Ch 14/15/16

Question 1

Health insurance polices include an exclusion provision. All of the following will be excluded under an accidental health policy accept.

Answer 1

Self inflicted injury

Question 2

What is the purpose of the coinsurance clause

Answer 2

To encourage the insured to share in the cost of care.

Question 3

Physicians expense coverage is often referred to

Answer 3

Out patient expense

Question 4

Which of the following polices pays a benefit if an insured suffers a illness due to cancer only

Answer 4

Dread decease policy

Question 5

What is the primary purpose of medical expense insurance deductible

Answer 5

To eliminate smaller claims

Question 6

A policy paying benefits on relative value basis is probably

Answer 6

Surgical expense plan

Question 7

In most major medical polices, if an insured 20 year old son drops out of collage, he will continue to be covered under his parents major medical policy

Answer 7

Yes up to age 26

Question 8

Which of the following is a eligible dependent that may be covered by a group or individual medical expense plain

Answer 8

A step child of the insured

Question 9

Which of the following is an example of a endodontic procedure

Answer 9

Root Canal

Question 10

Which of the following is a illustration of a prosthodtics

Answer 10

Dentures and bridgework

Question 11

Which of the following can a doctor use if she wants to find out prior to treatment being provided is such treatment is covered by an insured medical plain

Answer 11

prospective review

Question 12

Which of the following provides comprehensive insurance coverage

Answer 12

Medical expense

Question 13

Which of the following is based upon a fee for service approach

Answer 13

Major Medical Plan

Question 14

Which of the following is true regarding the Affordable Care Act

Answer 14

All exchanges must provide an internet portal fort all registrations

Question 15

If a covered worker qualifies for disability benefits under social security, monthly income benefits would begin after a waiting period of

Answer 15

five months

Question 16

Medicare is a federally sponsored two part health insurance program. Each of the following medical services is covered under Part A of Medicare Except

Answer 16

Physicians Care

Question 17

Part B of Medicare is optional coverage. Which of the following would not be covered by this portion of Medicare?

Answer 17

Eye Examination

Question 18

All the following are acts of daily living EXCEPT

Answer 18

Breathing

Question 19

Medicare Supplement polices may not include a pre existing condition limitation that exceeds

Answer 19

6 months

Question 20

What is the purpose of a elimination period which appears in a Long Term Care Policy.

Answer 20

To allow the insurer to lower cost for everyone’s benefit

Question 21

Polices providing Hospice care benefits are not required to provide

Answer 21

Home Health care

Question 22

Which of the following would not be eligible for enrollment in the Medicare prescription drug plan

Answer 22

A person 66 not eligible for social security benefits

Question 23

To be eligible for coverage under Part C of Medicare, an individual does not have to prove he or she is insurable if enrollment occurs during what period of time following the attainment age of 65

Answer 23

6 moths

Question 24

Which of the following Medicare coverage sections provides managed health care.

Answer 24

Part C

Question 25

Which of the following long term care benefits provides 24 hour care

Answer 25

Skilled nursing care

Question 26

Which provider is considered the second payor if an individual is covered by both Medicare and group health insurance

Answer 26

Medicare

Question 27

A long term care policy provides coverage for which of the following

Answer 27

Alzheimer

Question 28

What health insurance provision allows an insurer to deny a claim if finds that the insured concealed information about his health

Answer 28

Grace Period

Question 29

An insured suffers a covered illness. He or she must notify the insurer of the loss with in

Answer 29

20 days

Question 30

Which of the following provisions is a required uniform health insurance provision

Answer 30

Legal action

Question 31

A policy Owner may have his policy reinstated after a lapse if a reinstatement application is completed and approved. Once this application is submitted the insurer must notify the insured of its approval or declination with in

Answer 31

45 days

Question 32

In health insurance policy, the policy owner consideration is

Answer 32

the premium paid and representations on the application

Question 33

The fact that a A&H premium payment of S500 must be paid is stipulated in which of the following parts of the policy

Answer 33

Insuring Clause

Question 34

Once the insured is injured and notifies the insurer, the latter must send out proof of loss with in

Answer 34

15 Days

Question 35

If an insurer pays an A&H claim but later finds that the insured was injured while engaging in illegal activity, what action will they take

Answer 35

Attempt to recover the claim of payment

Question 36

What type of claim A&H policy can have its premiums increased for an entire class of polices

Answer 36

Guaranteed renewable