Accident & Health Exam Cram #2 Flashcards
1
Q
- Relevant factors in the health insurance principle of morbidity include all of the following EXCEPT
a. Age.
b. Income.
c. Intelligence.
d. Sex.
A
Intelligence
2
Q
- A surviving spouse without dependent children is eligible for Social Security survivor benefits at age
a. 55
b. 60
C. 62
d. 65
A
60
3
Q
- Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a qualifying event ensures that an employee who loses coverage can
a. Elect to continue coverage.
b. Request a waiver of premium.
c. Convert to an individual policy.
d. Transfer coverage to another group.
A
Elect to continue coverage.
4
Q
- The Family and Medical Leave Act (FMLA) covers all of the following EXCEPT
a. The adoption of a child.
b. Caring for a parent with a serious health condition.
c. Traveling with a spouse who has been transferred overseas.
d. A serious health condition that prevents an employee from working.
A
Traveling with a spouse who has been transferred overseas.
5
Q
- All of following statements about Medicare Part B are correct EXCEPT it
a. Requires a premium payment.
b. Pays for physician services.
c. Is optional to those enrolling in Medicare Part A.
d. Pays for virtually all drugs prescribed by a physician.
A
Pays for virtually all drugs prescribed by a physician.
6
Q
- Under social security, the definition of disability is the inability to engage in
a. An activity with a given level of compensation.
b. Any substantial gainful activity.
c. The person’s chosen career.
d. An approved occupation.
A
Any substantial gainful activity
7
Q
- All of the following conditions must be met to qualify for residual disability benefits under a disability income policy EXCEPT
a. Currently earns at least 20% less than prior income.
b. Qualifies for Social Security disability benefits.
c. Continues to be under a physician’s care.
d. Is able to work full- or part-time.
A
Qualifies for Social Security disability benefits
8
Q
- Probationary periods reduce costs to employers in all of the following ways EXCEPT
a. There is a reduction in adverse selection.
b. Employees must pay the entire premium during this time.
c. Employees must pay for all incurred expenses during this time.
d. Administrative costs are minimized for employees who terminate employment shortly after being hired.
A
Employees must pay the entire premium during this time.
9
Q
- Who submits Medicare part A claims?
a. Patients.
b. Hospitals.
c. Pharmacies.
d. Physicians.
A
Pharmacies
10
Q
- Members of the medical information bureau are REQUIRED to report
a. The cause of death where death benefits are paid.
b. Amounts of insurance applied for by all applicants.
c. The names of all patients treated by a member physician.
d. Medical impairments found during the underwriting process.
A
Medical impairments found during the underwriting process.
11
Q
- Unless certified by another governmental agency, which entity has jurisdiction over providers of coverage designed to pay for health care services?
a. The department of insurance.
b. The medical information bureau.
c. The department of health and safety.
d. The health insurance and counseling advocacy program.
A
The department of insurance
12
Q
- Which health plan might apply 90% coinsurance to network providers and 70% coinsurance to non-network
providers?
a. Exclusive provider organization (EPO).
b. Health maintenance organization (HMO).
c. Preferred provider organization (PPO).
d. Major medical.
A
Preferred provider organization (PPO).
13
Q
- All of the following are features of a preferred provider organization (PPO) EXCEPT
a. Employees have a choice of practitioners.
b. Primary care physicians act as gatekeepers.
c. Providers are paid on a fee-for-service basis.
d. Dependents do not need referrals to see a specialist.
A
Primary care physicians act as gatekeepers.
14
Q
- A Long-Term Care insurance rider can include coverage for all of the following EXCEPT
a. Hospice.
b. Respite care.
c. Adult day care.
d. Hospital acute care.
A
Hospital acute care
15
Q
- The employee retirement income security act of 1974 (ERISA) regulates group health insurance in the area of
a. Family and medical leave.
b. Disclosure and reporting.
c. Americans with disabilities.
d. Continuation of group health care.
A
Disclosure and reporting
16
Q
- The frequency and severity of certain illnesses and accidents is known as
a. Morbidity.
b. Mortality.
c. Insurability.
d. Incontestability.
