insurance test

58問 • 2年前

問題一覧

Which of the following actions is required by an isnured who leaves the primary area of medical coverage and seeks medical care?

obtain prior approval from the insurer for the medical service

Medicaid was designed to assist individuals who are:

below a specific income limit

Which of the following statements is true about most Blue Cross/Blue Shield organizations?

they are nonprofit organizations

A 66 year old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?

her group health plan

Which of the following does Social Security NOT provide benefits for?

dismemberment

A medical care provider which typically delivers heatlh services at its own local medical facility is known as a:

heatlh maintenance organization

Which of the following reimburses its insureds for covered medical expenses?

Commercial insurers

The first portion of a covered Major Medical insurance expense that the isnured is required to pay is called the:

initial deductible

All of these are characteristics of a Health Reimbursement Arrangement (HRA) EXCEPT:

HRA is fully funded by the employee

This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year

family maximum deductible

Which of the following medical expenses does Cancer insurance NOT cover?

Arthritis

A prospective insured completes and signs an application for heatlh insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will:

continue coverage but exclude the heart condition

J’s Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay:

$3,600

All of the following statements about Major Medical benefits are true, EXCEPT:

Benefits have no maximum

J was reviewing her Health Insurance policy and noticed the phrase “The policy will only pay for a semi-private room”. This phrase is considered to be a(n):

internal limit

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of heatlh care services that are covered. All of the following heatlh care services are typically covered, EXCEPT for:

experimental and investigative services

An individual ha a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses is incurred?

$7,000

This type of deductible provision states that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied

common accident deductible

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

the maximum amount considered eligible for reimbursement by an insurance company under a health plan

M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?

$1,600

Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?

$2,100

A Major Medical policy that typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. This provision is called:

Coinsurance

A characteristic of Preferred Provider Organizations (PPOs) would be:

discounted fees for the patient

Which of the following situations does a Critical Illness plan cover?

Leukemia

Which of the following policy features allows an insured to defer current heatlh charges to the following years deductible instead of the current years deductible?

carryover provision

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

Discourages overutilization of the insurance coverage

Which of the following phrases refers to the fees charged by a healthcare professional?

usual, customary, and reasonable expenses

The individual Health Insurance policy that offers the broadest protection is a(n) ______ ______ policy

major medical

A major medical policy typically:

provides benefits for reasonable and necessary medical expenses, subject to policy limits

For which of the following expenses does a Basic Hospital policy pay?

hospital room and board

T was treated for an ailment 2 months prior to applying for a health insurnace policy. This condition was noted on the applicaiton and the policy was issued shortly afterwards. How will the insurer likely consider this condition?

insurer will likely treats as a pre-existing condition which may not be covered for one year

Deductibles are used in health policies to lower:

overuse of medical services

R has received full disability income benefits for 6 months. When he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity?

residual disability

An insured owns an individual Disability Income policy with a 30-day Elimination Period for sickness and accidents and a monthly indemnity benefit of $500. If the insured is disabled for 3 1/2 months, what is the MAXIMUM amount he would receive for an approved claim?

$1,250

Z owns a Disability Income policy with a 30-day Elimination period. Z contract pneumonia that leaves him unable to work from January 1 until January 15. Z then becomes disabled from an accident on February 1 and the disability lasts until July 1 the same year. Z will become eligible to receive benefits starting on:

March 1

D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits?

residual benefit clause

X own a Disabilty Insurance policy. X recently suffered a disability which was due to the same cause as a previous disability. These disabilities both occurred over a 4-month span. Which of the following provisions allows X’s second disability to be covered without a new elimination period?

recurrent disability

R becomes disabled and owns an individual Disability Income policy. When is R eligible to receive disability benefits?

upon satisfying the elimination period requirement

Non-occupational disability coverage is designed for:

employees who suffer non-work related disabilities, since work-related disabilities are covered by Workers Compensation

J has a Disabiltiy Income policy that does NOT provide benefits for losses occurring as the result of his employment. What kind of coverage is this?

nonoccupational coverage

A CEO’s personal assistant suffered injuries at home and as a result, was unable to work for 4 months. Which type of policy will pay a monthly benefit to the personal assistant?

disability income

An individual Disability Income isnurance applicant may be required to submit all of the following information, EXCEPT:

spouses occupation

What is the elimination period of an individual disability policy?

timer period a disabled person must wait before benefits are paid

M becomes disabled and is unable to work for 6 months. M dies soon after from complications arising from this disability. M has a disability income policy that pays $2,000 a month. Whihc of the following statements BEST describes what is owed to her estate?

earned, but unpaid benefits

Disability policies do NOT normally pay for disabilities arising from which of the following?

war

A CEO’s personal assistant suffered injuries at home and as a result, was unable to work for 4 months. Which type of policy will pay a month benefit to the personal assistant?

disability income

What does a Guaranteed Insurability rider provide a Disability Income policyowner?

the ability to periodically increase the amount of coverage without evidence of insurability

In the event of an illness, a(n) _____ _____ policy would reimburse an insured for loss of earnings.

disability income

When determining the monthly benefit amount for a Disability Income policy, the factor that limits the amount a prospective isnured may purchase is:

income

A disability elimination period is best described as a:

time deductible

T has Disability Income policy that pays a monthly benefit of $5,000. If T becomes partially disabled, what can he likely expect?

less than $5,000 per month benefit regardless of the cause

A physician opens up a new practice and qualifies for a $7,000/month Disability Income policy. What rider would the physician add if he wants the ability to increase his policy benefit as his practice and income grow?

