question

On a Medcare Supplement, the statutory Free Look must me at least ______days:

answer

30

question

Nursing home care for those who are sick, but cannot take care of themselves is provided by:

answer

Medicaid

question

On a Medical Expense policy, coverage for newborn children must begin:

answer

At the time of birth

question

The premium paid by your employer for qualified long-term care insurance is:

answer

Excluded from the employee's gross income

question

The premium you pay for qualified long-term care insurance is tax-deductible, the same as:

answer

Medical Expense insurance

question

Medical Savings Accounts (MSAs) are available to small business employees and self-employed individuals who have:

answer

High deductible health insurance

question

Under HIPAA, The maximum probationary period for pregnancy on Group insurance is:

answer

Zero months

question

On an A policy with an "accidental bodily injury" clause, coverage will exist if the:

answer

Injury was accidental, even if the cause was not.

question

All of the following are true about Medi-Gap policies sold in this state:

answer

Only 10 standardized "plans" are available. All 10 plans must include the Plan A Core or basic benefits. Coverage may not duplicate Medicare. What is NOT true: insurers must offer all 10 plans.

question

Clients of an HMO are known as:

answer

Subscribers

question

Medical expense premiums paid by sole proprietors or partners:

answer

Are fully deductible

question

Which of the following is the most likely candidate for a Medicare Supplement policy?

answer

A 66-year-old retiree who is enrolled in Part A and B of Medicare

question

Under Dental insurance, crowns are considered to be:

answer

Restorative

question

Persons covered by Medicare are called:

answer

Beneficiaries

question

Under HIPAA, health coverage is "portable" from one group to another group without any new probationary period as long as coverage was continuous with no gaps greater than _______days:

answer

63

question

To qualify for disability income benefits from Social Security, you must:

answer

Have fully insured status.

question

The period of time between the onset of a claim and the start of disability income benefits is called the:

answer

Elimination period

question

A client covered by Group Health insurance needs kidney dialysis. Which coverage is primary?

answer

The Group Plan

question

The purpose of a 75% participation requirement on a contributory Group Health plan is to:

answer

Prevent adverse selection

question

All is true about Group Health insurance:

answer

The proof of coverage and employee receives is called a Certificate of Insurance. Participation requirements are designed to prevent adverse selection. Group coverage may be continued for terminated employees under COBRA. What is NOT true: The group contract is between the employer and the employee.

question

All are true about Preferred Provider Organizations (PPOs):

answer

Coverage may be reduced for out-of-network services. They may be started by insurance companies in order to compete with HMOs. Clients are known as subscribers. What is NOT true: They may only be started by hospitals.

question

All of the following provisions in a Health policy are designed to prevent over insurance:

answer

Relation of earnings to insurance. Other insurance clause. Coordination of benefits clause. What is NOT a provision: Assignment of benefits clause.

question

If a client buys to disability income policy is from two different insurers and has a claim:

answer

Both insurers will pay a pro rata amount and refund the premiums related to the benefits the insured is not entitled to.

question

A Medical Expense policy covers:

answer

Hospital and doctor bills.

question

When Medical Expense and Dental coverage are combined, an "integrated" deductible applies to :

answer

Both medical and dental bills.

question

All are true about Dental insurance:

answer

It usually covers preventative care. Orthodontics are sometimes covered. Endodontics (root canals) maybe covered. What is NOT true: it must be written as individual coverage.

question

All are true about Hosptal Indemnity policies:

answer

They pay in addition to each other. They pay a specified amount each day you are hospitalized. They are considered to be a "limited" type of coverage. What is NOT true: They follow the Principle of Indemnity.

question

The main purpose of HIPAA is:

answer

To waive the probationary period when switching group coverages.

question

All of the following are true about Worker's Compensation coverage:

answer

It provides occupational coverage for both sickness and accident. It does not cover intentional, self-inflicted injuries. Eligibility requirements are set state by state. What is NOT true: It is a type of health insurance required by state law.

question

On the disability income policy with the typical definition of total disability, you are still considered to be disabled if, after two years:

answer

You cannot perform any job you are suited to do by experience, education or training.

question

All are true about replacement of Health insurance insurance:

answer

Replacement to the detriment of your client is grounds for Errors and Omissions. Your agent should make sure that your pre-existing conditions are covered. You should not cancel your old policy until your new policy is issued. What is NOT true: Replacement is illegal.

question

All of the following are true about claims conditions contained in individual health insurance policies:

answer

Notice of claim to the agent is notice to the insurer. If your insured does not send you required claim forms, you should send in your own written verification of the claim. If a claim has not been paid within 60 days after proof of loss has been submitted, the claimant may bring legal action against the insured. What is NOT true: Insurers must pay claims immediately after receipt of notice of claim.

question

A guaranteed renewable Health insurance policy:

answer

May be renewed at the insured's option up to a certain specified age.

question

Which claims condition makes health insurance claims easier to process?

answer

Assignment of benefits.

question

Group health insurance for terminated employees is convertible to individual coverage without a physical exam for:

answer

31 days

question

The federal law that allows a terminated employee to continue coverage in the group is known as:

answer

Consolidated Omnibus Budget Reconciliation Act (COBRA)

question

An employers requirement for hospital pre-authorization on a group health policy is designed to:

answer

Prevent unnecessary hospitalization

question

Which of the following is considered to be a "presumptive" disability under a Disability Income policy?

