EXAM CRAM - Bonus Questions (p. 18- 23)

Question 1

175. Under the PPACA, which medical enrollment tier is 80% actuarial value?

Answer 1

Gold.

Question 2

176. Provision in a disability income policy include all of the following EXCEPT:

Answer 2

Deductible and Coinsurance amounts.

Question 3

177. The following statement is absolutely true regarding (HICAP) Health Insurance Counseling Advocacy Program counselors:

Answer 3

HICAP counselors are qualified to give legal advice.

• HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare.

Question 4

178. The initial enrollment period for Medicare Part B ends how many months after the 65th birthday month?

Answer 4

Three months.

Question 5

179. Which program is designed to provide medical assistance to people with low incomes?

Answer 5

Medi-Cal.

Question 6

180. A commonly used cost containment measure for emergency hospital care under a major medical expense plan is the:

Answer 6

Deductible.

Question 7

181. A supplemental insurance policy that pays a set amount for each day that an individual is hospitalized is known as:

Answer 7

hospital confinement indemnity.

Question 8

182. The group medical plan provision that applies when a claimant has coverage under more than one plan is known as:

Answer 8

Coordination of Benefits.

Question 9

183. Which group provides information about Health-Related issues to the elderly in California?

Answer 9

The Health Insurance Counseling and Advocacy Program (HICAP).

Question 10

184.The Employee Retirement Income Security Act of 1974 (ERISA) regulates group health insurance in the area of:

Answer 10

Disclosure and Reporting.

Question 11

185. Which health plan pays more for care received from a network provider than it pays for care from a non-network provider?

Answer 11

Preferred Provider Organization (PPO).

Question 12

186. A Long-Term Care insurance rider can include coverage for all of the following EXCEPT:

Answer 12

hospital acute care.

Question 13

187. Residual disability income insurance payments are based on:

Answer 13

the amount the insured’s income is reduced by the disability.

Question 14

188. Why is an injury caused by an accident at an employee’s workplace excluded from individual health insurance coverage?

Answer 14

It is covered by the state Worker’s Compensation program.

Question 15

189. In Health insurance the COINSURANCE is:

Answer 15

a percentage paid for covered expenses by the insured and insurer after the deductible is satisfied.

Question 16

190. Vision insurance usually limits coverage in all of the following ways EXCEPT:

Answer 16

a specific dollar amount for examinations.

Without vision insurance, you are responsible for paying the full price

Generally, insurance companies offer two types of vision insurance: benefits packages that give you access to a capped dollar amount of services and products and discount plans simply give you a predetermined discount, such as 20% on qualified services.

Question 17

191. What happens if an insurer violates the Medical Loss Ratio rule and spends too much money on administrative costs?

Answer 17

Insurers that don’t meet the MLR standard will be required to provide rebates to their customers and reduce spending on their administrative costs.

Question 18

192. What is the first step in submitting Medicare claims?

Answer 18

The medical provider submits expenses to Medicare.

Question 19

193. Health Insurance Counseling and Advocay Program (HICAP) counselors can do all of the following except.

Answer 19

charge for their services

Question 20

194.When medical expense policies do not state specific dollar benefit amounts, but instead base payments upon the charges for like services in the same geographical area, benefits are:

Answer 20

designated as usual, customary, and reasonable charges.

Question 21

195. As established by PPACA, an adult child may be covered by a parent’s health insurance plan until what age?

Answer 21

they’re 26 years old.

Question 22

196. Two of the long-term care chronically ill activities of daily living (ADLs) are:

Answer 22

eating and dressing.

Question 23

197. For Social Security purposes, a person with 40 quarters of coverage is considered:

Answer 23

fully insured.

Question 24

198. In California, a child may obtain Individual health coverage, EXCEPT through:

EXCEPT

Answer 24

Healthy Families.

Question 25

199. Which of the following is NOT an example of cost sharing in a health insurance policy?

Answer 25

Coordination.

Question 26

200. The insurer can do which of the following under a noncancelable health insurance policy?

Answer 26

Cancel the policy for nonpayment of premium.

Question 27

201. In the absence of a coordination of benefits clause, all of the following circumstances might result in recovery of more than 100% of actual health care expenses EXCEPT:

Answer 27

a worker’s medical plan includes a carryover deductible provision.

Question 28

202. What rights do individuals have if they disagree on the amount Medicare will pay?

Answer 28

They can ask a Medicare carrier to review the decision.

Question 29

203. An individual is allowed to enroll in individual health insurance under the following circumstances EXCEPT:

Answer 29

within 30 days of being diagnosed with an illness.

