Ch 14/15/16 Flashcards
Health insurance polices include an exclusion provision. All of the following will be excluded under an accidental health policy accept.
Self inflicted injury
What is the purpose of the coinsurance clause
To encourage the insured to share in the cost of care.
Physicians expense coverage is often referred to
Out patient expense
Which of the following polices pays a benefit if an insured suffers a illness due to cancer only
Dread decease policy
What is the primary purpose of medical expense insurance deductible
To eliminate smaller claims
A policy paying benefits on relative value basis is probably
Surgical expense plan
In most major medical polices, if an insured 20 year old son drops out of collage, he will continue to be covered under his parents major medical policy
Yes up to age 26
Which of the following is a eligible dependent that may be covered by a group or individual medical expense plain
A step child of the insured
Which of the following is an example of a endodontic procedure
Root Canal
Which of the following is a illustration of a prosthodtics
Dentures and bridgework
Which of the following can a doctor use if she wants to find out prior to treatment being provided is such treatment is covered by an insured medical plain
prospective review
Which of the following provides comprehensive insurance coverage
Medical expense
Which of the following is based upon a fee for service approach
Major Medical Plan
Which of the following is true regarding the Affordable Care Act
All exchanges must provide an internet portal fort all registrations
If a covered worker qualifies for disability benefits under social security, monthly income benefits would begin after a waiting period of
five months
Medicare is a federally sponsored two part health insurance program. Each of the following medical services is covered under Part A of Medicare Except
Physicians Care
Part B of Medicare is optional coverage. Which of the following would not be covered by this portion of Medicare?
Eye Examination
All the following are acts of daily living EXCEPT
Breathing
Medicare Supplement polices may not include a pre existing condition limitation that exceeds
6 months
What is the purpose of a elimination period which appears in a Long Term Care Policy.
To allow the insurer to lower cost for everyone’s benefit
Polices providing Hospice care benefits are not required to provide
Home Health care
Which of the following would not be eligible for enrollment in the Medicare prescription drug plan
A person 66 not eligible for social security benefits
To be eligible for coverage under Part C of Medicare, an individual does not have to prove he or she is insurable if enrollment occurs during what period of time following the attainment age of 65
6 moths
Which of the following Medicare coverage sections provides managed health care.
Part C
Which of the following long term care benefits provides 24 hour care
Skilled nursing care
Which provider is considered the second payor if an individual is covered by both Medicare and group health insurance
Medicare
A long term care policy provides coverage for which of the following
Alzheimer
What health insurance provision allows an insurer to deny a claim if finds that the insured concealed information about his health
Grace Period
An insured suffers a covered illness. He or she must notify the insurer of the loss with in
20 days
Which of the following provisions is a required uniform health insurance provision
Legal action
A policy Owner may have his policy reinstated after a lapse if a reinstatement application is completed and approved. Once this application is submitted the insurer must notify the insured of its approval or declination with in
45 days
In health insurance policy, the policy owner consideration is
the premium paid and representations on the application
The fact that a A&H premium payment of S500 must be paid is stipulated in which of the following parts of the policy
Insuring Clause
Once the insured is injured and notifies the insurer, the latter must send out proof of loss with in
15 Days
If an insurer pays an A&H claim but later finds that the insured was injured while engaging in illegal activity, what action will they take
Attempt to recover the claim of payment
What type of claim A&H policy can have its premiums increased for an entire class of polices
Guaranteed renewable