Guaranteed Insurability Option Rider

V is insured under an individual Disability Income policy with a 30-day Elimination period. On July 1, he is involved in an accident and temporarily disabled. He returns to work on December 1. How many months of beneift are payable?

4 months

Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this?

Guaranteed insurability rider

K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income?

disability income

P received Disability income benefits for 3 months then returns to work. She is able to work one months before her condition returns, leaving her disabled once again. What would the insurance company most likely regard this second period of disability as?

a recurrent disability

What is the primary factor that determines the benefits paid under a disability income policy?

wages

B is a teacher who was injured in a car accident and cannot work. She is now receiving monthly benefits as a result of this accident. Which type of policy does B have?

disability income

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問題一覧

Which of the following actions is required by an isnured who leaves the primary area of medical coverage and seeks medical care?

obtain prior approval from the insurer for the medical service

Medicaid was designed to assist individuals who are:

below a specific income limit

Which of the following statements is true about most Blue Cross/Blue Shield organizations?

they are nonprofit organizations

A 66 year old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?

her group health plan

Which of the following does Social Security NOT provide benefits for?

dismemberment

A medical care provider which typically delivers heatlh services at its own local medical facility is known as a:

heatlh maintenance organization

Which of the following reimburses its insureds for covered medical expenses?

Commercial insurers

The first portion of a covered Major Medical insurance expense that the isnured is required to pay is called the:

initial deductible

All of these are characteristics of a Health Reimbursement Arrangement (HRA) EXCEPT:

HRA is fully funded by the employee

This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year

family maximum deductible

Which of the following medical expenses does Cancer insurance NOT cover?

Arthritis

continue coverage but exclude the heart condition

J’s Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay:

$3,600

All of the following statements about Major Medical benefits are true, EXCEPT:

Benefits have no maximum

J was reviewing her Health Insurance policy and noticed the phrase “The policy will only pay for a semi-private room”. This phrase is considered to be a(n):

internal limit

experimental and investigative services

An individual ha a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses is incurred?

$7,000

This type of deductible provision states that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied

common accident deductible

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

the maximum amount considered eligible for reimbursement by an insurance company under a health plan

$1,600

Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?

$2,100

A Major Medical policy that typically contains a provision that requires the insurer to pay only part of a loss, while the balance is paid by the insured. This provision is called:

Coinsurance

A characteristic of Preferred Provider Organizations (PPOs) would be:

discounted fees for the patient

Which of the following situations does a Critical Illness plan cover?

Leukemia

Which of the following policy features allows an insured to defer current heatlh charges to the following years deductible instead of the current years deductible?

carryover provision

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

Discourages overutilization of the insurance coverage

Which of the following phrases refers to the fees charged by a healthcare professional?

usual, customary, and reasonable expenses

The individual Health Insurance policy that offers the broadest protection is a(n) ______ ______ policy

major medical

A major medical policy typically:

provides benefits for reasonable and necessary medical expenses, subject to policy limits

For which of the following expenses does a Basic Hospital policy pay?

hospital room and board

insurer will likely treats as a pre-existing condition which may not be covered for one year

Deductibles are used in health policies to lower:

overuse of medical services

residual disability

$1,250

March 1

residual benefit clause

recurrent disability

R becomes disabled and owns an individual Disability Income policy. When is R eligible to receive disability benefits?

upon satisfying the elimination period requirement

Non-occupational disability coverage is designed for:

employees who suffer non-work related disabilities, since work-related disabilities are covered by Workers Compensation

J has a Disabiltiy Income policy that does NOT provide benefits for losses occurring as the result of his employment. What kind of coverage is this?

nonoccupational coverage

A CEO’s personal assistant suffered injuries at home and as a result, was unable to work for 4 months. Which type of policy will pay a monthly benefit to the personal assistant?

disability income

An individual Disability Income isnurance applicant may be required to submit all of the following information, EXCEPT:

spouses occupation

What is the elimination period of an individual disability policy?

timer period a disabled person must wait before benefits are paid

earned, but unpaid benefits

Disability policies do NOT normally pay for disabilities arising from which of the following?

war

A CEO’s personal assistant suffered injuries at home and as a result, was unable to work for 4 months. Which type of policy will pay a month benefit to the personal assistant?

disability income

What does a Guaranteed Insurability rider provide a Disability Income policyowner?

the ability to periodically increase the amount of coverage without evidence of insurability

In the event of an illness, a(n) _____ _____ policy would reimburse an insured for loss of earnings.

disability income

When determining the monthly benefit amount for a Disability Income policy, the factor that limits the amount a prospective isnured may purchase is:

income

A disability elimination period is best described as a:

time deductible

T has Disability Income policy that pays a monthly benefit of $5,000. If T becomes partially disabled, what can he likely expect?

less than $5,000 per month benefit regardless of the cause

Guaranteed Insurability Option Rider

4 months

Guaranteed insurability rider

K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income?

disability income

a recurrent disability

What is the primary factor that determines the benefits paid under a disability income policy?

wages

B is a teacher who was injured in a car accident and cannot work. She is now receiving monthly benefits as a result of this accident. Which type of policy does B have?

disability income