Question 30

204. Medicare Part A provides coverage for all of the following EXCEPT:

Answer 30

physician’s services.

Question 31

205. After deductible, what portion does a patient pay for covered expenses under Medicare Part B?

Answer 31

80%.

Question 32

206. The premium of a proposed disability income policy could be lowered by increasing the:

Answer 32

elimination period.

Question 33

207. Providers of coverage for all of the following types of care are subject to the jurisdiction of the California Department of Insurance (CDI) EXCEPT:

Answer 33

Lasik.

Question 34

208. Which plan covers the medical expenses that are NOT covered by Medicare?

Answer 34

Medicare supplement.

Question 35

209. The type of health care provider that provides both the health care services and health care coverage is called:

Answer 35

Health Maintenance Organization (HMO).

Question 36

210. In medical expense insurance, what serves the same purpose as the elimination period in disability income insurance?

Answer 36

Deductible.

Question 37

211. An example of a third-party administrator is an:

Answer 37

outside organization that processes claims for an employer’s self-funded group plan.

Question 38

212. The Family and Medical Leave Act (FMLA) covers all of the following EXCEPT:

Answer 38

traveling with a spouse who has been transferred overseas.

Question 39

213. What is the purpose of social insurance?

Answer 39

To protect certain vulnerable segments of the population.

Question 40

214. Which program pays the cost of nursing home care for people who cannot afford it themselves?

Answer 40

Medi-Cal.

Question 41

215. Benefits under Social Security are available only for workers who are:

Answer 41

fully insured.

Question 42

216. Group health plans obligated by the Consolidated Omnibus Budget Reconciliation Act (COBRA) cover groups of at least:

Answer 42

20 employees.

Question 43

217. With Medicare coverage:

Answer 43

Part B provides benefits for diagnostic tests and X-rays performed on an outpatient basis.

Question 44

218. A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ratio (MLR) is less than what percentage?

Answer 44

80%.

Question 45

219. According to the California Insurance Code, all of the following Long- Term Care (LTC) insurance sales are considered unnecessary EXCEPT:

Answer 45

a replacement LTC policy with equal benefits for a lower premium.

Question 46

220. All of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT:

Answer 46

medical expense.

Question 47

221. The most common type of specified disease insurance policy is:

Answer 47

cancer.

Question 48

222. After the deductible is satisfied, what percentage of reasonable charges does Medicare Part B pay?

Answer 48

80%.

Question 49

223. Which of the following statements concerning the usual coordination of benefits provision is correct?

Answer 49

When two plans both have the provision, coverage as an employee is primary to coverage as a dependent.

Question 50

224. Which health insurance provision protects an insured from the expense of a catastrophic illness?

Answer 50

Stop-loss.

Question 51

225. Which health insurance contract provision addresses the problem of overinsurance?

Answer 51

Coordination benefits.

Question 52

226. Relevant factors in the health insurance principle of morbidity include all of the following EXCEPT:

Answer 52

intelligence.

Question 53

227. To reach currently insured status under the Social Security system, an individual must be credited with a MINIMUM of:

Answer 53

6 quarters of coverage during the last 13-quarter period.

Question 54

228. In Health Insurance, the result of rising morbidity rates is:

Answer 54

increased premiums.

Question 55

229. Which health plan might apply 90% coinsurance to network providers and 70% coinsurance to non-network providers?

Answer 55

Preferred Provider Organization(PPO).

Question 56

230. The Family and Medical Leave Act (FMLA) covers all of the following EXCEPT:

Answer 56

Traveling with a spouse who has been transferred overseas.

Question 57

231. A surviving spouse without dependent children is eligible for Social Security survivor benefits at age:

Answer 57

60.

Question 58

232. What happens if an insurer violates the Medical Loss Ratio rate and spends too much money on administrative costs?

Answer 58

Insurers that do not meet the Medical Less Ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs.

Question 59

233. Vision insurance usually limits coverage in all of the following ways EXCEPT:

Answer 59

a specific dollar amount for examinations.

Question 60

234. When an agent writes a replacing long-term care policy, the agent’s first year sales commission will be determined based on the:

Answer 60

difference between the new and original policy annual premiums.

Question 61

235. Why is an injury caused by an accident at an employee’s workplace excluded from individual health insurance coverage?

Answer 61

It is covered by the state Worker’s Compensation program.

Question 62

236. All of the following conditions must be met to qualify for residual disability benefits under a disability income policy EXCEPT:

Answer 62

*qualifies for Social Security disability benefits.