Accident and Health Insurance Basic Concepts and Principles

Question 1

What type of A&H policy is designed to pay benefits for chronic conditions and nursing home benefits?

Answer 1

A Long-Term Care policy

Question 2

Which health care program provides medical benefits for members and dependents of the military?

Answer 2

Tricare

Question 3

True or False: A Preferred Provider Organization actually provides the insured with medical benefits.

Answer 3

False.

A PPO negotiates and creates the rate structure used between employer groups and medical providers.

Question 4

What type of A&H policy is designed to provide income to an insured?

Answer 4

Disability income

Question 5

What is the probationary period?

Answer 5

The period of time following the issuance of the policy when benefits may not be provided

Question 6

Creating a _________________ Trust lets small employers with a common affiliation join together to buy group benefits.

Answer 6

Multiple Employer

Question 7

What term is used to describe a primary care provider that verifies the need for additional and specialized benefits?

Answer 7

Gatekeeper

Question 8

What is the general term used to describe medical, disability, and LTC policies?

Answer 8

Accident and health insurance

Question 9

Which type of health care delivery program emphasizes preventative care?

Answer 9

A Health Maintenance Organization

Question 10

What provision states that the amount of disability coverage allowed is directly related to a person’s income?

Answer 10

The Relation of Earnings to Insurance provision

Question 11

What organization provides the benefits of both an HMO and a PPO?

Answer 11

A Point of Service organization

Question 12

What is Blue Cross?

Answer 12

A nonprofit service provider that provides benefits for hospital expenses

Question 13

What type of insurance is purchased to protect agents and insurers in the event of a negligent act?

Answer 13

Errors and Omissions insurance

Question 14

Which nonprofit service provider provides benefits for the expenses related to a doctor?

Answer 14

Blue Shield

Question 15

What HMO requires members to use only doctors employed or contracted with the HMO?

Answer 15

A Closed Panel HMO

Question 16

What term is used to describe the contract that a PPO creates between an employer group and a medical provider?

Answer 16

Preferred Provider Arrangement (PPA)

Question 17

What is the Future Increase Option or Guaranteed Insurability rider?

Answer 17

The rider allows for additional coverage without being required to take a medical exam

Question 18

What is the name for the medical issues that exist prior to policy issuance that may not be covered by a new policy?

Answer 18

Preexisting conditions

Question 19

The ______________ rider assists an insured in getting back to work after a disability.

Answer 19

Rehabilitation

Question 20

Which concept indicates that the insured will be indemnified for actual losses and not profit from her injury/illness?

Answer 20

The No Loss/No Gain Statute

Question 21

What is the elimination (waiting) period?

Answer 21

The period of time that must elapse on a disability income policy prior to income benefits being received

Question 22

What is the term used by insurers to describe the containment of health care costs?

Answer 22

Managed care

Question 23

Members of a Blue Cross/Blue Shield program are called ______________.

Answer 23

subscribers.