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Ins > Chap 5 Cont 7 > Flashcards

Chap 5 Cont 7 Flashcards

1
Q

Optional benefits with long term care policies

Included in all policies
Available for additional premium
Only standard benefits are available with LTC policies

A

Available for an additional premium

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2
Q

Not an activity of daily living ADL

Dressing
Bathing
Talking
Eating

A

Talking

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3
Q

Regarding optional benefits with long term care policies

All included in all policies
Available for additional premium
Only standard benefits are available with LTC policies

A

Available for an additional premium

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4
Q

Longterm care covers three levels of care:

Skilled nursing, intermediate care custodial care
Home care home convalescent residential
Adult day care respite care adhesion care

A

Intermediate care custodial care skilled nursing care

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5
Q

Daily nursing and rehabilitative care only provided by medical personnel under direction of physician

Intermediate care
Skilled care
Custodial care

A

Skilled care

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6
Q

Care that can be given by nonprofessional staff is not considered

A

Skilled care

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7
Q

Occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care/ordered by physician and skilled personallel would deliver or monitor type of care

Intermediate care
Skilled care
Custodial care

A

Intermediate care

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8
Q

Could be as simple as medication to a group or changing bandage

Home health care
Residential care
Custodial care
Intermediate care

A

Intermediate care

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9
Q

Care for meeting personal needs such as assistance in eating, dressing, or bathing

Respite care
Custodial care
Intermediate care

A

Custodial care

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10
Q

Provided by a skilled nursing or other professional services in ones home/occasional visits to person’s home by registered nurses or community based orgs like hospice

Adult day care
Residential care
Home health care

A

Home health care

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11
Q

Provided in insureds home under a planned program established by the insureds attending physician by long term care facility home health care agency or hospital

Adult day care
Respite care
Home convalescent care

A

Home convalescent care

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12
Q

Provided while insured resides in a retirement community or residential care facility for elderly RCFE with some degree of independences (possibly) same as living in one[‘s own home

Bc of costs for middle and upper classes

Adult day care
Respite care
Residential care

A

Residential care

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13
Q

Provided for functionally impaired adults on less than 24 hour basis. Could be by neighborhood recreation or community center …includes transportation to and from day care center and activities/meals usually included

Respite care
Consideration
Home health care
Adult day care

A

Adult day care

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14
Q

Designed to provide relief to family caregiver and can include services such as someone coming over during nap for caregiver

Respite care
Consideration
Aleatory
Asset

A

Respite care

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15
Q

In longterm care ins what is provided with intermediate care

Intensive care
Occasional nursing or rehab care
Non medical daily care

A

Occasional nursing or rehabilitative care

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16
Q

Occasional visits where following with NOT be covered under LTC home health care

Nurses
Licenses practical nurses
Attending physician

A

Attending physician

17
Q

Not covered under long term care policy

Hospice care
Home health care
Acute care in hospital

A

Acute care in hospital

18
Q

Who can provide skilled nursing care

Spouse
Doctor
Family member

A

Doctor

19
Q

Which location would skilled care be provided

Patients home
Outpatient setting
Institutional setting

A

Institutional setting under direction of physician

20
Q

Functionally impaired adults on a less than 24 hour basis coverage

Adult day care
Residential care
Assured living

A

Adult day care

21
Q

Skilled nursing intermediate and custodial care may all be provided in an intituational setting true or false

A

True

22
Q

Not provided in institutional setting

Skilled nursing
Intermediate care
Home health care
Custodial care

A

Home health

23
Q

Can group formed for sole purpose of obtaining group ins qualify for group coverage

Yes any group scan apply for group coverage
Yes but only if group is over 35 ppl
No group must be formed for purpose other than obtaining group insurance

A

No group must be formed for purpose other than obtaining grou insurance

24
Q

Association could buy grou ins for its members if it meets all of following except

Has at least 50 members
Has constitution and by laws
Holds annual meetings
Is contributory

A

Has at least 50 members

Must have at least 100

25
Q

Less than 100 hours=adult daycare

A
26
Q

Underwriting a group health ins plan that is paid for by employer requires all except

Eligible employees must be covered
Coverage for plan Ppts is uniform
Individual members of group may select level of benefits fo their own coverage

A

Individual members of group may select the level of benefits for their own coverage

27
Q

Group health ins means all individual are covered under

Contract
Bill
Asset
Master policy

A

Master policy for same coverages

28
Q

Not characteristic of group health ins

Policy is issued to each insured individual

Dependents of insureds can be covered under group health plans

Group coverage may be converted to individual coverage if group contact is ended

A

Policy is issued to each insured individual

29
Q

Small company offers grou health ins to its employees but recently has decided to terminate the health ins contract leaving the workers without ins

Request a refund of unearned premium
Convert to individual health policy
Sue employer

A

Convert to an individual health policy

30
Q

Which concerning group health ins is correct

Only employer receives a certificate of ins
Each employee receives a policy
Employer ithe policyholder

A

Employer is the policy holder

31
Q

Employer receives master policy and each employee receives

Executive contract
Policy
Group ins
Certificate of ins

A

Employee receives certificate of ins

32
Q

Which statement is NOT true regarding underwriting group health insurance

Premiums are reassessed annually
Everyone is covered regardless of medical history
Group is assessed individually for insurability

A

Assessed individually for insurability

33
Q

Following are differences between individual and group health insurance EXCEPT

Individual can be written on an occupational or non occupational basis; grou plans cover only non occupational
Individual policies are renewable at the option of the insured while group usually terminate when the individual leaves the group
Individual ins does not require medical examination while group ins does not require medical examinations

A

Individual ins does not require medical exams while group ins does require medical exams

34
Q

Group health ins is characterized by all of the following except

Lower admin costs
Conversion privilege
Adverse selection
A master contract

A

Adverse selection

35
Q

What is the period of coverage for events such as death or divorce under cobra

12 months
36 months
60 days
31 days

A

36 months

36
Q

Which is NOT correct re cobra act of 1985

Cobra stands for consolidated omnibus reconciliation act
Requires all employers regardless of number or age of employees to provide extended group health coverage
Covers termed employees and/or their dependents for up to 36 months after qualifying event

A

Requires all employers regardless of number of age of employees to provide extended group health coverage

37
Q

Cobra act applies to only employers with

5
10
15
20

A

20 or more employees

38
Q

Re group health ins cobra stipulates that

Group coverage must be extended for terminated employees up to certain period of time at employer’s expense
Group coverage must be extended for terminated employees up to a certain period of time at former employee’s expense
Retiring employees must be allowed to convert their group coverage to individual policies

A

Group coverage must be extended for terminated employees up to a certain period of time at the former employee’s expense

39
Q

Cobra requires employers with twenty or more employees to continue group medical ins for termed workers and dependents for up to 18 to 36 months. Employee can be required to pay up to

5%
4%
102%
100%

of coverage’s premium

A

102%

Ins (77 decks)

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