Life and Health Insurance Texas – Flashcards
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Scheduled benefits are generally A)lower than reasonable and customary allowances B)higher than reasonable and customary allowances C)paid in addition to reasonable and customary allowances D)the same as reasonable and customary allowances
answer
lower than reasonable and customary allowances
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Which of the following is NOT a common exclusion or limitation of dental policies? A)Oral hygiene instructions and plaque control programs are often limited or excluded. B)Prosthetic appliances generally may not be replaced for 5 years after a benefit is paid. C)Teeth that are knocked out in an accident will generally not be replaced under a dental policy. D)Benefits are generally not payable for dental work that is not necessary for sound dental health.
answer
Teeth that are knocked out in an accident will generally not be replaced under a dental policy
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The ability of an individual to wait until covered by dental insurance before seeking treatment for dental issues is an example of A)adverse insurance B)improper selection C)improper insurance D)adverse selection
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adverse selection
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Prepaid dental plans offer services based on A)captive member selection B)capitulation C)concentration D)capitation
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capitation
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Sin Lan has a hospital income policy that will pay $1,500 per month for up to 12 months. There is no elimination period. If Sin Lan is hospitalized, to whom will the insurer make payments? A)Sin Lan B)The beneficiary C)The hospital D)The doctor
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Sin Lan
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Sin Lan has a hospital income policy that will pay $1,500 per month for up to 12 months. There is no elimination period. If Sin Lan is hospitalized for 10 days, how much will the policy pay? A)$1,000 B)$500 C)$1,500 D)$50
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$500
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Which of the following drugs may be excluded from a prescription drug policy? A)All of these B)Fertility drugs C)Rogaine D)Ginseng
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All of these
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A special type of policy tends to cover A)a broad number of situations as described in the policy itself B)a limited number of situations as described in the policy itself C)more areas than basic medical expense D)whatever the insured wants to be covered
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a limited number of situations as described in the policy itself
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Comprehensive dental policies A)never require deductibles B)limit benefits to specified maximums per procedure C)seldom require coinsurance D)work in much the same way as comprehensive medical expense coverage
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work in much the same way as comprehensive medical expense coverage
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Which of the following is NOT likely to be considered nonroutine dental care? A)Annual checkups and cleaning of teeth, including x-rays to check the health of the teeth B)Treatment of the soft tissue substance located in the center of each tooth C)Microscopic analysis of tissue biopsy material for diagnosis of oral diseases including oral cancer D)Repairing or restoring dental work that has been damaged in some way
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Annual checkups and cleaning of teeth, including x-rays to check the health of the teeth
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For nonroutine treatments, a comprehensive dental policy generally pays A)nothing B)a percentage of the reasonable and customary charges after a deductible C)a percentage of the reasonable and customary charges from the first dollar D)the full amount
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a percentage of the reasonable and customary charges after a deductible
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Which of the following is NOT a common way dental insurance programs work to minimize adverse selection? A)Graduating the coinsurance percentage to increase each plan year B)Increasing the maximum annual benefit to encourage the insured to maintain dental health for the long term C)Lowering the coinsurance percentage for optional expenses D)Basing the benefit on the least costly treatment option
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Increasing the maximum annual benefit to encourage the insured to maintain dental health for the long term
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What is the main difference between a prepaid dental plan and a comprehensive dental plan? A)Comprehensive dental plans pay on the basis of reasonable and customary charges, whereas prepaid dental plans pay on a capitation basis. B)Comprehensive dental plans do not cover routine services that are covered by prepaid dental plans. C)Comprehensive dental plans cover routine services, whereas prepaid dental plans do not. D)Comprehensive dental plans pay on a capitation basis, whereas prepaid dental plans pay based on reasonable and customary charges.
answer
Comprehensive dental plans pay on the basis of reasonable and customary charges, whereas prepaid dental plans pay on a capitation basis.
