Chap 5 Cont 7

Question 1

Optional benefits with long term care policies

Included in all policies
Available for additional premium
Only standard benefits are available with LTC policies

Answer 1

Available for an additional premium

Question 2

Not an activity of daily living ADL

Dressing
Bathing
Talking
Eating

Answer 2

Talking

Question 3

Regarding optional benefits with long term care policies

All included in all policies
Available for additional premium
Only standard benefits are available with LTC policies

Answer 3

Available for an additional premium

Question 4

Longterm care covers three levels of care:

Skilled nursing, intermediate care custodial care
Home care home convalescent residential
Adult day care respite care adhesion care

Answer 4

Intermediate care custodial care skilled nursing care

Question 5

Daily nursing and rehabilitative care only provided by medical personnel under direction of physician

Intermediate care
Skilled care
Custodial care

Answer 5

Skilled care

Question 6

Care that can be given by nonprofessional staff is not considered

Answer 6

Skilled care

Question 7

Occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care/ordered by physician and skilled personallel would deliver or monitor type of care

Intermediate care
Skilled care
Custodial care

Answer 7

Intermediate care

Question 8

Could be as simple as medication to a group or changing bandage

Home health care
Residential care
Custodial care
Intermediate care

Answer 8

Intermediate care

Question 9

Care for meeting personal needs such as assistance in eating, dressing, or bathing

Respite care
Custodial care
Intermediate care

Answer 9

Custodial care

Question 10

Provided by a skilled nursing or other professional services in ones home/occasional visits to person’s home by registered nurses or community based orgs like hospice

Adult day care
Residential care
Home health care

Answer 10

Home health care

Question 11

Provided in insureds home under a planned program established by the insureds attending physician by long term care facility home health care agency or hospital

Adult day care
Respite care
Home convalescent care

Answer 11

Home convalescent care

Question 12

Provided while insured resides in a retirement community or residential care facility for elderly RCFE with some degree of independences (possibly) same as living in one[‘s own home

Bc of costs for middle and upper classes

Adult day care
Respite care
Residential care

Answer 12

Residential care

Question 13

Provided for functionally impaired adults on less than 24 hour basis. Could be by neighborhood recreation or community center …includes transportation to and from day care center and activities/meals usually included

Respite care
Consideration
Home health care
Adult day care

Answer 13

Adult day care

Question 14

Designed to provide relief to family caregiver and can include services such as someone coming over during nap for caregiver

Respite care
Consideration
Aleatory
Asset

Answer 14

Respite care

Question 15

In longterm care ins what is provided with intermediate care

Intensive care
Occasional nursing or rehab care
Non medical daily care

Answer 15

Occasional nursing or rehabilitative care

Question 16

Occasional visits where following with NOT be covered under LTC home health care

Nurses
Licenses practical nurses
Attending physician

Answer 16

Attending physician

Question 17

Not covered under long term care policy

Hospice care
Home health care
Acute care in hospital

Answer 17

Acute care in hospital

Question 18

Who can provide skilled nursing care

Spouse
Doctor
Family member

Answer 18

Doctor

Question 19

Which location would skilled care be provided

Patients home
Outpatient setting
Institutional setting

Answer 19

Institutional setting under direction of physician

Question 20

Functionally impaired adults on a less than 24 hour basis coverage

Adult day care
Residential care
Assured living

Answer 20

Adult day care

Question 21

Skilled nursing intermediate and custodial care may all be provided in an intituational setting true or false

Answer 21

True

Question 22

Not provided in institutional setting

Skilled nursing
Intermediate care
Home health care
Custodial care

Answer 22

Home health

Question 23

Can group formed for sole purpose of obtaining group ins qualify for group coverage

Yes any group scan apply for group coverage
Yes but only if group is over 35 ppl
No group must be formed for purpose other than obtaining group insurance

Answer 23

No group must be formed for purpose other than obtaining grou insurance

Question 24

Association could buy grou ins for its members if it meets all of following except

Has at least 50 members
Has constitution and by laws
Holds annual meetings
Is contributory

Answer 24

Has at least 50 members

Must have at least 100

Question 25

Less than 100 hours=adult daycare

Question 26

Underwriting a group health ins plan that is paid for by employer requires all except Eligible employees must be covered Coverage for plan Ppts is uniform Individual members of group may select level of benefits fo their own coverage

Answer 26

Individual members of group may select the level of benefits for their own coverage

Question 27

Group health ins means all individual are covered under Contract Bill Asset Master policy

Answer 27

Master policy for same coverages

Question 28

Not characteristic of group health ins Policy is issued to each insured individual Dependents of insureds can be covered under group health plans Group coverage may be converted to individual coverage if group contact is ended

Answer 28

Policy is issued to each insured individual

Question 29

Small company offers grou health ins to its employees but recently has decided to terminate the health ins contract leaving the workers without ins Request a refund of unearned premium Convert to individual health policy Sue employer

Answer 29

Convert to an individual health policy

Question 30

Which concerning group health ins is correct Only employer receives a certificate of ins Each employee receives a policy Employer ithe policyholder

Answer 30

Employer is the policy holder

Question 31

Employer receives master policy and each employee receives Executive contract Policy Group ins Certificate of ins

Answer 31

Employee receives certificate of ins

Question 32

Which statement is NOT true regarding underwriting group health insurance Premiums are reassessed annually Everyone is covered regardless of medical history Group is assessed individually for insurability

Answer 32

Assessed individually for insurability

Question 33

Following are differences between individual and group health insurance EXCEPT Individual can be written on an occupational or non occupational basis; grou plans cover only non occupational Individual policies are renewable at the option of the insured while group usually terminate when the individual leaves the group Individual ins does not require medical examination while group ins does not require medical examinations

Answer 33

Individual ins does not require medical exams while group ins does require medical exams

Question 34

Group health ins is characterized by all of the following except Lower admin costs Conversion privilege Adverse selection A master contract

Answer 34

Adverse selection

Question 35

What is the period of coverage for events such as death or divorce under cobra 12 months 36 months 60 days 31 days

Answer 35

36 months

Question 36

Which is NOT correct re cobra act of 1985 Cobra stands for consolidated omnibus reconciliation act Requires all employers regardless of number or age of employees to provide extended group health coverage Covers termed employees and/or their dependents for up to 36 months after qualifying event

Answer 36

Requires all employers regardless of number of age of employees to provide extended group health coverage

Question 37

Cobra act applies to only employers with 5 10 15 20

Answer 37

20 or more employees

Question 38

Re group health ins cobra stipulates that Group coverage must be extended for terminated employees up to certain period of time at employer’s expense Group coverage must be extended for terminated employees up to a certain period of time at former employee’s expense Retiring employees must be allowed to convert their group coverage to individual policies

Answer 38

Group coverage must be extended for terminated employees up to a certain period of time at the former employee’s expense

Question 39

Cobra requires employers with twenty or more employees to continue group medical ins for termed workers and dependents for up to 18 to 36 months. Employee can be required to pay up to 5% 4% 102% 100% of coverage’s premium

Answer 39

102%