question

Group health insurance will cover you but not your immediate family.

answer

false

question

Group health insurance covers all of your health insurance needs.

answer

false

question

Individual health insurance covers either one person or family.

answer

true

question

Very few group health policy contracts have a coordination of benefits provision.

answer

false

question

The coordination of benefits is a method of integrating the benefits payable under more than one health insurance plan so that the benefits received from all sources are limited to 100 percent of allowable medical expenses.

answer

true

question

Employees of state or local governments are covered by the Consolidated Omnibus Budget Reconciliation Act of 1986.

answer

false

question

People often buy surgical expense insurance in combination with hospital expense insurance.

answer

true

question

Physician expense insurance coverage never includes visits to the doctor's office, x-rays, and lab tests.

answer

false

question

Basic health insurance coverage includes hospital expense insurance, surgical expense insurance, and physician expense insurance.

answer

true

question

The maximum benefits payable under major medical insurance are high--up to $1 million per illness per year.

answer

true

question

A deductible provision requires the policyholder to pay a basic amount before the policy benefits begin.

answer

true

question

Hospital expense insurance pays part or all of hospital bills for room, board, and other charges.

answer

true

question

Surgical expense insurance pays part or all of the surgeon's fees for an operation.

answer

true

question

Physician expense insurance helps pay for physician's care that does not involve surgery.

answer

true

question

Hospital expense insurance, surgical expense insurance, and physician expense insurance are called basic health insurance coverage.

answer

true

question

The maximum benefits payable under major medical insurance are limited to under $50,000 per illness per year.

answer

false

question

A coinsurance provision requires the policyholder to share the expenses beyond the deductible amount.

answer

true

question

A stop-loss provision requires the policyholder to pay up to a certain amount, after which the insurance company pays 100 percent of all remaining covered expenses.

answer

true

question

Comprehensive major medical insurance is a type of major medical insurance that has a very high deductible amount.

answer

false

question

A hospital indemnity policy pays benefits only when you are not hospitalized.

answer

false

question

The hospital indemnity policy is a good substitute for basic or major medical protection.

answer

false

question

Dread disease and cancer policies are usually very good values.

answer

false

question

Long-term care insurance provides day-in, day-out care for long-term illness or disability.

answer

true

question

When you assign benefits, you let your insurer make direct payments to you.

answer

false

question

Internal limits in a health insurance policy set specific levels of repayment for certain services.

answer

true

question

Co-payment and coinsurance are synonymous.

answer

false

question

Exclusions and limitations provision specifies services that the policy does not cover.

answer

true

question

Guaranteed renewable provision means that the insurer can't cancel the policy unless you fail to pay the premiums.

answer

true

question

A reimbursement policy does not pay you back for actual expenses.

answer

false

question

An indemnity policy provides you with specific amounts, regardless of how much the actual expenses may be.

answer

true

question

A policy with internal limits will cover only a fixed amount for an expense.

answer

true

question

The cost of a health insurance is rarely affected by the size of the deductible.

answer

false

question

The cost of health insurance can be affected by the terms of the coinsurance provision.

answer

true

question

Out-of-pocket limits help you lower your financial risk, but they also increase your premiums.

answer

true

question

Your health insurance plan should offer basic coverage for hospital and doctor bills.

answer

true

question

Most health insurance in the United States is provided by government health care programs.

answer

false

question

Most health insurance in the United States is provided by private organizations rather than by the government.

answer

true

question

Blue Cross provides benefits for surgical and medical services performed by physicians.

answer

false

question

Blue Shield, an independent nonprofit corporation, provides hospital care benefits.

answer

false

question

Managed care refers to prepaid health plans that provide comprehensive health care to their members.

answer

true

question

An HMO is a health insurance plan that provides a wide rage of health care services for a fixed, prepaid monthly premium.

answer

true

question

HMOs allow you to choose any physician of your choice.

answer

false

question

A preferred provider organization (PPO) is a variation of an HMO.

answer

true

question

The premiums for PPOs are slightly lower than the premiums for HMOs.

answer

false

question

PPO plan members often pay no deductibles and may make minimal co-payments.

answer

true

question

A point-of-service plan combines features of both HMOs and PPOs.

answer

true

question

Perhaps the best-known government health program is Medicaid.

answer

false

question

Medicare is a state-funded health insurance program available mainly to people over 65 and to people with disability.

answer

false

question

Part A of Medicare pays for all covered services for inpatient hospital care after you pay a single annual deductible.

answer

true

question

Medigap insurance, intended to supplement Medicare, is sold and serviced by the federal government.

answer

false

question

Medicaid is administered by each state within certain broad federal requirements and guidelines.

answer

true

question

Medicare does not cover the expenses of private-duty nursing care.