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A prepaid dental plan that wants to restrict an enrollee's ability to receive services from a class of providers A)must request permission from the federal Department of Insurance for the limitations B)is out of luck because such limitations are prohibited by law C)must request permission from the Insurance Commissioner for the limitations D)must describe the limitations in the evidence of coverage and in all solicitation documents
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must describe the limitations in the evidence of coverage and in all solicitation documents documents
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Dread disease policies A)are a good replacement for general health insurance B)cover specific diseases as named in the policy, such as heart disease or cancer C)cover any disease defined by the ADA as a dread disease D)are purchased to cover a variety of conditions that fall under the category of dread diseases
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cover specific diseases as named in the policy, such as heart disease or cancer
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Benefits of travel accident insurance are limited to A)losses caused while in transit, generally in personal vehicles such as cars or vans B)accident losses caused while outside of the state of residence C)accident or illness losses caused while outside of the state of residence D)losses caused by accidents while traveling, usually by common carriers such as airlines or bus lines
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losses caused by accidents while traveling, usually by common carriers such as airlines or bus lines
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Hospital indemnity insurance pays A)supplemental costs, such as television or phone charges, while the insured is confined to the hospital B)an income for each month the insured spends partially confined to the hospital C)medical costs only while the insured is confined to the hospital D)an income for each day the insured is confined to the hospital
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an income for each day the insured is confined to the hospital
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Vision care insurance is generally needed to cover all of the following EXCEPT A)eye examinations B)costs of contact lenses C)costs of prescription lenses D)injury to the eye
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injury to the eye
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Prescription drug policies generally exclude A)experimental drugs B)any narcotic substance C)any drugs not covered by other programs D)drugs for ongoing medical conditions
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experimental drugs
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Credit health insurance covers A)a debtor B)neither a creditor nor a debtor C)either a creditor or a debtor D)a creditor
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a debtor
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The amount of coverage available under a credit insurance policy is generally limited to A)the amount the policy is written for B)the total amount of the loan covered C)the total amount of indebtedness at any given point D)the amount of the debt plus the cost of the premium
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the total amount of indebtedness at any given point
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The creditor must notify the debtor that she may be covered by the group insurance plan A)if the debtor is to be charged more than half the premium amount B)even if the creditor pays the full cost of the coverage C)only if the creditor chooses to make the disclosure D)only if the debtor is to be charged the full premium for the insurance
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even if the creditor pays the full cost of the coverage
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The conversion privilege allows the insured to continue group coverage without A) providing proof of termination of employment B) paying individual premiums C) filling out an application D) providing evidence of insurability
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providing evidence of insurability
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All of the following could be considered dependents except the insured's A) 25-year-old child who became physically disabled at 24 B) adopted children C) parents D) 21-year-old child who is attending college full time
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25-year-old child who became physically disabled at 24
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The coordination of benefits provision provides that when a person is covered under more than one plan, the total benefits cannot exceed A) the greater of the benefits provided B) the lesser of the benefits provided C) the total medical expenses or loss of wages D) both of the benefits combined
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the total medical expenses or loss of wages
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An individual is NOT eligible for the group insurance policy conversion privilege if A) the insured's dependent child reaches the age specified in the policy as the age of terminating dependent coverage B) the insured's employment is terminated C) the insured fails to make the conversion within 31 days D) the insured becomes ineligible for coverage because the insured's class is no longer eligible for coverage
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the insured fails to make the conversion within 31 days
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Which of the following is NOT part of the qualification process for legal dependency? A) Relationship to the insured B) Eligibility for insurance C) Residency in the home D) Listing on the insured's tax return as a dependent
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Eligibility for insurance
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When both parents have employer-provided group coverage, the children are covered under A) the plan of the parent whose birthday falls closest to the start of the calendar year B) the plan of the parent whose birthday falls closest to the child's birthday C) the mother's plan D) the father's plan
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the plan of the parent whose birthday falls closest to the start of the calendar year
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Under the coordination of benefits rule, the primary company pays A) whatever the other coverage does not pay, up to the policy limits B) as if there were no other coverage C) only if the other coverage refuses the claim D) if there is no other coverage
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as if there were no other coverage
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Under the coordination of benefits rule, the secondary company pays A) whatever the other coverage does not pay, up to the policy limits B) if there is no other coverage C) only if the other coverage refuses the claim D) as if there were no other coverage
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whatever the other coverage does not pay, up to the policy limits
