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49 Cards in this Set
- Front
- Back
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In the insurance field , the term coinsurance means that an insured person
A. Has coverage under two or more policies B. Has to pay a portion of covered services C. Has coverage under his or her own policy and under the spouse's policy D. All parts of the contract, giving equal importance to each |
Has to pay a portion of covered expenses
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The principal purpose of the Medicaid program is to assist
in providing medical care to persons who are A. Not covered by Medicare B. Over the age of 65 C. Unable to afford he medical care they need D. Not covered by any individual insurance plan |
Unable to afford the medical care they need
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3. Because an insurer writes the policy language and the
insured has littele or no control over the content, any ambuguity in the wording is usually resolved in favor of the insured. Because the design ans wording of a policy are in the hands of the insurer, insurance policies are said to be A. Unilateral contracts B. Contracts of Indemnity C. Aleatory contracts D. Contracts of Adhesion |
Contracts of Adhesion
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4. Suppose an insurance contact contains inconsistent or
contradictory provisions. Various parts of the contract are printed, typewritten, and handwritten. In seeking to determine the original intent, the court is likely to rely on A. The handwritten material first, then the typewritten, and then the printed B. The typewritten material first, then the printed, and then the handwritten C. The printed material first, then the typewritten, and then the handwritten D. All parts of the contract, giving equal importance to each |
The handwritten material first, then the typewritten, and then the printed
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5. All of the following are true about Medicare supplement
policies except A. The policies are subject to approval by state insurance departments. B. They supplement Medicare by paying toward the deductibles and copayments C. They may cover some services not covered by Medicare D. They are sold by state and federal agencies. |
They are sold by state and federal government agencies
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6. A group major medical policyholder that provides benefitson a self-funding basis may limit its total liability for claims by purchasing
A. Supplemental coverage B. A stop-loss contract C. Coinsurance D. A, deductible |
A stop-loss contract
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7. One technique that helps conrtrol health care costs is a requirement for
A. Preeesting condition B. Second surgical opinion C. Waiver of premiums D. Optional benefit riders |
Preexisting conditions
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8. All of the following are true about insurance except
A. Insurance is a mechanism for handling speculative risk. B. Insurance transfers risks from one party to another C. It is a social device for spreading loss over a large number of people D. A large uncertain loss is traded foe a small certain loss |
Insurance is a mechanisn for handling speculative risk
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Members covered by a group health insurance plan receive a document that summarizes the benefits and the important policy provisions. This document is known as a
A. Master policy B. Member's policy C. Coordination of benefits D. Certificate |
Certificate
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All of th following are true about group health insurance except
A. It has fewer limitations on benefits that an individual insurance B. All participantsare insured under a single master contract. C. All members of the insurd group must be covered. D. It is rated on a group basis |
All members of the insured group must be covered.
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11. A type of insurance that provides a death benefit and benefits for a permanent loss of sight or limbs
A. Medical Expense policy B. Disability income insurance C. Life insurance with coinsurance D. Accidental death and dismemberment insurance |
Accidental death and dismemberment insurance
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12. In health insurance policies, a preexisting condition is one that
A. An insurer puts forth as a prerequisite to acceptance of the risk B. An applicant suspects already exists when completing the application. C. An applicant received medical advice or treatment for prior to applying D. An insurer requires the applicant to agree to before it issues a policy |
An applicant received medical advice or treatment for prior to applying
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13. A self-funded health care plan may be a practical alternative to insurance for an employer if
A. Claim costs are fairly predictable. B. Claim costs are generally unpredictable C. Th employer cannot afford to buy insurance D. The employer is engaged in a high-risk industry. |
Claim costs are fairly predictable
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14, It is illegal for an agent to pay, allow, give, offer. or promise to a prospective insurance buyer any return of premiums , any special favor or advantage or anything of value, as an inducement to buy insurance. This illegal practice is known as
A. Twisting B. Rebating C. Coercion D. Defamation |
Rebating
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15. Small employers, who might not be otherwise qualify for a group insurance plan, may be able to obtain similar low-cost benefits for their employees by joining a
A. Health care service organization. B. Health maintenance organization C. Preferred provider organization. D. Multiple employer trust. |
Multiple employer trust.
