Accident And Health Insurance

Front 1

Under Federal law, a Qualified long-term care policy must be guaranteed renewable?

Back 1

True.

Front 2

The Health Insurance Portability and Accountability Act (HIPAA) applies to group medical expense insurance written by insurers, HMO's and PPO's, but does not apply to disability income insurance.

Back 2

True.

Front 3

In order for Portability of coverage to apply under HIPAA, the applicant must have at least 12 months of prior creditable coverage with no gap of more than how many days?

Back 3

63 days.

Front 4

A Cancelable health insurance policy may be canceled by either the insurer or the insured.

Back 4

True.

Front 5

Distributions from Medical Savings Accounts (MSA's) that are not used to pay for qualified medical expenses are not taxable as ordinary income plus they are subject to a 15% penalty tax. HSA'a are similar, but get a 10% penalty.

Back 5

False.

They are taxable as ordinary income.

Front 6

MSA's, may be set up only by small employers or individuals.

Back 6

True.

Front 7

Multiple Employer Trusts offer group coverage for employees of employers in a different industry.

Back 7

False.

Must be the same Industry.

Front 8

What provides evidence of group insurance coverage?

Back 8

Certificate of Insurance.

Front 9

What is the Master Policyholder?

Back 9

Considered to be the employer of a group insurance plan.

Front 10

On Non-Contributory Group, what percent of eligible employees must enroll?

Back 10

100%.

Front 11

Group health benefits paid to an employee are not taxable except for what type of income?

Back 11

Group Disability Income.

Front 12

Group insurance often utilizes what metric that takes into account the prior history of the group?

Back 12

Experience Rating.

Front 13

Group underwriting takes into consideration the average age of the group, the health of
the group and PERSISTENCY factors.

Back 13

True.

Front 14

A disabled child may not remain in the group as long as the parent submits proof of the
childs incapacity and continued dependency prior to their attainment of the limiting age.

Back 14

False.

The child is allowed to remain if the parent submits disability proof (for continued dependency).

Front 15

Group coverage must be written for the benefit of employees and can discriminate in
favor of highly paid workers.

Back 15

False.

It cannot discriminate.

Front 16

Under dental insurance, PROSTHODONTICS includes bridgework.

Back 16

True.

Front 17

Dental insurance has NO DEDUCTIBLE on diagnostic or preventative care.

Back 17

True.

Front 18

Dental insurance has NO DEDUCTIBLE on diagnostic or preventative care.

Back 18

True.

Front 19

On an INTEGRATED medical/dental plan, both medical and dental expenses are not subject
to the SAME DEDUCTIBLE.

Back 19

False.

They both are.

Front 20

A health insurance policy that covers virtually all medical expenses is known as:

Back 20

COMPREHENSIVE PLAN.

Front 21

Medicare covers SKILLED NURSING, but not custodial care.

Back 21

True.

Front 22

Health insurance EXCLUDES injury or sickness resulting from WAR.

Back 22

True.

Front 23

When selling a MEDICARE SUPPLEMENT, an agent must give out the Outline of
Coverage (or Guide) no later than:

Back 23

The time of application and must obtain a signed receipt from the applicant.

Front 24

MEDICARE SUPPLEMENT plans are required to be approved by Medicare.

Back 24

False.

They are required.

Front 25

After receipt of NOTICE OF CLAIM from the insured, the insurer must send out CLAIM
FORMS.

Back 25

True.

Front 26

Insurers do not have to pay UNSUBSTANTIATED claims.

Back 26

True.

Front 27

When an insured has a PRESUMPTIVE DISABILITY, they no longer have to prove that
they meet the definition of total disability.

Back 27

True.

Front 28

To be FULLY INSURED for social security disability benefits, a worker must have
contributed to social security for at least:

Back 28

40 QUARTERS.

Front 29

Health insurance policies sometimes pay claims on a USUAL, CUSTOMARY AND
REASONABLE basis, which is based upon the geographic area where the insured
resides.

Back 29

True.

Front 30

Health Maintenance Organizations (HMOs) wont cover out of network services unless it
is on an ____________ basis.

Back 30

Emergency.

Front 31

PPO subscribers who go out of network for services will receive __________ benefits.

Back 31

Reduced.

Front 32

Monitoring the length of a hospital stay is a form of _____________ review.

Back 32

CONCURRENT.

Front 33

HMOs waive pre-authorization requirements in the event of EMERGENCIES.

Back 33

True.

Front 34

On medical expense insurance with family coverage, newborn children must be covered
from the MOMENT OF BIRTH.

Back 34

True.

Front 35

A CARRY-OVER DEDUCTIBLE applies to claims that occur during the last how many months
of the calendar year. They carry over and apply to next years deductible.

Back 35

3 months.

Front 36

Medicare covers end-stage renal disease on an excess (or secondary) basis over and
above any group medical expense insurance that applies, regardless of the number of
employees covered by the group policy.

Back 36

True.

Front 37

On groups of at least __, employees remain eligible for group coverage even after
attaining AGE 65.

Back 37

20.

Front 38

Under HIPAA, pregnancy MAY NOT be considered to be a pre-existing condition.

Back 38

True.

Front 39

The Medicare Part B co-insurance requirement is calculated as a percentage of
Medicares __________ AMOUNT, not the amount the doctor charges.

Back 39

APPROVED.

Front 40

On Medicare, the difference between what the doctor bills and what Medicare pays is
called the EXCESS CHARGE.

Back 40

True.

Front 41

Both insurance companies and HMOs may offer _________ _________, which is a type
of Medicare Supplement policy that limits the insureds choice of providers, but offers
broader coverage for a lower price.

Back 41

MEDICARE SELECT.

Front 42

An older person with little income or assets who is concerned about custodial care may
obtain coverage through ________.

Back 42

MEDICAID.

Front 43

The period of time that a Long Term Care (LTC) policy will provide custodial care in a
nursing home is known as the BENEFIT PERIOD.

Back 43

True.

Front 44

NON-CONTRIBUTORY group disability income benefits are taxable to the employee.

Back 44

True.

Front 45

Under the ________ __ _____ clause, benefits are adjusted to what the premium
paid would have purchased if the correct age was known.

Back 45

MISSTATEMENT OF AGE.

Front 46

Requiring a SECOND OPINION prior to performing surgery will result in more claims.

Back 46

False.

It actually results in fewer claims.

Front 47

Medical Expense is:

Back 47

Insurance that covers your doctor and hospital bills and is the most common type of disability insurance.

Front 48

Dental Expense is:

Back 48

Insurance that is usually sold on a group basis due to adverse selection.