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Carla enrolls in group insurance when she is eligible under her employer's plan. Because of an administrative error, her enrollment form is never sent to the company. When she later has a claim, the insurer will A) deny the claim because it has no record of her policy B) force the employer to pay the claim because it was the employer's error C) pay the claim only if the insurer is proven to have made an error D) accept the enrollment form and all of the past due premium and pay the medical claim
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accept the enrollment form and all of the past due premium and pay the medical claim
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Which federal law requires employers with more than 20 employees to include in their group insurance plan a continuation of benefits provision for all eligible employees? A) ERISA B) TEFRA C) OBRA D) COBRA
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COBRA
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Which federal law is intended to prevent group term life plans from discriminating in favor of key employees? A) ERISA B) OBRA C) TEFRA D) COBRA
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TEFRA
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Which federal law extends the minimum continuation of coverage period from 18 to 29 months for qualified beneficiaries disabled at the time of termination or reduction in hours? A) TEFRA B) OBRA C) ERISA D) COBRA
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OBRA
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Which federal law is intended to accomplish pension equity but also protects group insurance plan participants? A) TEFRA B) ERISA C) OBRA D) COBRA
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ERISA
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Which of the following provisions is NOT a part of HIPAA? A) Annual limits and lifetime spending limits may be applied to mental health coverage. B) Employers must make full health care coverage available immediately to newly hired employees who were previously covered for at least 18 months. C) Small employers may not be denied group health insurance coverage because one or more employees is in poor health. D) New mothers and their babies must be allowed to stay in the hospital for at least 48 hours after a regular delivery.
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Annual limits and lifetime spending limits may be applied to mental health coverage.
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Which of the following is considered a disqualifying event under COBRA? A) The employee's employment is terminated by the employer. B) The employee voluntarily leaves employment with the employer. C) The employee is no longer eligible for the group health plan because of a change in the covered classes. D) The employer ceases to maintain any group health plan.
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The employer ceases to maintain any group health plan.
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Under OBRA, an employer may terminate COBRA coverage because of coverage under another health plan A) as long as the other health plan limits benefits for the insured's preexisting conditions B) as soon as the coverage is in force C) as long as the other health plan does not limit benefits for the insured's preexisting conditions D) only if the premiums for the new plan are paid entirely by the insured's new employer
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as long as the other health plan does not limit benefits for the insured's preexisting conditions
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The Age Discrimination in Employment Act applies to employees age A) 45 or older B) 50 or older C) 40 or older D) 55 or older
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40 or older
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The Americans with Disabilities Act A) applies to all employers with 25 or more employees B) permits exclusion of benefits for individual distinct groups of afflictions, such as cancer, muscular dystrophy, or kidney disease C) requires that employees with disabilities be given equal access to whatever health insurance is provided to other employees D) does not apply to acquired diseases such as AIDS
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requires that employees with disabilities be given equal access to whatever health insurance is provided to other employees
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Which of the following individuals is least likely to be eligible for Medicare? A) Genevieve, who has been receiving benefits from Social Security for 3 years B) Margaret, who is not eligible for Social Security, but is willing to pay a fee for her insurance C) Karl, who has been diagnosed with end-stage liver disease D) Mannie, who is 65 and just registered for his Social Security benefits
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Karl, who has been diagnosed with end-stage liver disease
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Under Medicare Part B, individuals pay a deductible each A) week B) benefit period C) year D) month
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year
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After the deductible is satisfied, Part B pays what percentage of all approved charges? A) 100% B) 10% C) 80% D) 20%
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80%
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Doctors and suppliers who agree to accept the amount Medicare will pay are said to have agreed to A) assessment B) payment C) capitation D) assignment
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assignment
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All of the following outpatient services are covered under Part B EXCEPT A) most immunizations B) emergency room services C) artificial limbs D) physical therapy
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most immunizations
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Which of the following outpatient services is excluded from Part B coverage? A) Hearing exams B) Laboratory tests billed by hospitals C) Casts and splints D) Medically necessary ambulance services
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Hearing exams
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The Original Medicare Plan consists of A) Medicare Parts C and D B) Medicare Parts A and B C) Medicare Part B D) Medicare Part A
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Medicare Parts A and B
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Michelle is 65 and starting to receive Social Security benefits. To receive Medicare Part A, she needs to A) pay a monthly premium B) prove eligibility C) do nothing D) fill out an enrollment form at her local Social Security office
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do nothing
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The annual general enrollment period for Medicare Part B begins on A) January 1 B) March 31 C) March 1 D) July 1
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January 1
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Does Medicare pay all medical costs for its beneficiaries? A) Yes B) No
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No