A
Morbidity
17
Q
- Which funded government program is jointly administered by the federal and state governments?
a. Medi-Cal.
b. Medicare.
c. Social Security.
d. Medicare assignment.
A
Medi-Cal
18
Q
- Which of the following conditions would NOT be included among the chronic illness triggers of a long-term
care policy?
a. Alzheimer’s
b. Deafness
c. Dementia
d. Incontinence
A
Deafness
19
Q
- Which long-term care policy provision allows for a periodic increase in policy benefits?
a. Portability
b. Suitability
c. Nonforfeiture
d. Inflation protection.
A
Inflation protection.
20
Q
- How long do worker’s compensation medical expenses
continue for disabled workers?
a. 1 year.
b. 2 years.
c. 5 years.
d. There is no limit.
A
There is no limit
21
Q
- Long-term care insurance may be purchased in all of the following forms EXCEPT
a. Individual policies.
b. Employer-sponsored group policies.
c. Federal government-sponsored policies.
d. Riders to cash value life insurance policies.
A
Federal government-sponsored policies.
22
Q
- At what age are individuals eligible for Medicare Part A benefits?
a. 55
b. 59
C. 62
d. 65
A
65
23
Q
- A worker dies who is credited with quarters of coverage during the last 13-quarter period. What status does the
worker have under Social Security?
a. Fully insured.
b. Partially insured.
c. Currently insured.
d. Disability insured.
A
Currently insured.
24
Q
- To reach currently insured status under the Social Security system, an individual must be credited with a MINIMM of
a. 13 quarters of coverage during the last 20-quarter period.
b. 6 quarters of coverage during the last 13-quarter period.
c. 20 quarters of coverage in total.
d. 40 quarters of coverage in total.
A
6 quarters of coverage during the last 13-quarter period.
25
25. An insured has a disability income policy with a $1,500 monthly benefit and a 30-day elimination period. The
insured is unable to work for 120 days following an accident. What amount will the policy pay?
a. $1,500
b. $3,000
c. $4,500
d. $6,000
$4,500
26
26. Which program is designed to provide medical assistance to people with low incomes?
a. Medi-Cal.
b. Medicare.
c. Social Security.
d. Workers' Compensation.
Medi-Cal
27
27. Why is an injury caused by an accident at an employee's workplace excluded from individual health insurance coverage?
a. It is covered by the employer's group disability insurance plan.
b. It is covered by the employer's group health insurance plan.
c. It is covered by the state worker's Compensation program.
d. It is covered by Social Security Benefits.
It is covered by the state worker's Compensation program.
28
28. Insurers are prohibited from denying claims based on misrepresentations in a disability policy application after the policy has been in force for
a. One year.
b. Two years.
c. Three years.
d. Four years.
Two years
29
29. A terminating employee who wants to exercise the conversion privilege must meet all of the following requirements EXCEPT
a. Pay the premium.
b. Fill out the required forms.
c. Supply evidence of insurability.
d. Apply within 31 days of termination.
Supply evidence of insurability
30
30. What rights do individuals have if they disagree with a decision on the amount Medicare will pay?
a. They can change Medicare carriers.
b. They can ask the Medicare carrier to review the decision.
c. They can request a second opinion by the state medical examiner.
d. They can terminate making premium payments until the claim is resolved.
They can ask the Medicare carrier to review the decision.
31
31. The social security normal retirement age depends upon the
a. Worker's year of birth.
b. Number of years of employment.
c. Number of quarters of coverage.
d. Worker's average annual earnings.
Worker's year of birth
32
32. What is the first step in submitting Medicare claims?
a. The patient submits expenses to Medicare.
b. The medical provider submits expenses to Medicare.
c. The medical provider submits expenses to the patient.
d. Medicare submits expenses to the Medicare supplement provider.
The medical provider submits expenses to Medicare.