answer

Loss of two limbs

question

A Basic Medical Expense Insurance policy has which of the following features?

answer

First dollar coverage for schedule benefits

question

All of the following are true about the insured's co-insurance requirement on Major Medical:

answer

It is designed to prevent overutilization of coverage. It is the percentage of the claim the insured has to pay after the deductible. It may be subject to a "Stop Loss" provision. What is NOT true: It always applies before the deductible is subtracted.

question

Group Disability income benefits are usually:

answer

Based on the employees gross income.

question

All are true about individual Disability Income insurance:

answer

Benefits are not taxable. Premiums are not tax-deductible. The definition of total disability varies by company. What is NOT true: Benefits should be written to reflect gross income.

question

On an HMO, initial care and consultation is performed by:

answer

The Primary Care Physician

question

Under the Federal Affordable Care Act, Young adults will be able to stay on their parents medical expense insurance plan until they turn age:

answer

26

question

Under Social Security, you were considered to be totally disabled if you cannot perform any job and your disability is expected to last at least ______ months, or to result in death:

answer

12

question

If an insured drops their Medi-Gap policy to enroll in Medicaid, they can reinstate it for up to:

answer

Two years

question

Which of the following Disability Income policies has the highest premium?

answer

15-day waiting period / 10-year benefit period

question

Medicaid is funded by:

answer

Matching State and Federal moneys

question

The maximum probationary period on a Medicare Supplement policy is:

answer

Six months

question

A 46-year-old is paralyzed in an accident on vacation. Disability benefits would most likely be paid by:

answer

Social Security

question

What term describes the concept that the insurer and the insured share in the cost of medical expenses, with the insurer being the greater share:

answer

Coinsurance

question

All are true regarding employee Group Health insurance:

answer

The employer is the policyholder. The new employees receive a Certificate of Insurance. New employees may not be covered right away due to a waiting period. What is NOT true: Employees with pre-existing conditions may be excluded from the group coverage.

question

All are true about Disability Income benefits under Social Security:

answer

Benefits are subject to a five month waiting period. The claimant must not be able to perform any job. The disability must be expected to last at least 12 months or result in death. What is NOT true: Disability benefits may be paid beyond age 65.

question

Employees covered under a group health policy who attain age 65:

answer

May continue in the group with no change in coverage.

question

When a person takes early retirement under Social Security at age 62, when does coverage for Medicare Part A begin?

answer

Automatically at age 65

question

When does a Part A Medicare claim begin?

answer

Date of hospitalization

question

A Health insurance claim occurs on May 30th, but the policy lapses on June 1st. If the claim is turned in on June 8th, the company will:

answer

Pay the claim

question

Under the Legal Actions Provision, the insured cannot sue for non-payment of a valid claim until after 60 days in order to:

answer

Give the insurer time to investigate the claim.

question

A cancelable policy of Health insurance may be cancelled:

answer

By either the insurer or the insured.

question

Premiums paid for individual Disability Income policies are:

answer

Not tax deductible.

question

All are true regarding Key Employee Disability Income Insurance:

answer

Benefits are paid to the business to train a new person. Premiums are not tax deductible. This is a part of Third Party ownership. What is NOT true: Benefits are taxable as income to the business.

question

Employees of small employers in the same type of business insured under multiple employer trust must do all of this:

answer

Pay their share of the premiums via payroll deduction. Receive a Certificate of Insurance. Meet certain underwriting criteria. What they do NOT do: Buy all the coverage offered by the trust.

question

All are true regarding Group Medical Expense insurance:

answer

Covered employees receive a Certificate of Insurance. Coverage is generally better than individual coverage. Rates are generally lower than those charged on individual coverage. What is NOT true: Group coverage is subject to continuation under COBRA, but not conversion.

question

Coverage under Medicaid for custodial care in a nursing home is conditioned upon:

answer

Low income and asset levels.

question

All are true regarding continuation of health insurance after termination of employment:

answer

Continuation is generally permitted up to 18 months. Continuation requirements are addressed in the COBRA regulations. Continuing employees must pay their own premium. What is NOT true: Continuation requires passing a physical examination.

question

All of the following are true about Medicare Supplements:

answer

They have a 30 day free look. They are guaranteed renewable. They can only be canceled for nonpayment or misrepresentation. What is NOT true: They cannot contain any probationary period.

question

Which of the following is most likely to be considered an employee:

answer

An insurance agent with Social Security withholding taken out of their paycheck.

question

Which of the following terms is defined as the chance, uncertainty or possibility of lass:

answer

Risk

question

A file claimed under an individual Accident and Health policy might be denied if the loss was due to:

answer

Alcohol or narcotics

question

A premium that is due could be deducted from a claims payment under which of the following circumstances:

answer

The loss occurred during the grace period.

question

All of the following are required in the application for an insurance license:

answer

An application form approved by the state. A non-refundable fee. Employment history. What is NOT required: A letter of recommendation from an insurance agent.

question

When an insurance company may or may not renew an individual health policy, the policy would be considered:

answer

Optionally Renewable.

question

The waiting period before a qualified person can receive Social Security disability benefits is:

answer

Five months

question

Medicare Part ______ is also known as the "managed care" option:

answer

Part C

question

If a person wishes to purchase a health policy that would pay for hospital bills in case of an accident, they would purchase a:

answer

Major Medical Policy

Health Insurance Final Exam B Practice Test (WFG) – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards