Chapter 6: Types of Health Policies

Question 1

Basic hospital, surgical, and medical policies and the major medical policies are commonly grouped into what are referred to as ______.

Answer 1

Medical Expense Insurance (Hospital, Surgical, Medical)

Question 2

______ provide benefits for the cost of medical care that results from accidents or sickness and are often referred to as first-dollar coverage because they usually do not require the insured to pay a deductible.

Answer 2

Medical Expense Insurance (Hospital, Surgical, Medical)

Question 3

______ policies cover hospital room and board, and miscellaneous hospital expenses, such as lab and x-ray charges, medicines, use of operating room and supplies, while the insured is confined in a hospital.

Answer 3

Hospital Expense

Question 4

Under basic hospital expense coverage, there is no deductible and the limits on ______ are set at a specified dollar amount per day up to a maximum number of days.

Answer 4

Room and Board

Question 5

The ______, which normally has a separate limit, pays for other miscellaneous expenses associated with a hospital stay and can be expressed either as a multiple of the room and board charge or as a flat amount.

Answer 5

Miscellaneous Hospital Expenses

Question 6

______ coverage is often referred to as Basic Physicians’ Nonsurgical Expense Coverage because it provides coverage for nonsurgical services a physician provides.

Answer 6

Basic Medical Expense Coverage

Question 7

______ coverage is commonly written in conjunction with Hospital Expense policies and pay for the costs of surgeons’ services, whether the surgery is performed in or out of the hospital.

Answer 7

Basic Surgical Expense

Question 8

Each surgical expense contract has a(n) ______ that lists the types of operations covered and their assigned dollar amounts. If an operation is not listed, the contract may pay for a comparable operation.

Answer 8

Surgical Schedule

Question 9

When the ______ approach is used, each surgical procedure will be assigned a number of points that are relative to the number of points assigned to the maximum benefit.

Answer 9

Relative Value

Question 10

______ policies offer a broad range of coverage under one policy and generally provide the following coverage:

1. Comprehensive coverage for hospital expenses.
2. Catastrophic medical expense protection.
3. Benefits for prolonged injury or illness.

Answer 10

Major Medical Expense

Question 11

There are two common types of major medical policies available: ______ policies and ______ policies.

Answer 11

1. Supplemental Major Medical

2. Comprehensive Major Medical

Question 12

______ policies are used to supplement the coverage payable under a basic medical expense policy.

Answer 12

Supplementary Major Medical

Question 13

After the limits of the basic policy are exhausted, the insured must pay a(n) ______ before the major medical coverage will pay benefits. This is applied between the basic coverage and the major medical coverage.

Answer 13

Corridor Deductible

Question 14

By means of the Health Maintenance Act of 1973, Congress strongly supported the growth of ______ in this country. The act forced employers with more than 25 employees to offer the ______ as an alternative to their regular health plans.

Answer 14

1. Health Maintenance Organizations (HMOs)

2. HMO

Question 15

The main goal of the HMO Act was to reduce the cost of health care by utilizing ______, which includes free annual check-ups for the entire family and free or low-cost immunizations.

Answer 15

Preventive Care

Question 16

The HMO provides benefits in the form of ______ rather than in the form of reimbursement for the services of the physician or hospital. The HMO concept is unique in that it provides both the ______ and ______ for its members.

Answer 16

1. Services
2. Financing
3. Patient Care

Question 17

The ______ offers services to those living within specific geographic boundaries, such as county lines or city limits.

Answer 17

Health Maintenance Organizations (HMOs)

Question 18

The ______ tries to limit costs by only providing care from physicians that meet their standards and are willing to provide care at a prenegotiated price.

Answer 18

Health Maintenance Organizations (HMOs)

Question 19

HMO’s require ______ which is a specific part of the cost of care or a flat dollar amount that must be paid by the member.

Answer 19

Health Maintenance Organizations (HMOs)

Question 20

HMOs operate on a(n) ______ basis: the HMO receives a flat amount each month attributed to each member, whether they see a physician or not. In essence, it is a prepaid medical plan.

Answer 20

Capitated

Question 21

When an individual becomes a member of the HMO, they will choose their ______ or ______.

Answer 21

1. Primary Care Physician (PCP)

2. Gatekeeper

Question 22

In order for the HMO member to get to see a(n) ______, the primary care physician (gatekeeper) must refer the member.

Answer 22

Specialist

Question 23

The ______ provides the member with inpatient hospital care, in or out of the service area.

Answer 23

Health Maintenance Organizations (HMOs)

Question 24

The the ______ system, the physicians are paid fees for their services rather than a salary, but the member is encouraged to visit approved member physicians that have previously agreed upon the fees to be charged. This encouragement comes in the form of benefits.

Answer 24

Preferred Provider Organization (PPO)

Question 25

A(n) ______ is a group of physicians and hospitals that contract with employers, insurers, or third party organizations to provide medical care services at a reduced fee.

Answer 25

Preferred Provider Organization (PPO)

Question 26

The ______ plan is merely a combination of HMO and PPO plans. Employees do not have to be locked into one plan or make a choice between the two plans. A different choice can be made every time a need arises for medical services.

Answer 26

Point-Of-Service (POS)

Question 27

______ plans enter into contractual arrangements with health care providers who form a provider network. However, plan members do not have to use only in-network providers for their care.

Answer 27

Point-Of-Service (POS)

Question 28

In a(n) ______ plan the individuals can visit an in-network provider at their discretion. If they decide to use an out-of-network physician then member copays, coinsurance, and deductibles may be substantially higher.

Answer 28

Point-Of-Service (POS)

Question 29

In ______ plans, participants usually have access to a provider network that is controlled by a PCP. Plan members have an option to seek care outside the network, but at reduced coverage levels.

Answer 29

Point-Of-Service (POS)

Question 30

In a(n) ______, the insured does not have to select a primary care physician. All network providers are considered “preferred,” and you can visit any of them, even specialists, without first seeing a primary care physician.

Answer 30

Preferred Provider Organization (PPO)

Question 31

A(n) ______ is a form of cafeteria plan benefit funded by salary reduction and employer contributions. These benefits are subject to annual maximum and “use-or-lose” rule.

Answer 31

Flexible Spending Account (FSA)

Question 32

There are 2 types of Flexible Spending Accounts: a(n) ______ for out-of-pocket health care expenses, and a(n) ______ (subject to annual contribution limits) to help pay for dependent’s care expenses.

Answer 32

1. Health Care Account

2. Dependent Care Account

Question 33

A(n) ______ is exempt from federal income taxes, Social Security (FICA) taxes and, in most cases, state income taxes.

Answer 33

Flexible Spending Account (FSA)

Question 34

______ child and dependent care expenses must be for the care of one or more qualifying persons:

1. A dependent who was under age ______ when the care was provided and who can be claimed as an exemption.
2. A(n) ______ who was physically or mentally not able to care for himself or herself.
3. A dependent who was physically or mentally not able to care for himself or herself and who can be claimed as an exemption.

Answer 34

1. Flexible Spending Account (FSA)
2. 13
3. Spouse

Question 35

The insured may only make changes to ______ benefits during open enrollment and possibly under certain circumstances known as ______ changes:

1. Marital status
2. Number of dependents
3. Change in dependent eligibility
4. Employment status affects eligibility
5. Change in dependent care provider
6. Family medical leave

Answer 35

1. Flexible Spending Account (FSA)

2. Qualified Life Event

Question 36

______ are often used in coordination with Medical Savings Accounts (MSAs), Health Savings Accounts (HSAs), or Health Reimbursement Accounts (HRAs). These feature higher annual deductibles and out-of-pocket limits than traditional health plans, which means lower premiums.

Answer 36

High-Deductible Health Plans (HDHPs)

Question 37

______ are designed to help individuals save for qualified health expenses that they, their spouse, or their dependents incur. An individual who is covered by a high deductible health plan an make a tax-deductible contribution to a(n) ______, and use it to pay for out-of-pocket medical expenses.

Answer 37

Health Savings Accounts (HSAs)

Question 38

To be eligible for a(n) ______, an individual must be covered by a HDHP, must not be covered by other health insurance, must not eligible for Medicare, and can’t be claimed as a dependent on someone else’s tax return.

Answer 38

Health Savings Accounts (HSAs)

Question 39

HSAs are linked to high deductible insurance with established minimum deductibles (______ for singles and ______ for families in 2020). Current annual contribution limits are ______ for singles and ______ for families.

Answer 39

1. $1,400 and $2,800

2. $3,550 and $7,100

Question 40

______ is designed to replace lost income in the event of this contingency, and is a vital component of a comprehensive insurance program. It may be purchased individually or through an employer on a group basis.

Answer 40

Disability Income Insurance

Question 41

______ is a waiting period that is imposed on the insured from the onset of disability until benefit payments commence, typically ranging from ______ days to ______ days. The purpose is to eliminate coverage for short-term disabilities in which the insured will be able to return to work in a relatively short period of time.

Answer 41

1. Elimination Period

2. 30 to 180 days

Question 42

______ is another type of waiting period that is imposed under some disability income policies. It does not replace the elimination period, but is in addition to it, often ______ to ______ days from the policy issue date during which benefits will not be paid for illness-related disabilities.

Answer 42

1. Probationary Period

2. 10 to 30

Question 43

______ refers to the length of time over which the monthly disability benefit payments will last for each disability after the elimination period has been satisfied. Most policies offer increments of ______, ______, ______, and to ______. Some plans offer ______ benefits.

Answer 43

1. Benefit Period
2. 1 Year, 2 Year, 5 Years
3. Age 65
4. Lifetime

Question 44

______ means the damage to the body is unexpected and unintended.

Answer 44

Accidental Bodily Injury

Question 45

______ indicates that the cause of the accident must be unexpected and unintended.

Answer 45

Accidental Means

Question 46

A policy that uses the accidental ______ definition will provide broader coverage than a policy that uses the accidental ______ definition.

Answer 46

1. Bodily Injury

2. Means

Question 47

______ or ______ is defined as either a sickness or disease contracted after the policy has been in force for at least ______; or a sickness or disease that first manifests itself after the policy is in force.

Answer 47

1. Sickness or Illness

2. 30 Days

Question 48

______ is a provision that is found in most disability income policies which specifies the conditions that will automatically qualify the insured for full disability benefits.

Answer 48

Presumptive Disability

Question 49

The amount of monthly benefit that is payable under most disability income policies is based on a percentage of the insured’s past earnings. The ______ are the maximum benefits the insurer is willing to accept for an individual risk; commonly to roughly ______ of the insured’s average earning for the period of two years prior.

Answer 49

1. Benefit Limits

2. 66%

Question 50

______ or ______ are used to supplement or replace benefits that might be payable under Social Security Disability. These provide for the payment of income benefits generally in three different situations:

1. When the insured is eligible for SS benefits but before the benefits begin.
2. If the insured has been denied coverage under SS.
3. When the amount payable under SS is less than the amount payable under the rider.

Answer 50

1. Social Insurance Supplement (SIS)

2. Social Security Riders

Question 51

The three types of disability income policies used for businesses are ______, ______, and ______.

Answer 51

1. Business Overhead Expense
2. Key Person Disability
3. Disability Buy-Sell Insurance

Question 52

______ insurance is a unique type of policy that is sold to small business owners who must continue to meet overhead expenses such as rent, utilities, employee salaries, installment purchases, leased equipment, etc., following a disability.

Answer 52

Business Overhead Expense (BOE)

Question 53

The ______ specifies who will purchase a disabled partner’s interest and legally obligates that person or party to purchase such interest upon disability. A provision for the contingency of disability can be added to a(n) ______ to eliminate the need for two separate agreements.

Answer 53

1. Disability Buyout Agreement

2. Buy-Sell Agreement

Question 54

______ is purchased by the employer on the chance of disability of a key employee, to protect the business of potential loss of business income as well as the expense of hiring and training a replacement.

Answer 54

Key Person Disability

Question 55

______ disability plans usually specify the benefits based on a percentage of the worker’s income, while ______ disability policies usually specify a flat amount.

Answer 55

1. Group

2. Individual

Question 56

______ disability plans usually provide maximum benefit periods of 13 to 52 weeks (with 26 weeks being the mot common), with weekly benefits of 50% to 100% of the individual’s income.

______ disability plans have maximum benefit periods of 6 months to 2 years.

Answer 56

1. Short-Term Group

2. Individual Short-Term

Question 57

______ disability plans provide maximum benefit periods of more than 2 years, with monthly benefits usually limited to 60% of the individual’s income.

Answer 57

Group Long-Term

Question 58

______ disability plans have minimum participation requirements. Usually, the employee must have worked for 30 to 90 days before becoming eligible for coverage.

Answer 58

Group

Question 59

______ disability plans usually make benefits supplemental to any benefits received under workers compensation.

Answer 59

Group

Question 60

Some ______ disability plans limit coverage to only nonoccupational disabilities.

Answer 60

Group

Question 61

______ coverage only pays for accidental losses and is thus considered a pure form of accident insurance.

Answer 61

Accidental Death and Dismemberment (AD&D)

Question 62

The ______ is paid for accidental death (when caused by the accident within ______ days) and is usually equal to the amount of coverage under the insurance contract, or the face amount. In case of loss of sight or accidental dismemberment, a percentage of that ______ will be paid b the policy, often referred to as the ______ and varying according to the severity of the injury.

Answer 62

1. Principal Sum
2. 90 Days
3. Principal Sum
4. Capital Sum

Question 63

The ______ defines the specific risk in which accidental death or dismemberment benefits will be paid. For example, the policy may be a Travel Accident Policy which only covers losses occurred during travel.

Answer 63

Limited Risk Policy

Question 64

The ______ will cover unusual types of risks that are not normally covered under AD&D policies. It covers only the specific hazard or risk identified in the policy, such as a racecar driver test-driving a new car.

Answer 64

Special Risk Policy

Question 65

______ policies, which can be marketed in the form of individual policies, group policies, or as riders to life insurance policies, provide coverage for individuals who are no longer able to live an independent lifestyle and require living assistance at home or in a nursing home facility.

Answer 65

Long-Term Care

Question 66

Long-term care policies must provide coverage for at least ______ in a setting other than an acute care unit of a hospital.

Answer 66

12 Consecutive Months

Question 67

Long-term care policies usually include a(n) ______, ranging from 0 to 365 days, similar to those found in disability income policies.

Answer 67

Elimination (Waiting) Period

Question 68

Long-term care policies also define the ______ for how long coverage applies, after the elimination period. This period of time is usually ______ to ______, with a few policies offering lifetime coverage.

Answer 68

1. Benefit Period

2. 2 to 5 Years

Question 69

The benefit amount payable under most LTC policies is usually a specific ______ amount per day, regardless of the actual cost of care.

Answer 69

Fixed Dollar

Question 70

Most LTC policies are also ______; however, insurers do have the right to increase the premiums.

Answer 70

Guaranteed Renewable

Question 71

The following are ______ or actions in long-term care policies:

1. Cancel, nonrenewal or otherwise terminate a LTC policy on the grounds of the insured’s age or the deterioration of mental or physical condition.
2. Establish a new waiting period when coverage is converted or replaced within the same company, except for increased benefits voluntary selected by the insured.
3. Cover only skilled nursing care, or provide significantly more coverage for skilled care than lower levels of care.

Answer 71

Prohibited Provisions

Question 72

Long-term care policies may have the following ______:

1. Pre-existing conditions or diseases.
2. Mental and nervous disorders or disease.
3. Alcoholism and drug addiction.
4. Treatment or illness caused by war, participation in criminal activities, or attempted suicide.
5. Treatment payable by the government, Medicare, workers compensation, or similar coverage.

Answer 72

Exclusions

Question 73

Generally, long-term care policies will cover 3 levels of care: ______ care, ______ care, and ______ care. In addition to these levels of care, the long-term care policy may provide coverage for ______ care, ______ care, ______ care, or ______ care, all of which can be received at home.

Answer 73

1. Skilled Nursing
2. Intermediate
3. Custodial
4. Home Health
5. Adult Day
6. Hospice
7. Respite

Question 74

______ is daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician. Care that can be given by nonprofessional staff is not considered ______.

Answer 74

Skilled Care

Question 75

______ is occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care.

Answer 75

Intermediate Care

Question 76

______ is care for meeting personal needs such as assistance in eating, dressing, or bathing, which can be provided by nonmedical personnel, such as relatives or home health care workers.

Answer 76

Custodial Care

Question 77

______ is care provided by a skilled nursing or other professional services in one’s home and might include physical therapy, occupational therapy, speech therapy, and medical services by a social worker.

Answer 77

Home Health Care

Question 78

______ is provided in the insured’s home under a planned program established by his or her attending physician and must be provided by a long-term care facility, a home health care agency, or a hospital.

Answer 78

Home Convalescent Care

Question 79

______ is provided while the insured resides in a retirement community or a residential care facility for the elderly (RCFE).

Answer 79

Residential Care

Question 80

______ is care provided for functionally impaired adults on less than a 24-hour basis and could be provided by a neighborhood recreation center or a community center.

Answer 80

Adult Day Care

Question 81

______ is designed to provide relief to the family caregiver, and can include a service such as someone coming to the home while the caregiver takes a nap or goes out for a while.

Answer 81

Respite Care

Question 82

______ long-term care insurance is the most common LTC in the private market. The advantages include state regulation of LTC plans, guaranteed renewability, and the ability to customize the plan to the individual’s own needs.

Answer 82

Individual

Question 83

______ LTC offers lower rates and less underwriting, allowing someone who might be denied individual coverage to enroll in open enrollment periods.

Answer 83

Group

Question 84

In order to qualify for group coverage, the group must be formed for a purpose other than obtaining ______.

Answer 84

Group Health Insurance

Question 85

With a(n) ______, the employer (a partnership, corporation, or a sole proprietorship) provides group coverage to its employees. Group health insurance may also be either contributory or noncontributory.

Answer 85

Employer-Sponsored Group

Question 86

A(n) ______ (alumni or professional) can buy group insurance for its members. The group must have at least 100 members, be organized for a reason other than buying insurance, have been active for at least two years, have a constitution, by-laws, and must hold at least annual meetings.

Answer 86

Association Group

Question 87

The actual group health insurance policy, called a(n) ______, is issued t to the group sponsor, while the individual insureds are issued ______ as proof of their coverage.

Answer 87

1. Master Contract

2. Certificates of Insurance

Question 88

Underwriting of ______ is unique in that when a group policy is written every eligible member of the group must be covered regardless of physical condition, age, sex, or occupation. Cost of the policy will vary by ratio of ______ and the ______ of the group.

Answer 88

1. Group Health Insurance Policies
2. Males to Females
3. Average Age

Question 89

The group health insurance underwriting process is designed to avoid adverse selection by the following requirements:

1. The insurance must be ______ to the group. The group cannot have been formed for the sole purpose of purchasing insurance.
2. There should be a(n) ______ of persons through the group, with the older or unhealthy individuals being replaced by younger and healthier individuals.
3. The ______ of the group: insurers do not want to write risks that frequently change insurers.
4. A method of ______ that prevents the individual selection of benefits.
5. How ______ are selected: employees are usually full-time only and meet minimum service requirements.
6. Whether the group is ______ or ______.
7. The ______ and ______ of the group, as well as the industry the group is involved in.
8. The ______ of the group.

Answer 89

1. Incidental
2. Steady Flow
3. Persistency
4. Selecting Benefits
5. Eligible Participants
6. Contributory or Noncontributory
7. Size and Composition
8. Prior Claims Experience

Question 90

______ contracts are issued to cover the applicant and usually dependents. Most are issued guaranteed renewable, so the underwriting to determine insurability is completed with care.

Answer 90

Individual Health Insurance

Question 91

______ underwriting can be less restrictive than with individual contracts in part because the yearly renewable term contract under which the insurance is written contemplates annual revaluation of the risk and adoption of remedial measures if the initial evaluation proved to be incorrect.

Answer 91

Group Health Insurance

Question 92

The ______ requires any employer with 20 or more employees to extend group health coverage to terminated employees and their families after a qualifying event.

Answer 92

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Question 93

______ for COBRA include the following:

1. Voluntary termination of employment.
2. Termination of employment for reasons other than gross misconduct.
3. Employment status change: from full time to part time.

Answer 93

Qualifying Events

Question 94

For any COBRA qualifying events, coverage is extended up to ______ and the employee must exercise extension of benefits within ______ of separation from employment. For events such as death of the employee, divorce or legal separation, the period is ______ for dependents.

Answer 94

1. 18 Months
2. 60 Days
3. 36 Months

Question 95

COBRA benefits apply to group ______ insurance, not group ______ insurance.

Answer 95

1. Health

2. Life

Question 96

______ insurance plans are designed to provide temporary coverage for people in transition (those between jobs or early retirees), and are available for terms from one month up to 11 months, depending on the state.

Answer 96

Short-Term Medical

Question 97

______ policies are limited policies that provide coverage for death, dismemberment, disability, or hospital and medical care resulting from an accident. It will only pay for losses resulting from accidents and not sickness.

Answer 97

Accident-Only

Question 98

A(n) ______ policy covers multiple illnesses, such as heart attack, stroke, renal failure, and pays a lump-sum benefit to the insured upon the diagnoses (and survival) of any of the illnesses covered by the policy.

Answer 98

Critical Illness

Question 99

______ cover only one illness: cancer, and pay a lump-sum cash benefit when the insured is first diagnosed with cancer. It is a supplemental policy intended to fill in the gap between the insured’s traditional health coverage and the additional costs associated with being diagnosed with the illness.

Answer 99

Cancer Policies

Question 100

A(n) ______ policy provides a specific amount on a daily, weekly, or monthly basis while the insured is confined to a hospital. Payment is unrelated to the medical expense incurred, but based only on the number of days confined in a hospital.

Answer 100

Hospital Indemnity

Question 101

______ insurance is a form of medical expense health insurance that covers the treatment, care, and prevention of dental disease and injury to the insured’s teeth.

Answer 101

Dental Expense

Question 102

Pediatric dental coverage is an essential health benefit under the Affordable Care Act that ______ as part of a health plan or as a stand-alone plan for children 18 or younger.

Answer 102

Must Be Available

Question 103

______ may be packaged or integrated with other health insurance benefits like major medical.

Answer 103

Dental Expense

Question 104

Some employers provide ______ and ______ group health insurance to their employees to cover eye examinations and eyeglasses, or hearing aids on a limited basis.

Answer 104

Vision and Hearing

Question 105

______ disability does not go away (such as loss of a limb).

Answer 105

Permanent

Question 106

______ disability policies have shorter elimination periods than ______ disability policies.

Answer 106

1. Short-Term

2. Long-Term

Question 107

______ paid by the insured on an individual disability income policy are not tax deductible, but any benefits received would be received ______.

Answer 107

1. Premiums

2. Tax Free

Question 108

A(n) ______ disability policy may be written to cover passengers on a common carrier, an employee group, a student group, a debtor group, or a sports team. ______ policies do not require individual applications, nor are certificates of insurance issued to those covered.

Answer 108

Blanket

Question 109

______ insurance will cover the ongoing business expenses of a self-employed person, such as rent or salaries, while the self-employed person is disabled.

Answer 109

Business Overhead

Question 110

______ insurance indemnifies the business for the loss of services of a key employee due to disability.

Answer 110

Key Person Disability

Question 111

On a(n) ______ policy, loss of eyesight due to an accident is covered. Loss of hearing is not covered.

Answer 111

Accidental Death & Dismemberment (AD&D)

Question 112

On an AD&D policy, loss of a limb is ______ but loss of the use of a limb is ______ .

Answer 112

1. Covered

2. Not Covered (since that would not be considered dismemberment)

Question 113

______ policies (like AD&D) only cover limited perils and amounts.

Answer 113

Limited Health Insurance

Question 114

______ plans cover in-hospital only. There is no deductible or coinsurance.

Answer 114

Base

Question 115

When calculating how much the company will pay on a claim, always subtract the ______ first, and then apply the ______ percentage.

Answer 115

1. Deductible

2. Coinsurance

Question 116

______ policies cover both accident and sickness.

Answer 116

Medical Expense

Question 117

______ policies provide first dollar coverage without a deductible.

Answer 117

Basic Medical Expense

Question 118

______ excludes war, self-inflicted injury, and cosmetic surgery.

Answer 118

Health Insurance

Question 119

______ underwriters may discriminate based on an applicant’s health history.

Answer 119

Health Insurance

Question 120

A(n) ______ policy will pay a claim up to the policy limit. They are the only health insurance policies that may use a relative value schedule.

Answer 120

Surgical Expense

Question 121

______ and ______ policies have both deductibles and coinsurance requirements.

Answer 121

1. Major Medical

2. Medicare Part B

Question 122

The stop loss feature on a(n) ______ policy applies after the insured first pays the deductible.

Answer 122

Major Medical

Question 123

POS plans, HMOs, and PPOs are all types of ______.

Answer 123

Managed Care

Question 124

______ may not be formed just to buy insurance. They must exist for another reason.

Answer 124

Groups

Question 125

______ usually does not have a probationary period and has little underwriting. ______ rates are usually lower than individual rates since the cost of administration is much lower.

Answer 125

1. Group Health Insurance

2. Group

Question 126

Experience rating is used on ______ and is based on past claims experience.

Answer 126

Group Health

Question 127

______ (a federal regulation applying to group medical expense policies) allows an employee to continue group coverage for 18 months in case he or she quits or is released from employment.

Answer 127

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Question 128

Under ______, the family of a deceased or disabled employee may continue group coverage for another 36 months.

Answer 128

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Question 129

______ policies cover skilled nursing, intermediate care, and custodial care.

Answer 129

Long-Term Care (LTC)

Question 130

______ coverage includes home health care, adult day care, and hospice care.

Answer 130

Optional Long-Term Care (LTC)

Question 131

A person who cannot perform the ______ needs a long-term care policy.

Answer 131

Activities of Daily Living (ADLs)

Question 132

______ include eating, bathing, dressing, toileting, continence, and mobility.

Answer 132

Activities of Daily Living (ADLs)

Question 133

______ insurance will pay if an insured dies in a common carrier (commercial aircraft).

Answer 133

Travel Accident

Question 134

Dental and vision insurance may be a(n) ______ plan, ______ policy, or offered as a(n) ______ policy.

Answer 134

1. Family
2. Individual
3. Group

Question 135

______ and ______ insurance may require the insured to go to an in-network dentist or eye doctor to receive maximum benefits.

Answer 135

Dental and Vision

Question 136

Vision and dental insurance may have a(n) ______ and/or ______ amounts, as well as annual ______ amounts.

Answer 136

1. Deductible
2. Coinsurance
3. Annual Maximum

Question 137

______ plans pay the benefits directly to the insured.

Answer 137

Critical Illness

Question 138

______ are short-term health insurance plans purchased to fulfill temporary needs (6 months or less). They are often used to cover gaps in insurance between jobs.

Answer 138

Interim Policies