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16. Blue Cross and Blue Shield are
A. Health Maintenance organizations B. Prepaid health care service organizations C. Administrative service organizations D, Preferred provider organizations |
Prepaid health care service organizations
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17. All of the following are common charasteristics of disability income insurance except
A. The policies do not have any exclusions B. Each contract defines the disabilities it covers. C. Benefits are usually paid in periodic installments. D. Disabilities causes by accidental injury or illness are covered. |
Benefits are usually paid in periodic installments.
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18. A residual disability benefit provides an income in an insured
A, Has exhausted all partial disability benefits B. Has exhausted all temporary disability benefits C. It coordinated benefits under all available group and individual policies D. Disabled children may be covered beyond the limiting age. |
It coordinates benefits under all available group and individual policies.
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19. All of the following are true about dependent coverage group health insurance policy except
A. It establishes which plan pays first. B. It is designed to prevent over compensation for incurred losses. C. It coordinateds the benefits under all available group and individual policies. D. It limits benefits when insurance is provided under more than one plan |
It coordinated benefits under all available group and individual policies.
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20. All of the following are true about dependent coverage under group health insurance policy except
A, Generally, eligible children must be under a specific age B. All dependents must be related to the insured by blood or marriage. C. The insured worker's parents may be covered beyond the limiting age. |
The insured worker's parents may be covered beyond the limiting age.
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21. In the administration os a group health insurance plan, if there is a clerical error concerning the information about an insured, the person's coverage and benefits
A. Could be reduced B. Could be delayed C. Could be terminated D. Will be affected |
Could be delayed
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For employer-paid (noncontributory) group health insurance, the percentage of eligible group members that must be covered is
A. 50% B. 65% C. 75% D. 100% |
100%
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Which of the following terms means that an insurance contract is dependent on an uncertain outcome?
A. Valued B. Aleatory C. Unilateral D. Adhesion |
Adhesion
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One of the reasons why so many group disability insurance policies are written on a nonoccupational basis is that
A, Occupational coverage is too expensive B. Health Insurance can no longer be written on an occupational basis C. Occupational coverage is provided by worker's compensation D. Few occupational risks exist because of health and safety regulations |
Health insurance can no longer be written on an occupational basis.
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A disability that prevents a person from performing one or more of the regular duties of that person's job and that is a condition that will last for the remainder of the person's life, is a
A. Permanent partial disability B. Permanent total disabability C. Temporary partial disability D. Temporary total disability |
Temporary partial disability
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Under contract law, the payment of mony in exchange for a service would be known as
A. Agreement B. An offer C, Consideration D. Implied authority |
An offer
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What is the name of a health care delivery system providing prepaid doctor and hospital care, emphasizing preventive care, and charging a fixed periodic fee to its enrolled members?
A. Preferred provider network B. Administrative serviced organization C. Health care service organization D. Health maintenance organization |
Health care service organization
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What is the name of a health care deliverysystem involving private insurers who contractwith doctors and hospitals to provide services at set prices and that allows insureds to choose among designated doctors and hospitalswhen medical treatment and care is needed?
A. Preferred provider organizatiom B. Administrative services organization C. Health care service organization. D. Health maintenance organization |
Preferred provider organization
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Th part of the health insurance policy that states the kind of benefits provided and the circumstances under which they will be paid is/ are the
A/ Definitions B. Conditions C. Benefit clause D. Face of the policy |
Benefit clause
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In health insurance policies, the purpose of a grace period is to give a policyholder extra time to
A. Pay a premium after the due date B. Submit a proof of loss to an insurer C. Appear for a medcal exam to justify a claim D. Face of the policy |
Pay a premium after the due date
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Each of the followingis a significant consideration in the underwriting of individual health insurance risks except
A. Occupations B. Age of applicant C. Physival condition D. Geographic location |
Geographic location
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Which definition of total disability would be the most restrictive for an insured claiming risks?
