OHIO HEALTH INSURANCE EXAM QUESTIONS WITH 100% CORRECT VERIFIED ANSWERS LATEST UPDATE 20, Exams of Nursing

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OHIO HEALTH INSURANCE EXAM QUESTIONS WITH

100% CORRECT VERIFIED ANSWERS LATEST

UPDATE 2024-2025 ALREADY GRADED A

Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this? A.) Guaranteed insurability rider B.) Additional coverage rider C.) Paid-up option rider D.) Extended insurability rider ✔✔Guaranteed insurability rider All of the following are included as part of a contract in the entire contract provision EXCEPT the: A.) riders B.) application C.) changes made by the producer D.) policy ✔✔changes made by the producer

Which of the following statements is TRUE about Medicaid? A.) it is health insurance for the elderly B.) it is administered by the Federal government C.) it is funded by federal, state, and local taxes D.) Coverage includes compulsory hospital and voluntary supplementary medical insurance ✔✔it is funded by federal, state, and local taxes An insurer's ability to make unpredictable payouts to policyowners is called: A.) investment values B.) liquidity C.) assests D.) capital ✔✔liquidity Low frequency diseases can be exclusively covered by what kind of health insurance policies? A.) Limited policies B.) Blanket policies C.) Employer policies D.) Restricted policies ✔✔Limited policies Which of these is NOT considered a supplemental health insuring corporation (HIC) service? A.) outpatient medical services B.) foot care services C.) dental care

D.) chiropractic care ✔✔outpatient medial services Which of the following would evidence ownership in a participating health insurance contract? A.) Stock ownership B.) Irrevocable beneficiary status C.) Policy ownership D.) Collateral assignment ✔✔Policy ownership What percentage of a participant's income are group long-term disability benefit amounts typically limited to? A.) 30% B.) 40% C.) 50% D.) 60% ✔✔60% All of the following may be an unfair claims practice EXCEPT: A.) Turning down a claim without providing the basis of denial B.) Denying an insured's fraudulent claim C.) Failing to promptly acknowledge pertinent communications concerning claims D.) Failing to effectuate prompt, fair, and equitable settlements of a claim ✔✔Denying an insured's fraudulent claim Which of the following is NOT a common exclusion for a medical expense policy? A.) Physical therapy

B.) Act of war C.) On-the-job injury D.) Self inflicted injury ✔✔Physical therapy A long-term care policy typically provides all of the following levels of care EXCEPT: A.) skilled care B.) intermediate care C.) acute care D.) custodial care ✔✔acute care All of the following are elements of an insurance policy EXCEPT: A.) definitions B.) other insurance C.) claim forms D.) conditions ✔✔claim forms In group health care, what is the purpose of the coordination of benefits provision? A.) Determines where an insured goes to receive treatment B.) Determines what is paid by the primary and secondary insurers in the event of a claim C.) Ensures that a health provider receives the proper benefit amount owed D.) Determines which parent's plan covers a dependent child ✔✔Determines what is paid by the primary and secondary insurers in the event of a claim

Group dental plans will frequently place a limit on annual benefits in order to minimize: A.) adverse selection B.) enrollment C.) coinsurance D.) administrative costs ✔✔adverse selection The cause of a loss is referred to as a(n) A.) hazard B.) adversity C.) peril D.) risk ✔✔peril Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled? A.) Disability overhead policy B.) Business continuation policy C.) Disability buy-sell policy D.) Business overhead expense policy ✔✔Business overhead expense policy An applicant's character and personal habits can be obtained for underwriting purposes from which source? A.) Investigative consumer report B.) Attending physician's statement

C.) Medical Information Bureau (MIB) D.) Credit report ✔✔Investigative consumer report Which of the following is NOT a type of Medicare Advantage Plan? A.) Health Maintenance Organization (HMO) B.) Preferred Provider Organization (PPO) C.) Private Fee-For-Services (PFFS) D.) Social Security Disability Income (SSDI) ✔✔Social Security Disability Income (SSDI) A Medicare Supplement Policy is: A.) government insurance designed to provide healthcare to the elderly B.) designed to provide prescription drug coverage to the elderly C.) designed to fill in the gaps of Part A and Part B Medicare D.) a supplement to Medicare Advantage Part C ✔✔designed to fill in the gaps of Part A and Part B Medicare The difference between pre-certification and concurrent review is that pre-certification: A.) costs more to the patient B.) costs less to the patient C.) is considered a cost containment measure D.) occurs before the treatment is provided ✔✔occurs before the treatment is provided Medical Expense Insurance would cover:

A.) an injury occurring at the insured's residence B.) an injury occurring at work C.) an injury caused by war D.) elective surgeries ✔✔an injury occurring at the insured's residence Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes? A.) Partially taxable income B.) Non-taxable income C.) Taxable income D.) Conditionally taxable income ✔✔Taxable income A disability elimination period is best described as a: A.) time deductible B.) dollar deductible C.) eligibility period D.) probation period ✔✔time deductible The purpose of the Coordination of Benefits provision in group accident and health plans is to: A.) avoid overpayment of claims B.) reduce out-of-pocket costs C.) reduce adverse selection D.) lower the cost of premiums ✔✔avoid overpayment of claims