answer

true

question

Two sources of government health insurance are Medicare and Medicaid.

answer

true

question

President Franklin D. Roosevelt established Medicare for people who are at least 60 years old.

answer

false

question

Local IRS offices take applications for Medicare and provide information about the program.

answer

false

question

Medicare has two parts: hospital insurance (Part A) and medical insurance (Part B).

answer

true

question

Hospital insurance (Part A) is financed from a portion of the Social Security payroll tax.

answer

true

question

Medicare hospital insurance (Part A) helps pay for doctors' services and a variety of other medical services and supplies not covered by hospital insurance.

answer

false

question

Medicare medical insurance (Part B) helps pay for doctors' services and a variety of other medical services and supplies not covered by hospital insurance.

answer

true

question

To get medical insurance (Part B) you must sign for it and pay a monthly premium.

answer

true

question

Medicare covers all medical costs but only if you are at least 65 years of age.

answer

false

question

Skilled nursing care is approved and covered by Medicare.

answer

false

question

Medicare covers routine checkups, dental care, most immunizations, cosmetic surgery, routine foot care, eyeglasses, and hearing aids.

answer

false

question

Medigap insurance is not sold or serviced by the federal government or state governments.

answer

true

question

Medicaid provides for a program of medical assistance to certain low-income individuals and families.

answer

true

question

Medicaid is financed by both state and federal funds.

answer

true

question

Medicaid differs from Medicare because eligibility for Medicaid depends on having very low income and assets.

answer

true

question

The Department of Health and Human Services maintains one of the richest and most reliable sources of information on the Internet.

answer

true

question

Unfortunately, the federal government does not provide any medical information on the Internet.

answer

false

question

Healthfinder, Medlineplus, and JIH Health Information are just a few sources provided by the American Medical Association.

answer

false

question

Disability income insurance benefits provide regular cash income lost by employees as the result of an accident, illness, or pregnancy.

answer

true

question

Disability income insurance is very common today, and several hundred insurance companies offer it.

answer

true

question

Disability can cause even greater financial problems than death.

answer

true

question

Basically, the word disability has only one definition.

answer

false

question

Good disability plans pay when you are unable to work at your regular job; poor disability plans pay only when you are unable to work at any job.

answer

true

question

Disability benefits begin on the first day you are disabled.

answer

false

question

Generally, disability income policies with shorter waiting periods have lower premiums.

answer

false

question

You should seek a disability policy that pays benefits for life.

answer

true

question

Disability income benefits begin on the 10th day you are disabled.

answer

false

question

You should aim for a disability benefit amount that when added to your other income will equal about 90 percent of your gross pay.

answer

false

question

The premium for non-cancelable and guaranteed renewable coverage is higher, but the coverage is well worth the extra cost.

answer

true

question

Most health insurance policies in the United States are sold to A) victims of communicable diseases. B) individuals with families. C) single individuals with no dependents. D) Employees and their dependents. E) Employers, who in turn offer the benefits to employees.

answer

E) Employers, who in turn offer the benefits to employees.

question

Which health insurance coverage requires careful shopping because coverage and cost vary from company to company? A) group health B) individual health C) hospital expense D) surgical expense E) physician's expense

answer

B) individual health

question

Which type of insurance provides for the partial replacement of income lost by employees as a result of an accident, illness, etc.? A) Comprehensive major medical B) major medical expense C) physician's expense D) Disability income E) surgical expense

answer

D) Disability income

question

Which type of health insurance pays part or all of hospital bills for room, board, and other charges? A) surgical expense B) hospital expense C) physician's expense D) Basic health E) major medical

answer

B) hospital expense

question

Which type of health insurance pays part or all of the surgeon's fee for an operation? A) surgical expense B) hospital expense C) physician's expense D) Basic expense E) major medical expense

answer

A) surgical expense

question

Which type of health insurance pays for physician's care that does not involve surgery? A) surgical expense B) hospital expense C) physician's expense D) Basic expense E) major medical expense

answer

C) physician's expense

question

Which type of insurance is usually bought in combination with hospital and surgical insurance? A) Disability income B) Comprehensive major medical C) major medical expense D) hospital indemnity E) physician's expense

answer

E) physician's expense

question

Which type of insurance protects against the large expenses of a serious injury or a long illness? A) Disability income B) major medical expense C) hospital indemnity D) physician's expense E) interim medical

answer

B) major medical expense

question

Which one of the following provisions requires that the policyholder pay a basic amount before the policy benefits begin? A) Coinsurance B) stop loss C) Deductible D) self insurance E) incontestable

answer

C) Deductible

question

Which health insurance policy pays benefits only when you are hospitalized, but pays these benefits in cash which you can use as you like? A) hospital indemnity B) interim or short-term C) Disability income D) Comprehensive major medical E) major medical expense

answer

A) hospital indemnity

question

Dental expense insurance provides reimbursement for A) oral examinations. B) fillings. C) Extractions. D) oral surgery. E) All of the above provide reimbursement.