33
33. Which of the following statements concerning the usual coordination of benefits provision are CORRECT?
a. Medicare coverage is always primary to coverage as an active employee.
b. Coverage under COBRA is primary to coverage as an active employee.
c. When two plans both have the provision, coverage as an employee is primary to coverage as a dependent.
d. Coverage under any plan with the provision is primary to coverage under any plan without the provision.
When two plans both have the provision, coverage as an employee is primary to coverage as a dependent
34
34. Which plan covers the medical expenses that are NOT covered by Medicare?
a. Medi-Cal.
b. Long-term care.
c. Disability income.
d. Medicare supplement.
Medicare supplement
35
35. After the deductible, what portion does a patient pay for covered expenses under Medicare Part B?
a. 20%
b. 50%
c. 80%
d. 100%
20%
36
36. In health insurance, the result of rising morbidity rates is
a. Decreased claims.
b. Increased premiums.
c. Increased profitability.
d. Decreased insurance rates.
Increased premiums
37
37. What happens if an insurer violates the Medical Loss Ratio rate and spends too much money on administrative
costs?
a. Insurers that do not meet the medical loss ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs.
b. Insurers that do not meet the medical loss ratio standard will pay a tax penalty to the federal government.
c. Insurers that do not meet the medical loss ratio standard will pay a tax penalty to the health benefits exchange.
d. Insurers that do not meet the medical loss ratio standard will only be required to reduce their spending on
administrative costs.
Insurers that do not meet the medical loss ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs.
38
38. The initial enrollment period for Medicare part B ends how many months after the 65" birthday month?
a. One month.
b. Three months.
c. Five months.
d. Seven months.
Three months
39
39. The Americans with disabilities act (ADA) defines a disabled person as one who is unable to perform any of the
following life activities EXCEPT
a. Breathing.
b. Driving.
c. Learning.
d. Speaking.
Driving
40
40. When an agent writes a replacement long-term care
policy, the agent's first year sales commission will be determined based on the
a. Original and new policy annual premiums combined.
b. New policy premiums reduced by a contributions penalty.
c. Difference between the new and original policy annual premiums.
d. New policy premium minus the original policy earned commissions.
Difference between the new and original policy annual premiums
41
41. In the worker's compensation policy, part one, worker's compensation, pays for
a. Sums the insured is required to pay under the master doctrine.
b. Sums the insured is required to pay under state worker's compensation law.
c. Sums the insured becomes legally obligated to pay under common law due to work injuries.
d. Sums the insured is required to pay to improve the safety conditions at the business location.
Sums the insured is required to pay under state worker's compensation law.
42
42. What is covered by part A of Medicare?
a. Hospitalization.
b. Prescription drugs.
c. Physicians' services.
d. Outpatient hospital treatment.
Hospitalization
43
43. Under PPACA, what is a health benefit exchange?
a. PPACA creates new entities called American health benefit exchanges through which individuals, small
businesses, and those who do not have access to affordable employer coverage, can purchase coverage.
b. A health benefits exchange is created by health insurers to allow individuals to access benefits in other insurer's plans.
c. A health benefits exchange is created by employers to relieve them of having to provide health benefits to
employees.
d. PPACA creates new entities called American health benefits exchanges through which low-income
individuals can access public health care programs.
PPACA creates new entities called American health benefit exchanges through which individuals, small
businesses, and those who do not have access to affordable employer coverage, can purchase coverage.
44
44. Social Security survivor benefits are available for all of the following EXCEPT
a. Surviving spouse over age 60.
b. Children under age 19 who are full-time students.
c. A spouse of any age who is caring for children under age 16.
d. Parents of any age who were dependent upon the deceased worker.
Parents of any age who were dependent upon the deceased worker.
45
45. Which statement is TRUE regarding worker's compensation?
a. Negligence is a factor in determining the employer's liability.
b. Worker's compensation benefits are usually received in a lump sum.
c. The employer pays the entire premium for worker's compensation coverage.
d. The amount received from workers' compensation is usually greater than the employee might receive if he or
she sued a negligent employer.
The employer pays the entire premium for worker's compensation coverage.