A. The inability to perform the duties of any occupation B. The inability to perform all the duties of the insured's regular occupation C. The inability to perform some of the duties of the insured's regular occupation D. The inability to perform any of the duties of the insured's regular occupation |
The inability to perform the duties of any occupation
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In health insurance policies,a waiver of premium provision keeps the coverage in force without premium payments
A. Whenever an insured os unablr to work B. During the time an insured is confined in a hospital C. Following an accidental injury D. After an insured has become totally blinded as defined in the policy |
After the insured has become totslly blinded as defined in the policy
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Social security disability benefits begin ahter a waiting period. Generally , benefits begin with the
A. 3rd month of disability B. 6th month of disability C. 9h month of disability D. 18th month of disability |
6th month of disability
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Disability income policies often do not begin paying benefits immediately when an insured person has become disabled. Usually the disability must continue for a period of time before benefits begin, This period is known as the
A. Trial period B. Probationary period C. Elimination period D. Verification period |
Elimination period
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Eligibility for social security disability benefits depends on having the required work credits, which are accumulated in units of time. During each calendar year , a full - time worker may earn up to
A. Three work credits. B. Four work credits C. Six work credits D. Twelve work credits |
Four work credits
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Workers compensation programs provide each of the following types of benefits except
A. Death benefits B. Medical benefits C. Disability benefits D. Retirement benefits |
Retirement benefits
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All of the following are true about a presumptive disability except
A. Such an examination is considered to be total and permanent. B. Examinations to verify the loss will be required only every two years. C. Loss of two limbs qualifies as a presumptive disability D. Loss of sight qualifies as a presumptive disability |
Examinations to verify the loss will be required only every two years.
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Not all disabilities are covered by social security disability benefits, a disability must be serious enough to be expected
to be fatal or at least A.. six months B.12 months C.18 months D. 24 months |
12 months
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Health Insurance policies have a consideration clause, which states that the insurance is provided in consideration of what?
A. Payment of conditional premium B. Statements made by the applicant to the agent C. The representations made in the completed, signed application D. Payment of the first premium and completion of the application |
Payment of the premium and the completion of the application
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Under the Uuniform Provisions law. a required provision concerning a notice of claim obligates a policyholder to give the insured or its agent notice of claim within
A. 20 days after a los, or as soon as reasonably possible B. 30 days after a loss, or as soon as reasonably possible C. 60 days after a loss, or as soon as reasonably possible D. 90 days after a loss, or as soon as reasonably possible |
20 days after a loss
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Restrictions are usually placed on the amount of insurance that agents can write on their own property or interests, or those of their immediate family, their employers, and certain business relationships, This type of insurance is called
A. Admitted business B. Controlled business C. Authorized business D. Unauthorized business |
Controlled business
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When a party appears to have given up a particular right by acts or by inaction that another party has relied on, the legal basis for asserting the original right my have been lost. This is known as the legal dictrine of
A. Waiver B. Warranty C. Estoppel D. Condition precedent |
Estoppel
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Under a provision known as the time payment of claims in a health insurance policy, after receiving proof of loss, all benefits other than those that are apid in periodic installments are supposed to be paid
A. Within 30 days B. Within 60 days C. Immediately D. At the end of the month |
Immediately
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A health insurance policy has lapsed because if nonpayment of premiums. If th policy does not require an application for reinstatement, the policy must be reinstated on
A. Accpetance of the overdue premium by the agent B. avveptance of the overdue premium by the insurer C. Receipt by the agent of a written request for reinstatement D. Receipt by the insurer of a written request for reinstatement |
Acceptance of the overdue premium by the insurer
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If a health insurance policy has lapsed and it is later reinstated, the reinstated policy will cover only sickness that begins
A. After the date of reinstatemnet B. At least 10 days after the date oF reinstatement C. At least 20 days after the date of reinstatement D. At least 30 days after the date of reinstatement |
At least 10 days after the date of reinstatement
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Individual health insurance policies may include a provision concerning unpaid premiums. When a provision applies, if a premium payment is overdue when a claim for benefits is made
A. Coverage is suspended until the premium is paid. B. The insurer may pay the claim and then cancel the policy C. A written demand for premium payment will be sent to the insured. D. The insurer may deduct the overdue premium from the benefits |
The insurer may deduct the overdue premium from the benefits.
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Which of the following is not covered under Medicare hospital insurance benefits
( Part A) A. Physician's services B. Semiprivate room and board C. Home health care D, Skilled nursing facility care |
Physician's services
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It's an agents obligation to act in an insured's best interest, based on faith and trust placed on an agent by members of the insurance-buying public, is known as
A. A presumption of the agency B. The warranty of the agent C. A fiduciary duty D. The duty owed to the principal |
A fiduciary duty
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