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Some kind of supplement to Medicare is needed by almost everyone covered by Medicare. Which of the following individuals would NOT need Medicare supplement insurance? A) Carl, whose net worth is high enough to cover any medical bills that might incur B) Larry, who has high blood pressure that is controlled with medication C) Ken, whose income is low enough to qualify him for help from Medicaid D) George, whose medical conditions are currently under control
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Ken, whose income is low enough to qualify him for help from Medicaid
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Medicare SELECT policies offer _______________ coverage, compared with standard Medigap policies. A) less extensive B) the same C) more extensive D) unlimited
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the same
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Which type of policy requires use of approved doctors and hospitals to receive benefits? A) Both B) Standard Medigap policies C) Medicare SELECT D) Neither
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Medicare SELECT
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Medicare supplement policies are also known as A) Medigap policies B) Medicaid policies C) Medicare policies D) Medichoice policies
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Medigap policies
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All of the following statements about Medigap insurance are correct EXCEPT A) Medigap Plan A covers basic benefits B) Medigap policies are sold by private insurance companies C) Medigap policies are available through Medicare D) Medigap policies were standardized by the NAIC
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Medigap policies are available through Medicare
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Which of the following benefits are NOT required in any Medicare supplement policy? A) All charges for 365 days of hospitalization after all Part A inpatient hospital and lifetime reserve days are used up B) Part A co-payments for the 61st through the 90th day of hospitalization C) Part B co-payments on Medicare-approved charges for physician's and medical services D) Skilled nursing care benefit that covers the Part A co-payments for the 21st through the 100th day of skilled nursing facility care
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Skilled nursing care benefit that covers the Part A co-payments for the 21st through the 100th day of skilled nursing facility care
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Which of the following individuals is NOT likely to be eligible for Medicaid? A) Carmen, who has not been able to work since losing both legs in an accident B) Ginny, who is over 65 and working as a manager of a retail outlet C) Darrell, who has been unable to work since becoming blind 2 years ago D) Pam, a single mom who relies on Aid to Families with Dependent Children to help feed her family
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Ginny, who is over 65 and working as a manager of a retail outlet
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Fully insured and disability insured are defined by A) Social Security regulations B) state departments of insurance C) individual insurers D) state legislatures
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Social Security regulations
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Under Social Security benefits, disabled workers receive a benefit equal to A) their preferred insurance amount B) their primary insurance amount C) their earnings at the time of the disability D) 66% of their earnings at the time of the disability
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their primary insurance amount
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Carla is 67 and eligible for Social Security and Medicare. When she comes out of retirement to work at a large corporation that provides health benefits A) her Medicare benefits become secondary to her private benefits B) the employer is not required to offer her private benefits C) she will cease to be eligible for Medicare benefits D) her private benefits become secondary to Medicare benefits
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her Medicare benefits become secondary to her private benefits
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Medicare is administered by A) individual state governments B) the Centers for Medicare and Medicaid Services (CMS) C) the Social Security Administration D) the Health Care Focus Association
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the Centers for Medicare and Medicaid Services (CMS)
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Medicare Part A covers all of the following EXCEPT A) skilled nursing facility care B) home health care C) charges for a private room D) hospice care
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charges for a private room
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For each benefit period, Medicare will pay the full cost of up to how many days of hospital care? A) 30 B) 90 C) 365 D) 60
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60
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Medicare will pay the entire cost for skilled nursing facility care for the first A) 80 days B)0 days C) 100 days D) 20 days
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20 days
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Individuals who are eligible for Social Security benefits become eligible for Medicare Part A benefits as of A) the day they become eligible for Social Security benefits B) the first day of the month in which they become eligible for Social Security benefits C) the day they turn 65 D) the first day of the month in which they turn 65
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the first day of the month in which they turn 65
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Medicare Part A provides coverage for all of the following kinds of care EXCEPT A) hospice care B) skilled nursing facility care C) home health care D) private-duty nursing
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private-duty nursing
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Medicare Part B provides coverage for all of the following kinds of care EXCEPT A) doctors' services B) outpatient medical services and supplies C) home health care not covered by Part A D) skilled nursing facility care not covered by Part A
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skilled nursing facility care not covered by Part A
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Which of the following Medicare supplement plans covers the Part A and Part B deductible? A) Plan E B) Plan C C) Plan D D) Plan B
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Plan C
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Which of the following Medicare supplement plans covers the Part B excess at 80%? A) Plan B B) Plan H C) Plan E D) Plan G
answer
Plan G
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Which of the following statements about Medicare supplement plans is NOT true? A) Losses resulting from sickness may not be treated differently than losses resulting from accidents. B) Benefits must automatically change to coincide with changes in Medicare deductibles and co-payments. C) Policies must be at least guaranteed renewable. D) The definition of accident may employ an accidental means test.
