CH6 Flashcards
(26 cards)
Which of the following is NOT a characteristic or a service of an HMO plan?
A- Providing care on an outpatient basis
B- Encouraging early treatment
C- Providing free annual checkups
D- Contracting with insurance companies
D- Contracting with insurancecompanies
A hospital indemnity policy will pay
A- Income lost while the insured is in the hospital.
B- All expenses incurred by the stay in the hospital.
C- Any expenses incurred by the stay in the hospital, minus coinsurance payments and deductibles.
D- A benefit for each day the insured is in a hospital.
D- A benefit for each day the insured isinahospital.
In a Disability Income policy, all of the following are considered presumptive disabilities EXCEPT
A- Loss of speech.
B- Loss of one eye.
C- Loss of hearing.
D- Loss of two limbs.
B- Loss of one eye.
Which of the following statements is NOT correct concerning the COBRA Act of 1985?
A- It covers terminated employees and/or their dependents for up to 36 months after a qualifying event.
B- It applies only to employers with 20 or more employees that maintain group health insurance plans for employees.
C- COBRA stands for Consolidated Omnibus Budget Reconciliation Act.
D- It requires all employers, regardless of the number or age of employees, to provide extended group healthcoverage.
D- It requires all employers, regardless of the number or age of employees, to provide extended group healthcoverage.
When health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost, is called
A- Point of Service Plans (POS).
B- Indemnity plans.
C- Managed care.
D- Preferred Provider Organization(PPO).
D- Preferred Provider Organization(PPO).
The type of dental plan which is incorporated into a major medical expense plan is a/an
A- Stand-alone dental plan.
B- Supplemental dental plan.
C- Blanket dental plan.
D- Integrated dental plan.
D- Integrated dental plan.
All of the following are differences between individual and group health insurance EXCEPT
A- Individual coverage can be written on an occupational or nonoccupational basis; group plans cover only nonoccupational.
B- Individual policies are renewable at the option of the insured, while group policies usually terminate when the individual leaves the group.
C- individual policies, the individual selects coverage options, while in a group plan all employees are covered for the same coverage which is chosen by the employer.
D- Individual insurance does not require medical examinations, while group insurance does require medical examinations.
D- Individual insurance does not require medical examinations, while group insurance does require medicalexaminations.
Assuming that all of the following people are covered by a High Deductible Health Plan and are not claimed as dependents on anyone’s tax returns, which would NOT be eligible for a Health Savings Account?
A- Jenny is 60 and also has a long-term care insurance plan
B- Andy is 55 and is covered under a dental care policy
C- Joe is 40 and is not covered by any other health insurance
D- Amanda is 67 and is covered by a basic medical expense policy
D- Amanda is 67 and is covered by a basic medicalexpensepolicy
Which of the following answers does NOT describe the principal goal of a Preferred Provider Organization?
A- Provide the subscriber a choice of hospitals
B- Provide the subscriber a choice of physicians
C- Provide medical services at a reduced cost
D- Provide medical services only from physicians in the network
D- Provide medical services only from physiciansinthenetwork
The benefits for individual disability plans are based on
A- The number of employees of the company.
B- The employer’s net worth.
C- A percentage of the worker’s income.
D- A flat amount
D- A flat amount.
How often must group plans pay short-term disability benefits?
A- Monthly
B- Weekly
C- Bi-weekly
D- Once, at the end ofthedisability
B- Weekly
Employers can reduce health plan costs by coupling a Health Reimbursement Account (HRA) with
A- A low deductible health plan.
B- A high deductible health plan.
C- An IRA.
D- Nothing; HRAs cannot be coupled with any otherhealthplan.
B- A high deductible health plan.
Todd has been informed that he has a hernia which requires repair. When Todd researches the cost, he learns that his insurance plan will cover 200 points worth of surgical expenses. Each point represents $10, which means that $2000 of his surgery will be covered by his insurance plan. What system is Todd’s insurance company using?
A- Point-based medical
B- Basic Surgical
C- Relative value
D- Conversionfactor
C- Relative value
After a person’s employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true?
A- The employee can convert from group to individual insurance within 31 days of termination.
B- By law, the new, individual policy must provide the same benefits as the group insurance policy.
C- The premium of the individual health insurance policy can be higher than the original policy.
D- Continuation of group coverage need not include dental, vision, or prescriptiondrugbenefits.
B- By law, the new, individual policy must provide the same benefits as the group insurance policy.
How can a new physician be added to the PPO’s approved list?
A- Fill out the appropriate paperwork and wait the 12 month pre-certification period.
B- Agree to follow the PPO standards and charge the appropriate fees.
C- New physicians are only added once a year, and are selected by the PO’s Board of Directors.
D- Pay an annual fee for being onthePPOlist.
B- Agree to follow the PPO standards and charge the appropriate fees.
Can an individual who belongs to a POS plan use an out-of-network physician?
A- Yes, and they may use any preferred physician, even if not part of the HMO
B- No
C- Yes, but they must use the POS physician first
D- Yes, but they must use the HMOphysicianfirst
A- Yes, and they may use any preferred physician, even if not part of the HMO
What are the tax implications for contributions to a Health Savings Account?
A- Post-tax dollars
B- Subject to capital gains taxes
C- Subject to personal income taxes
D- Tax deductible
D- Tax deductible
Benefit periods for individual short-term disability policies will usually continue from
A- 2 years to age 65.
B- 6 months to 2 years.
C- 3 months to 3 years.
D- 1 weekto4weeks.
B- 6 months to 2 years.
What size companies are eligible for health reimbursement accounts (HRAs)?
A- Sole proprietors only
B- Companies of all sizes
C- Small employers only
D- Companies with at least 100employeesonly
B- Companies of all sizes
Which statement accurately describes group disability income insurance?
A- In long-term plans, monthly benefits are limited to 75% of the insured’s income.
B- There are no participation requirements for employees.
C- The extent of benefits is determined by the insured’s income.
D- Short-term plans provide benefits forupto1year.
C- The extent of benefits is determined by the insured’s income.
Don has both a basic expense and a major medical policy. He is injured in an accident, which requires several major surgeries. This quickly exhausts Don’s basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?
A- Pay a special deductible on his major medical policy
B- Nothing needs to be done. The hospital’s billing staff will make the appropriate arrangements.
C- Submit written notification to his major medical insurance company
D- Wait 6 months in order to becoveredagain
A- Pay a special deductible on his major medical policy
A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as
A- AD&D.
B- Major medical.
C- Critical illness
D-Medicalexpense.
C- Critical illness
When an insurer combines two periods of disability into one, the insured must have suffered a
A- Residual disability.
B- Recurrent disability.
C- Presumptive disability.
D- Partialdisability.
B- Recurrent disability.
Regarding the taxation of Business Overhead policies,
A- Premiums are deductible, and benefits are taxed.
B- Premiums are not deductible, but expenses paid are deductible.
C- Premiums are not deductible, and benefits are taxed.
D- Premiums are not deductible, but benefitsaredeductible.
A- Premiums are deductible, and benefits are taxed.
