Chapter 5

Question 1

Unforeseen and unintended injury resulted from accident rather than sickness

Cafeteria plan
Cancellation
Deductible

Answer 1

Accidental bodily injury

Question 2

Type of employee benefit plan that allows insureds to choose between different types of benefits

Accidental bodily injury
Lump sum
Riders
Cafeteria plan

Answer 2

Cafeteria plan

Question 3

Termination of in-force insurance policy by either insured or by insurer prior to expiration date shown in policy

No renewal
Riders
Sickness
Cancellation

Answer 3

Cancellation

Question 4

Health ins that provides coverage format types of medical expenses

Deductible
Lump sum
Comprehensive coverage

Answer 4

Comprehensive coverage

Question 5

Specified dollar amount insured must pay first before ins company will pay policy benefits

Lump sum
No renewal
Riders
Deductible

Answer 5

Deductible

Question 6

Payout method that pays beneficiary entire benefit in one payment

No renewal
Tax exempt
Lump sum

Answer 6

Lump sum

Question 7

Termination of ins policy at expiration date by not offering continuation of existing policy or replacement policy

Riders
Sickness
Underwriting
Nonrenewal

Answer 7

Nonrenewal

Question 8

Added to basic ins policy to add modify or delete policy provisions

Underwriting
Cafeteria pan
Lump sum
Riders

Answer 8

Riders

Question 9

Illness which first manifests itself while policy is in force

Answer 9

Sickness

Question 10

Not subject to taxation

Tax exempt
Taxable
Deductible
Cancellation

Answer 10

Tax exempt

Question 11

Subject to taxation

Underwriting
Accidental bodily injury
Taxable

Answer 11

Taxable

Question 12

Risk selection and classification process

Underwriting
Cafeteria plan
Cancellation

Answer 12

Underwriting

Question 13

Assigned points=

Answer 13

Relative value

Question 14

Assigned points multiplied by conversion factor
200x$10

Answer 14

Total amount payable
Relative value system

Question 15

In relativ value system of determining coverage for given procedure what term describes total amount payable per point

Relative value
Practical value
Conversion factor

Answer 15

Conversion factor

Question 16

Coverage written in conjunction with hospital expense policies covers surgeons fees anesthesiologist and operating room

Basic surgical expense
Basic medical expense
Major medical expense

Answer 16

Basic surgical expense

This includes surgeons fees anesthesiologist and operating room when covered as miscellaneous medical item

Question 17

Which would basic medical expense coverage not cover

Mental illness
Metarnity
Hospice
Surgeons services

Answer 17

Surgeon services

Question 18

Not true regarding basic surgical expense coverage

Coverage is unlimited
No deductible
Include surgical schedule
Commonly written in conjunction with hospital expense policies

Answer 18

Coverage is unlimited

Question 19

If not required to pay deductible what kind of coverage

Major medical
Comprehensive
Corridor
First dollar

Answer 19

First dollar

Question 20

Three basic coverages for medical expense ins

Reimbursement preventive service

Hospital surgical medical

Basic major overhead

Medical dental vision

Answer 20

Hospital surgical medical

Question 21

Not covered under basic hospital

Hospital room and board
Lab charges
Surgeons fees

Answer 21

Surgeon fees

Question 22

Good has hernia which requires repair. Learns ins plan will cover 200 points of surgical expenses. Each point represents $10
$2000 will be covered by ins plan. What system is Todd’s ins company using?

Relative value
Basic surgical
Point based medical
Conversion factor

Answer 22

Relative value

Question 23

Typical deductible for basic surgical expense ins

0
100
200
500

Answer 23

0

But coverage is limited

Question 24

Best describes first dollar coverage principal in basic medical ins

Not required to pay deductible
Must first pay deductible
Insurer covers first claim on policy

Answer 24

Insured not required to pay deductible

Question 25

In basic expense policy after limits of basic policy are exhausted insured must pay what kind of deductible None Cooidor Full Half

Answer 25

Corridor

Question 26

Derives its name from fact that applied between basic coverage and major medical coverage

Answer 26

Coridoor

Question 27

Describes coverage on first dollar basis Accident expense Limited major medical Basic expense

Answer 27

Basic expense

Question 28

Which is NOT true of major medical health ins policy Benefits are subject to deductibles Usually has maximum benefit amount Designed to pay on first dollar of expense basis Designed to cover hospital and medical expenses of a catastrophic nature

Answer 28

Designed to pay a first dollar of expense basis

Question 29

Usually has deductibles and copayment requirement

Answer 29

Major medical policy

Question 30

Corridor deductible derives its name from the fact that it is applied between basic coverage and Interval expense Limited coverage Major medical coverage

Answer 30

Major medical coverage

Question 31

Don has basic expense and major medical policy He is injured in accident which requires several major surgeries. Quickly exhausts don’s basic expense policy. What does don need to do before major medical policy can pick up where basic expense policy left off? Submit notification to major medical ins implant Wait six months in order to be covered again Pay special deductible on his major medical policy

Answer 31

Pay special deductible on his major medical policy

Question 32

Lists types of operations covered and their assigned dollar amounts

Answer 32

Surgical schedule