answer
The definition of accident may employ an accidental means test.
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To be compensable as interpreted in workers' compensation law, an injury must meet all of the following criteria EXCEPT A) it must arise in the course of the individual's employment B) it must be accidental C) it must arise out of the individual's employment D) it must be unforeseeable
answer
it must be unforeseeable
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Juanita is employed in California. She takes a business trip to Colorado to demonstrate some techniques to workers in another facility and is injured in the process. Her workers' compensation benefits will be paid according to the laws of A) whichever state would provide the greater benefit B) Colorado C) California D) Whichever state would provide the lesser benefit
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California
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Carla is age 32. How many quarters of coverage does she need to be fully insured? A) 6 B) 8 C) 12 D) 10
answer
10
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Social Security benefits are expressed as a percentage of A) the presiding insurance amount B) the primary insurance amount C) the potential insurance amount D) the preferred insurance amount
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the primary insurance amount
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Disability benefits under Social Security require at least A) a 12-month waiting period B) a 3-month waiting period C) a 5-month waiting period D) a 7-month waiting period
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a 5-month waiting period
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Nursing home care is generally covered by A) long-term care policies B) Medicare C) Medicare supplements D) all of these
answer
long-term care policies
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Which of the following would be least likely to be a good candidate for an LTC policy? A) Darrell, whose inherited estate has provided him with over $6 million in net worth B) Carla, whose 25 years of civil service have provided a generous retirement, but who worries about the legacy she will leave her children C) Nina, a single mother whose financial struggles raising her children have left her with few assets and no independent retirement savings D) George, whose law practice has allowed him to fund a generous retirement fund for himself and his wife
answer
Nina, a single mother whose financial struggles raising her children have left her with few assets and no independent retirement savings
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Early long-term care policies were A) prohibited by law B) the same as current policies C) less restrictive than current policies D) more restrictive than current policies
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more restrictive than current policies
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Which of the following individuals is most likely to be rated a substandard risk under an LTC policy? A) Gerald, who lives alone and has no trouble taking care of himself, but who has been diagnosed with an inoperable brain aneurysm that, if it bursts, would almost certainly kill him immediately B) Garrison, who has been diagnosed with earlystage Alzheimer's disease C) Ken, who is on medication to bring down his blood pressure, but who gets around and takes care of himself easily D) Brenda, whose diabetes is under control
answer
Garrison, who has been diagnosed with earlystage Alzheimer's disease
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Which of the following is the type of care most people will require at some time during their later years? A) Skilled nursing care B) Inpatient hospital care C) Custodial or residential care D) Intermediate care
answer
Custodial or residential care
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Virtually all of the current LTC policies are guaranteed renewable. This means the insurer cannot cancel the policy A) or increase policy premiums on individual policies B) or increase policy premiums on specified classes of policies C) but does reserve the right to increase policy premiums on specified classes of policies D) but does reserve the right to increase policy premiums on individual policies
answer
but does reserve the right to increase policy premiums on specified classes of policies
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When waiver of premium applies A) the premium payment generally resumes when the insured is no longer disabled B) the premium is waived immediately upon disability C) the premium payment is waived only if disability is considered permanent and total D) the premium payment is suspended permanently once it is invoked
answer
the premium payment generally resumes when the insured is no longer disabled
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Typically, the expenses incurred in a hospice will be A) room and board and physical therapy B) surgical and room and board C) room and board and medication for pain D) surgical and physical therapy
answer
room and board and medication for pain
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The elimination period may be thought of as A) a dollar amount co-payment B) a dollar amount deductible C) a time deductible D) a time co-payment
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a time deductible
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Which of the following is NOT considered an activity of daily living? A) Transferring B) Bathing C) Working D) Dressing
answer
Working
