Chapter 7 Pt 5

Question 1

insurer combines two periods of disability into one. Insured must have suffered a

Recurrent disability
Partial disability
Residual disability

Answer 1

Recurrent disability

Question 2

Typically 50% of total disability benefit limited to a certain period of time

Partial disability benefit
Recurrent disability
Residual disability

Answer 2

Partial disability benefit

Question 3

Provision specifies period of time usually 3-6 monthls when recurrence of injury or illness will be considered as continuation of prior period of disability

Recurrent disability

Residual disability

Managed care

Answer 3

Recurrent disability

Question 4

Type of disability policy that provides benefits for loss of income when person returns to work after total disability but is still not able to work as long or at same level worked before becoming disabiled

Recurrent
Residual
Partial

Answer 4

Residual

Question 5

Brain surgeon has accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for al losses

Own occupation-less restrictive than other definitions

Own occupation -more restrictive than other definitions

Any occupation less restrictive than other definitions

Answer 5

Own occupation

Question 6

If you could find other work but your disability policy specifies that you are covered for your OWN occupation you would be

Answer 6

Wholly covered

Question 7

Purpose of managed care health ins plans is to

Coordinate benefits

Control health ins claims expenses
Provide for continuation of coverage when employee leaves the plan

Give the insured an unlimited cohoice of providers

Answer 7

Control health ins claims expenses

Question 8

Applies to partial disability benefits

Payment is limited to certain period of time

Based on termination of employment

Benefits reduced once insured is no longer under doctor’s care

Answer 8

Payment is limited to a certain period of time

Question 9

NOT true re partial disability

Payments are typically 50% of total disability benefit

This is a form of ins that covers part time workers

Insured can still report to work and rec benefits

Insured would qualify if he couldn’t perform some of his normal job duties

Answer 9

This is a form of ins that covers part time workers

Question 10

Five characteristics of controlled access of providers; comprehensive case management; preventive care; risk sharing; high quality care

What program

Managed care

Accident program

Ins program defense

Answer 10

Managed care

Question 11

Which of following definitions would make it easier to qualify for total disability benefits

More strict any occupation

Liberal any occupation

More liberal own occupation

Answer 11

More liberal own occupation

Question 12

Purpose of managed care ins plan is to

Coordinate benefits

Control health ins claims expenses

Give insured an unlimited choice of providers

Answer 12

Control health ins claims expenses

Question 13

Workers comp benefits are regulated by which entity

State govt
Federal govt
Employer
Insurer

Answer 13

State govt

Question 14

Which does not describe managed care

High quality care
Shared risk
Preventive care
Unlimited access to providers

Answer 14

Unlimited access to providers

Question 15

Will pay an amount to make up difference between what insured would have earned before the loss

Recurrent
Partial
Income
Residual

Answer 15

Residual

Question 16

Benefit that is based on insured’s loss of earnings after recovery from a disability

Residual disability
Recurrent disability
Partial disability

Answer 16

Residual disability

Question 17

Describes total disability

Work significantly reduced or eliminated for life

Inability to perform one of regular duties of occupation

Total loss of income

Answer 17

Work significantly reduced or eliminated for life

Question 18

Main factors taken into account when calculating residual disability benefits

Present earnings and earnings prior to disability

Present earnings and standard cost of living

Earnings prior to disability and length of disability

Answer 18

Present earnings and earnings prior to disability

Question 19

Which would make it easier to qualify for total disability benefits

More liberal own occupation
More strict own occupation
More liberal any occupation

Answer 19

More liberal own occupation

Question 20

Health providers share assumed risk for patients and encourage preventive care. Which best describes health system that woman is using

Major medical
Group health
Managed care

Answer 20

Managed care

Question 21

Merely has to prove that they cannot perform the job for which previously trained

Answer 21

Own occupation

Question 22

More strict; coverage will apply only if insured cannot find any means of income whatsoever

Answer 22

Any occupation

Question 23

Specifies that policy covers insured if he is unable to perform any job which he is qualified. Total disability defined as

Any occupation more restrictive than other def

Any occupation less restrictive than other def

Own occupation more restrict than other def
Own occupation less restrictive than other def

Answer 23

Any occupation more restrictive than other def

Question 24

When calculating residual disability benefits

Earnings prior to disability and length of disability

Present earnings and standard cost of living

Present earnings and earnings prior to disability

Answer 24

Present earnings and earnings prior to disability

Question 25

When are group disability income benefits recd by an employee NOT taxable as income

When the employer makes all the premium payments

When employee is 59 1/2

When bed it’s recd are equal or less than the employee’s percentage of the contribution

Answer 25

When bed it’s recd are equal or less than the employees percentage of contribution