An insurer has the right to recover payment made to the insured from the negligent party. These rights are called: A.) contributory B.) indemnity C.) estoppel D.) subrogation ✔✔subrogation Which of these is a TRUE statement regarding HIC's? A.) Urgent care services are provided B.) HIC's must establish a complaint system C.) HIC's operate on a prepayment basis D.) Benefits are provided on a reimbursement basis ✔✔HIC's operate on a prepayment basis In what form do disability income policies typically pay benefits? A.) Lump sum B.) Periodic income C.) Tax credit D.) Annuity ✔✔Periodic income In an insurance contract, the applicant's "consideration" is the: A.) offer and acceptance B.) premium only

C.) statements made in the application and the premium D.) statements made in the application only ✔✔statements made in the application and the premium How does one become eligible for Part D: Prescription Drug coverage? A.) Must meet certain underwriting guidelines B.) Must have a valid prescription C.) Must have Medicare coverage D.) Must have Medicaid coverage ✔✔Must have Medicare coverage A dread disease policy is considered to be a type of: A.) hospital expense policy B.) group health insurance policy C.) major medical insurance policy D.) limited health insurance policy ✔✔limited health insurance policy An insurer must furnish to a claimant forms for filing proof of loss within ___ days upon receiving a notice of claim. A.) 10 B.) 15 C.) 20 D.) 25 ✔✔ 15

Which of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage? A.) Standard deductible B.) Combined deductible C.) Integrated deductible D.) Blended deductible ✔✔Integrated deductible Preferred risk policies with reduced premiums are issued by insurance companies because the insured has? A.) a higher face amount than average B.) a better ability to pay premiums over a long period of time C.) worse than average mortality or morbidity experience D.) better than average mortality or morbidity experience ✔✔better than average mortality or morbidity experience Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the: A.) employee's benefits still owed can be claimed B.) employee cannot be excluded from the new employer's health plan C.) employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan D.) new health insurance carrier will have a clear record of any chronic conditions that exist ✔✔employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan

People with higher loss exposure have the tendency to purchase insurance more often than those at average risk. This is called: A.) risk retention B.) preexisting conditions C.) law of large numbers D.) adverse selection ✔✔adverse selection How many employees must an employer have for a terminated employee to be eligible for COBRA? A.) 20 B.) 30 C.) 40 D.) 50 ✔✔ 20 Which of the following does Medicare Part D cover? A.) Intensive care coverage B.) Doctor visits C.) Prescription drugs D.) Hospital coverage ✔✔Prescription drugs The term which describes the fact that both parties of a contract may NOT receive the same value is referred to as? A.) Apparent B.) Estoppel C.) Aleatory D.) Unilateral ✔✔Aleatory

Loss of income insurance provides: A.) an individual the means to replace wages B.) an individual the ability to collect workers' compensation C.) an individual the ability to continue with medical coverage after a disability D.) unlimited income replacement to a disabled person ✔✔an individual the means to replace wages The type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called: A.) noncancelable B.) conditionally renewable C.) optionally renewable D.) cancelable ✔✔cancelable A Medicare Supplement policy must NOT contain benefits which: A.) charge additional premiums B.) duplicate Medicare benefits C.) cover more than Medicare coverage D.) are covered by Worker's Compensation ✔✔duplicate Medicare benefits When the principal gives the agent authority in writing, it's referred to as: A.) express authority B.) implied authority

C.) apparent authority D.) imposed authority ✔✔express authority An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay? A.) $ B.) $5, C.) $5, D.) $5,600 ✔✔$5, When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid? A.) No deductible payment is required B.) Deductible specified in the contract is payable by the insured C.) Insured must pay a percentage of covered losses D.) An initial deductible plus a percentage of the remaining covered loss is owed by the insured ✔✔No deductible payment is required Pierre is covered by his employer's group major medical plan. His employer pays for 75% of the premium and he pays for 25%. How much would a $10,000 benefit be taxable as income under this plan? A.) $10, B.) $7, C.) $2, D.) $0 ✔✔$

Which of the following nursing home options would BEST suit an individual who needs some nursing care and supervision but NOT full-time care? A.) Custodial care homes B.) Assisted living facilities C.) Skilled nursing facilities D.) Congregate housing ✔✔Assisted living facilities Which of the following decisions would a Health Savings Account (HSA) owner NOT be able to make? A.) The amount contributed by the employer B.) The amount contributed by the owner C.) The underlying account investments used D.) The medical expenses paid for by the HSA ✔✔The amount contributed by the employer Claims payable to a Disability Income insured, even when the insured can continue to work, are the result of a: A.) Total disability B.) Recurrent disability C.) Presumptive disability D.) Lengthy elimination period ✔✔Presumptive disability The difference between a Long Term Care Partnership Plan and a Non-Partnership Plan is which of the following?

A.) Pre-existing conditions B.) Level of benefits C.) Asset Protection D.) Elimination period ✔✔Asset Protection When a preferred provider organization (PPO) insured goes out-of-network, which of the following actions occur? A.) The insured will pay a reduced amount B.) The benefits are taxable C.) The insured has lower out-of-pocket expenses D.) The insurer will pay a reduced amount ✔✔The insurer will pay a reduced amount