 65. A guaranteed renewable health insurance policy allows the - Correct Answer Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class. An insured wants to name her husband as the beneficiary of her health policy. She also wishes to reain all the rights of ownership. The insured should have her husband named as what type of beneficiary? - Correct Answer Revocable beneficiary (if her husband is named as the revocable beneficiary, the insured would be the policyowner and could make no changes to the contract. Her husband would receive any death benefit) 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 - Correct Answer Pay the claim (since it occured within the grace period) Medicare Part A services do NOT inlcude the following? - Correct Answer Outpatient Hospital Treatment (Part B) If a person is disabled at age 27 and meets Social Security's defintion of total disability, how many work credits must he/she have earned to receive benefits? - Correct Answer 12 credits (Persons disable between ages 24 and 31 can qualify for benefits if they have credit for having worked half of the time between age 21 and the start of the disability. For example, if Joe becomes disabled at age 27, he would need 12 credits (or 3 years' worth) out of the prior 6 years (between ages 21 and 27). Medicare Part D provides: - Correct Answer Prescription drug benefit Which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner? - Correct Answer Disability Buy-Sell A husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses be paid? - Correct Answer The benefits will be coordinated 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? - Correct Answer The group plan will not pay because the employee was injured at work. When an insurer combines two periods of disability into one, the insured must have suffered a - Correct Answer Recurrent disability (usually within 3-6 months) The Patient Protection and Affordable Care Act mandates that insurers provide coverage for adult children of the insured up to the age of - Correct Answer 26 A woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnant. Which of the following is true about coverage for pregnancy? - Correct Answer Pregnancy will be covered immediately Which of the following is correct regarding the taxation of group medical expense premiums and benefits? - Correct Answer Premiums are tax deductible. Benefits are not taxed. A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim, - Correct Answer The insurance through HIS company is primary Individuals who itemize deductions can claim deductions for medical expenses not covered by health insurance that exceed what percent of their adjusted gross income? - Correct Answer 10% 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 insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer? - Correct Answer $500 - secondary insurer covers what the primary insurer did not pay A policyowner has a health insurance policy with his wife listed as the primary beneficiary. he would like to change the primary beneficiary to his sister. Which of the following is true? - Correct Answer Unless the policy designated the current beneficiary as irrevocable, the policyowner can make the change at any time. In order for an insurer to legally transact insurance, it must obtain which of the following? - Correct Answer Certificate of Authority An example of an insurance adjuster would be - Correct Answer A person who investigates claims arising out under insurance contracts for fee or commission Which of the following is not an insurer but an organization formed to provide insurance benefits for members of an affiliated lodge or religious organization? - Correct Answer Fraternal benefit society What is the minimum age to apply for a resident license in this state? - Correct Answer 18 Pertaining to insurance, what is the definition of a fiduciary responsibility? - Correct Answer Promptly forwarding premiums to the insurance company A producer who fails to segregate premium monies from his own personal funds is guilty of - Correct Answer Commingling Which of the following entities investigates and negotiates settlement of claims arising under insurance contracts, on behalf of the insurer? - Correct Answer Adjuster After receiving a cease and desist order, how long does a person have to request a hearing? - Correct Answer 30 days The authority granted to an agent through the agent's contract is referred to as - Correct Answer Express authority Upon assuming office, the Commissioner must - Correct Answer Post a performance bond What must happen when an individual policy or annuity has been personally delivered to the policyowner? - Correct Answer The must sign a delivery receipt What is the maximum fine for attempting to obtain a license through fraud or misrepresentation? - Correct Answer $1,000 Limited lines producers are authorized to sell and service which line(s) of insurance? - Correct Answer Title insurance If an insurer meets the state's financial requirements and is approved to transact business in the state, it is considered to be - Correct Answer Authorized If a producer's appointment is not renewed, or is terminated, the Commissioner must be notified within - Correct Answer 30 days An insurance producer just sold an insurance policy to his sister. What kind of business is this? - Correct Answer Controlled All of the following would be considered an insurance transaction EXCEPT - Correct Answer obtaining an insurance license The Commissioner sent the producer a letter, and requested a response form that producer. The producer lost the letter, and, subsequently, never replied. What is the greatest civil penalty she could be assessed for this? - Correct Answer $10,000 Following the death of her husband, an insurance agent, Mary obtained a temporary insurance license. This license will allow Mary to do all of the following EXCEPT - Correct Answer Solicit new business An insurer just filed a premium rate with the Commissioner. Assuming the rate is not denied, within how many days can the insurer begin using that premium rate? - Correct Answer 31