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20 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in sharing of expenses ? |
Stop-loss limit |
A"Stop-loss limit" is a specified dollar amount beyond which the insured n longer participates in the sharing of expenses |
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An HMO is regarded as an organized system of health care that provides a comperhensive array of medical services on a ? |
Prepaid basis |
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What is franchise insurance ? |
It is health coverage for small groups that are to small to qualify for true group insurance. |
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All of the following can qualify as a trust EXCEPT ? |
Anempolyer insuring at least 5 employees for the benefit of that employer |
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Which of the following is true regarding MET's ? |
They allow several small employers purchase less expensive insurance together |
Thoses small employers who cannot qualify for group health insurance band together for the purpose of buying insurance. |
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In franchise insurance, premiums are usually ? |
Lower than individual policies, but higher than group policies |
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Which of the following is NOT a feature of a guaranteed renewable provision ? |
The insurer can increase the policy premium on an individual basis |
Gusranteed renewable provision has all of the same features that the noncancellable provision dose, with the exception that the insurer can increase the policy premium on the policy anniversary date. However the premiums can olny increase on a class basis, not on an individual policy |
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Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the remiums for any class of the insureds ? |
Optionally renewable |
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In health insurance, what is a copayment ? |
A specified amount paid by the insured when treatment is recieved |
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Which of the following is true concerning an Exclusive Provider Organization (EPO) |
It has a very limited number of providers |
EPO is a type of PPO, in which the members do not choose healthcare provider. Instead,they use specific providers who are paid on a fee-for-service basis. Numbers of providers are very limited; how even the offerdeeper discounts on their rates. |
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Mortality- Interest + Expense = |
Gross premium |
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Which of the following is true regarding elinination peroids and cost of coverage ? |
The Longer the elination peroid the LOWER the cost coverage. |
The "elimination peroid" is a peroid of days which must expire after the onset of an illness or occurance of an accident before benefits will be payable. The LONGER th elimination peroid the LOWER the cost of coverage will be. |
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All of the following are TRUEregarding the medical Information Bureau (MIB) EXCEPT? |
MIB reports are based upon information supplied by doctors and hospitals. |
The information contained in MIB reports come from the underwriting disclosures made by applicants to MIB memeber insurers on prior insurance applicants to MIB member insurers on prior insurance applications. |
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An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This incates that his policy is written with a 30-day |
Elimination peroid |
The elimination peroid is a time IMMEDIATELY following the START of a DISABILITY when benefits are not payable. This is used to reduce the cost of providing coverge and eliminates the filing ofmany claims. |
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What document describes an insured's medical history, including diagnoses andtrements ?t |
Attending Physician's Statement |
An Attending Physician's Statement (APS) is the best way for an underwriter to evaluated an insured's medical history. The report includes past diagnosis treatments, length of recovery time, and prognosis. |
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L has major medical policy with a $500 deductable and a 80/20 coinsurance, L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will pay ? |
$900 (deductable + 20% of the bill after deductable [20%of $2,500]) |
L woulf first pay the $500 deductable; out of the remaining $2,000, the insurer will pay 80% ($1,600) and the insured will pay 20% ($400) |
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Which type of hospital policy pays a fixed amount EACH DAY that the insured is in the hospital |
Indemnity |
AHospitial Indemnity policy pays a fixed amount each day the insured is hospitialized , unrelated to medical epenses. |
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Insurer X charges the premiumfrom its insured costomers, passing on operating expenses for the company. The operating expenses plus the premium equals the gross premium. What is another name for the operating cost for Insurer X ? |
Expenses loading |
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Which of the following would an accident-only NOTcover ? |
Surgery to repair a wrist damage by tendonitis |
Accident-only cover medical cost caused by accident not sickness. Because the wrist was damage by sickness, not an accident, the policy would not cover anymedical claims relating to the surgery or the condition itself |
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wHICH OF THE FOLLOWING IS TRUE REGARDING A TERM HEALTH POLICY ? |
Its nonrenewable |
In term health policies the owner has NO rights of renewable |