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As an individual ages, their chance of being confined to a nursing home A) is irrelevant because Medicare provides coverage for long-term care B) decreases C) increases D) remains about the same
answer
increases
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Wanda's company pays the entire premium for her group disability coverage. If Wanda became disabled, how much of her benefits from this coverage would be subject to tax? A) None B) It depends on her tax bracket C) Half D) All
answer
All
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If Wanda paid 50% of premiums, what percentage of her benefits would be tax free? A) 100% B) It depends on her tax bracket C) 50% D) 0%
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50%
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If Wanda paid 100% of her premiums, what percentage of her benefits would be tax free? A) 0% B) It depends on her tax bracket C) 50% D) 100%
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100%
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The Delectable Doughnut Company may deduct its premiums for business overhead expense insurance A) only if it is a corporation B) premiums are not deductible C) if is a corporation, partnership, or sole proprietorship D) only if it is a partnership or a corporation
answer
if is a corporation, partnership, or sole proprietorship
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The premiums are deductible for which of the following? A) Neither B) Disability policy to fund a buy-sell agreement C) Key employee disability policy D) Both
answer
Neither
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Social Security disability income and medical benefits are financed through A) State government B) voluntary contributions C) Mandatory payroll taxes D) ERISA
answer
Mandatory payroll taxes
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The taxes to finance Social Security benefits are paid A) equally by employees and employers B) solely by employees C) the federal governmnet D) solely by employers
answer
equally by employees and employers
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Medicare Part A hospital insurance is primarily funded by A) state government taxes B) premiums from beneficiaries C) general tax revenue D) Social Security payroll taxes
answer
Social Security payroll taxes
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Social Security taxes are paid by employees with A) tax-deductible dollars B) pretax dollars C) tax-deferred dollars D) after-tax dollars
answer
after-tax dollars
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Premiums for individually owned health policies may be deductible if the taxpayer's medical expenses exceed A) 5% of their adjusted gross income during the taxable year B) 5% of their adjusted net income during the taxable year C) 10% of their adjusted gross income during the taxable year D) 10% of their adjusted net income during the taxable year
answer
10% of their adjusted gross income during the taxable year
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The premiums paid by a company for group health for its employees are A) not tax deductible to either the company or the business B) tax deductible by the company and considered taxable income to the employees C) tax deductible to the employees and the company D) tax deductible by the company and not considered taxable income to the employees
answer
tax deductible by the company and not considered taxable income to the employees
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Benefits paid by individually owned accident, health, disability, or long-term care policies generally are A) received income-tax free by the taxpayer, provided benefits do not exceed actual expenses B) received partially tax free by the taxpayer, provided benefits do not exceed actual expenses C) received income-tax free by the taxpayer, even if benefits exceed actual expenses D) taxed upon receipt by the taxpayer
answer
received income-tax free by the taxpayer, provided benefits do not exceed actual expenses
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Qualified group long-term care coverage is A) deductible by the employee but not the company B) deductible by neither the company or the employee C) deductible by the company but not the employee D) deductible by both the company and the employee
answer
deductible by the company but not the employee
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Individual disability insurance premiums are A) not deductible to the insured, and the benefits are taxed B) not deductible to the insured, but the benefits are received tax free C) deductible to the insured, and the benefits are received tax free D) deductible to the insured, but the benefits are taxed
answer
not deductible to the insured, but the benefits are received tax free
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An individual who is considered chronically ill must be recertified as such A) every 2 years B) every 6 months C) every month D) annually
answer
annually
question
Social Security taxes are often shared between the employer and employee. What do self-employed people pay? A) Just the employee's portion of the tax B) Both the employer's portion and the employee's portion of the tax C) Just the employer's portion of the tax D) Neither the employer's portion nor the employee's portion of the tax
answer
Both the employer's portion and the employee's portion of the tax
question
Shane is a master carpenter in business for himself. His business is probably operated as A) a sole proprietorship B) a limited liability company C) a corporation D) a partnership
answer
a sole proprietorship