answer

E) All of the above provide reimbursement.

question

According to your textbook, dread disease policies A) are almost always excellent buys. B) should never be purchased. C) play upon unrealistic fears. D) should be purchased only by older people. E) are meant for couples with two or three children.

answer

C) play upon unrealistic fears.

question

Which type of health insurance is illegal in many states? A) Individual health insurance B) Group health insurance C) Dread disease policy D) Dental insurance E) Vision insurance

answer

C) Dread disease policy

question

In choosing health insurance, ideally, you should A) get a basic plan and a major supplementary plan. B) get dental and vision plans. C) buy dread disease and cancer insurance plans. D) purchase nursing home insurance. E) purchase accident insurance.

answer

A) get a basic plan and a major supplementary plan.

question

Which plan provides benefits for surgical and medical services performed by physicians? A) Blue Cross B) Blue Shield C) Medicare D) Medicaid E) HMO

answer

B) Blue Shield

question

Health insurance is available from A) private insurance companies. B) Blue Cross and Blue Shield. C) HMOs. D) PPOs. E) All of the above offer health insurance.

answer

E) All of the above offer health insurance.

question

Most private insurance companies sell health insurance policies to A) individuals. B) families. C) Employers. D) Employees.

answer

C) Employers.

question

Which statewide health plan provides hospital care benefits to millions of Americans? A) Blue Cross B) Blue Shield C) managed care D) Medicare E) Medicaid

answer

A) Blue Cross

question

Which statewide health plan provides benefits for surgical and medical services performed by physicians? A) Blue Cross B) Blue Shield C) home health agencies D) home health associations

answer

B) Blue Shield

question

Which health care institution directly employs or contracts with selected medical care specialists to give you health care services in exchange for a fixed, prepaid monthly premium? A) Blue Cross B) Blue Shield C) Medicare D) Medicaid E) HMO

answer

E) HMO

question

Which health care program is perhaps the best-known government health program? A) Blue Cross B) Blue Shield C) Medicare D) Medicaid E) HMO

answer

C) Medicare

question

Hospital insurance Part A and medical insurance Part B is characteristics of A) Blue Cross. B) Blue Shield. C) Medicare. D) Medicaid. E) HMO.

answer

C) Medicare.

question

What is covered by Medicare? A) intermediate and custodial nursing care B) out-of-hospital prescription drugs C) private-duty nursing D) physician charges above Medicare's approved amount E) None of the above is covered.

answer

E) None of the above is covered.

question

Which health care plan is administered by each state within certain broad federal requirements and guidelines? A) Blue Cross B) Blue Shield C) Medicare D) Medicaid E) HMO

answer

D) Medicaid

question

Hospital insurance Part A. of Medicare is financed from part of the ____________ taxes. A) state income B) federal excise C) individual income D) Corporate income E) Social Security payroll

answer

E) Social Security payroll

question

Medigap is sold or serviced by A) Medicare. B) Medicaid. C) private insurance companies. D) Health Care Financing Administration. E) National Institutes of Health.

answer

C) private insurance companies.

question

Which one of the following is a source of government health insurance? A) Blue Cross B) Blue Shield C) Medicare D) HMO E) PPO

answer

C) Medicare

question

Which one of the following is a source of government health insurance? A) Blue Cross B) Blue Shield C) National Institutes of Health D) HMO E) Medicaid

answer

E) Medicaid

question

Hospital insurance is which part of Medicare? A) Part A B) Part B C) Part C D) Part D E) None of the above

answer

A) Part A

question

Medical insurance is which part of Medicare? A) Part A B) Part B C) Part C D) Part D E) None of the above

answer

B) Part B

question

Which one of the following is not covered by Medicare? A) Care in a skilled nursing facility B) Intermediate and custodial nursing care as would be needed in a nursing home. C) Private duty nursing D) Out-of-hospital prescription drugs E) All of the above would not be covered by Medicare.

answer

E) All of the above would not be covered by Medicare.

question

Hospital insurance (Part A) of Medicare helps pay for A) inpatient hospital care B) inpatient care in a skilled nursing facility. C) home health care. D) hospice care. E) all of the above.

answer

E) all of the above.

question

Medicare medical insurance (Part B) helps pay for A) inpatient hospital care B) doctors' services and other medical services and supplies not covered by hospital insurance. C) home health care. D) hospice care. E) none of the above.

answer

B) doctors' services and other medical services and supplies not covered by hospital insurance.

question

Medicare medical insurance (Part B) for people 65 or over is A) mandatory B) financed by corporations. C) voluntary, and individuals must pay for it. D) state supported and partially funded by the National Institutes of Health. E) None of the above.

answer

C) voluntary, and individuals must pay for it.

question

Which of the following is correct about Medigap or MedSup insurance? A) It is sold and serviced by the federal government. B) It is sold and serviced by the state government. C) It is sold and serviced by both the federal and state governments. D) Private insurance companies sell Medicap Insurance policies. E) None of the above.

answer

D) Private insurance companies sell Medicap Insurance policies.

question

Which of the following statement is correct about Medicaid A) Medicaid coverage is very comprehensive. B) Medicaid is a program of medical assistance to certain low-income individuals and families. C) Medicaid is administered by each state within certain federal guidelines. D) Medicaid if financed by both state and federal funds. E) All of the statements are correct.

answer

E) All of the statements are correct.

question

Which of the following statements is correct about Medicaid? A) Many members of the Medicaid population are also covered by Medicare. B) Once eligible, Medicaid provides more benefits than does Medicare. C) Medicaid coverage is so comprehensive, people using it do not need to purchase supplemental insurance. D) Medicaid is financed by both state and federal funds. E) All of the above.

answer

E) All of the above.

question

Which type of insurance is probably the most ignored form of available insurance protection? A) life B) liability C) Disability D) Car E) home and property

answer

C) Disability

question

Definition of disability A) is universally accepted. B) varies. C) is standardized by American Council of Life Insurance. D) is provided by the Insurance Information Institute.

answer

B) varies.

question

Good disability plans pay when you are A) unable to work at your regular job. B) unable to work at any job. C) on an extended vacation. D) ill even for a short period. E) fired from your regular job.

answer

A) unable to work at your regular job.

question

With disability income insurance, benefits usually begin A) on the first day of disability. B) Between 30 and 90 days after the disability occurs. C) on the 10th day of disability. D) one year after the start of the disability.

answer

B) Between 30 and 90 days after the disability occurs.

question

The waiting period in disability income insurance is called ____________ period. A) Exclusion B) no benefit C) Coverage D) trade-off E) Elimination

answer

E) Elimination

question

Generally, disability income policies with longer waiting periods A) have higher premiums. B) have lower premiums. C) have about the same premium. D) Are issued by smaller insurance companies. E) Are issued by larger insurance companies.

answer

B) have lower premiums.

question

The premium for non-cancelable and guaranteed renewable disability income insurance is higher, A) therefore, younger people should skip these coverage. B) hence, the insurance companies enjoy better profit margins. C) therefore, very few older workers should carry these coverage. D) But the coverage is well worth the extra cost.

answer

D) But the coverage is well worth the extra cost.

question

In most employer-sponsored disability income insurance plans, A) your employer pays part or all of the cost. B) you pay all the cost. C) your union pays all the cost. D) the Social Security Administration pays most of the premium. E) the Veterans Administration foots the bill.

answer

A) your employer pays part or all of the cost.

question

What is the importance of health insurance and disability insurance in personal financial planning?

answer

Both protections should be a part of your overall insurance program to safeguard your family's economic security.

question

What are the four basic types of health insurance? What are their benefits and limitations?

answer

Four basic types of health insurance are available under group and individual policies: hospital expense insurance, surgical expense insurance, physician's expense insurance, and major medical expense insurance. The benefits and limitations of each policy differ. Ideally, you should get a basic plan and a major medical policy that combines the values of both of these plans in a single policy.

question

What factors should you consider as you decide which health insurance plan to buy?

answer

Consider the following trade-offs: a. Reimbursement versus indemnity; b. Internal limits versus aggregate limits; c. Deductibles and coinsurance; d. Out-of-pocket limits; e. Benefits based on reasonable and customary charges.

question

What are private sources of health care insurance?

answer

Health insurance and health care are available from private insurance companies, hospital and medical service plans such as Blue Cross/Blue Shield, health maintenance organizations (HMOs), preferred provider organizations (PPOs), health associations, home health agencies, and employer self-funded health plans

question

What are government sources of health care insurance?

answer

The federal government and state governments offer health coverage in accordance with laws that define the premiums and benefits. Two well-known government health programs are Medicare and Medicaid

question

What is disability income insurance? What are the major sources of disability income insurance?

answer

Disability income insurance benefits provide regular cash income lost by employees as the result of an accident, illness, or pregnancy. Sources of disability income insurance include your employer, social security, workers' compensation, the Veterans Administration, the federal government, state governments, unions, and private insurance.

Chapter 9 Health and Disability Income Insurance – Flashcards

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