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EXAM CRAM - Life Agent Test Questions - Bonus Exam Questions > EXAM CRAM - Bonus Questions (p. 24- 30) > Flashcards

EXAM CRAM - Bonus Questions (p. 24- 30) Flashcards

1
Q
  1. Terms of a Preferred Provider Organization (PPO) do not:

DO NOT!

A

stipulate that primary care physicians act as gatekeepers.

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2
Q
  1. In the Worker’s Compensation policy, Part One, Workers’ Compensation, pays for:
A

sums the insured is required to pay under state Workers’ Compensation law.

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3
Q
  1. Social Security defines disability as:
A

the inability to engage in any substantial gainful activity.

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4
Q
  1. At what age are individuals eligible for Medicare Part A benefits?
A

65.

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5
Q
  1. The Employee Retirement Income Security Act of 1974 (ERISA), regulates group health insurance in the area of:
A

Disclosure and Reporting.

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6
Q
  1. Which plan covers the medical expenses that are NOT covered by Medicare?
A

Medicare supplement.

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7
Q
  1. The following condition would NOT be included among the chronic illness triggers of a long-term care policy?
A

Deafness.

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8
Q
  1. Insurers are prohibited from denying claims based on misrepresentations in a disability policy application after the policy has been in force for:
A

Two years.

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9
Q
  1. Which funded government program is jointly administered by the federal and state governments?
A

Medi-Cal.

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10
Q
  1. What rights do individuals have if they disagree with a decision on the amount Medicare will pay?
A

They can ask the Medicare carrier to review the decision.

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11
Q
  1. Which long-term care policy provision allows for a periodic increase in policy benefits?
A

Inflation protection.

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12
Q
  1. All of the following statements about Medicare Part B are correct EXCEPT:
A

it pays for virtually all drugs prescribed by a physician.

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13
Q
  1. Under PPACA, what is a health benefit exchange?
A

PPACA creates new entities called American Health Benefit Exchanges through which individuals, small businesses, and those who do not have access to affordable employer coverage, can purchase coverage.

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14
Q
  1. The initial enrollment period for Medicare Part B ends how many months after the 65th birthday?
A

Three months.

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15
Q
  1. What is the first step in submitting Medicare claims?
A

The medical provider submits expenses to Medicare.

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16
Q
  1. Unless certified by another governmental agency, which entity has jurisdiction over providers of coverage designed to pay for health care services?
A

The Department of Insurance.

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17
Q
  1. Long-term care insurance may be purchased in all of the following forms EXCEPT:
A

federal government-sponsored policies.

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18
Q

Under COBRA, the (Consolidated Omnibus Budget Reconciliation Act) , a qualifying event ensures that an employee who loses coverage can:

A

elect to continue coverage.

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19
Q

256.Which statement is TRUE regarding Worker’s Compensation?

A

The employer pays the entire premium for Workers’ Compensation coverage.

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20
Q
  1. Which program is designed to provide medical assistance to people with low incomes?
A

Medi-Cal.

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21
Q
  1. The Social Security normal retirement age depends upon the:
A

worker’s year of birth.

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22
Q
  1. Who submits Medicare Part A claims?
A

Hospitals.

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23
Q
  1. How long do Worker’s Compensation medical expenses continue for disabled workers?
A

There is no (time?) limit.

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24
Q
  1. Which of the following statements concerning the usual Coordination of Benefits provision are CORRECT?
A

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

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25
Q

262.The Americans with Disabilities Act (ADA) defines a disabled person as one who is unable to perform any of the following life activities EXCEPT:

A

Driving.

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26
Q
  1. After the deductible, what portion does a patient pay for covered expenses under Medicare Part B?
A

20%.

27
Q
  1. Probationary periods reduce costs to employers in all of the following ways EXCEPT:
A

Employees must pay the entire premium during this time.

28
Q
  1. Members of the Medical Information Bureau are REQUIRED to report:
A

medical impairments found during the underwriting process.

29
Q
  1. A worker dies who is credited with 6 quarters of coverage during the last 13-quarter period. What status does the worker have under Social Security?
A

Currently insured.

30
Q
  1. What is the cost of service from the Health Insurance Counseling Advocacy Program (HICAP)?
A

No charge.

31
Q
  1. What is covered by Part A of Medicare?
A

Hospitalization.

32
Q
  1. The frequency and severity of certain illnesses and accidents is known as:
A

morbidity.

33
Q
  1. A Long-Term Care Insurance rider can include coverage for all of the following EXCEPT:
A

hospital acute care.

34
Q
  1. A terminating employee who wants to exercise the conversion privilege must meet all of the following requirements EXCEPT:
A

supply evidence of insurability.

35
Q
  1. An insured has a disability income policy with a $1500 monthly benefits and a 30-day elimination period. The insured is unable to work for 120 days following an accident. What amount will the policy pay?
A

$4500

36
Q
  1. Social Security survivor benefits are available for all of the following EXCEPT:
A

parents of any age who were dependent upon the deceased worker.

37
Q
  1. Under group disability insurance an employee is eligible for a partial disability benefit when they can:
A

perform some of their job activities on a part time basis after injury.

38
Q
  1. Which of the following is NOT an example of cost sharing in a health insurance policy?
A

Coordination

39
Q
  1. The insurer can do which of the following under a non-cancelable health insurance policy?
A

Cancel the policy for nonpayment of premium.

40
Q
  1. 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:
A

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

41
Q
  1. What rights do individuals have if they disagree with a decision on the amount Medicare will pay?
A

They can ask a Medicare carrier to review the decision.

42
Q
  1. An individual is allowed to enroll in individual health insurance under the following circumstances EXCEPT:
A

within 30 days of being diagnosed with an illness.

43
Q
  1. Medicare Part A provides coverage for all of the following EXCEPT:
A

physicians’ services.

44
Q
  1. After the deductible, what portion does a patient pay for covered expenses under Medicare Part B?
A

80%.

45
Q
  1. The premium of proposed disability income policy could be lowered by increasing the:
A

elimination period.

46
Q
  1. Providers of coverage for all of the following types of care are subject to the jurisdiction of the California Department of Insurance (CDI) EXCEPT:
A

Lasik.

47
Q
  1. Which plan covers the medical expenses that are NOT covered by Medicare?
A

Medicare supplement.

48
Q
  1. The type of health care provider that provides both the health care services and health care coverage is called:
A

a Health Maintenance Organization.

49
Q
  1. In medical expense insurance, what serves the same purpose as the elimination period in disability income insurance?
A

the Deductible.

50
Q
  1. An example of a third-party administrator is an:
A

outside organization that processes claims for an employer’s selffunded group plan.

51
Q
  1. The Family and Medical Leave Act (FMLA) covers all of the following EXCEPT:
A

traveling with a spouse who has been transferred overseas.

52
Q
  1. What is the purpose of social insurance?
A

To protect certain vulnerable segments of the population.

53
Q
  1. Which program pays the cost of nursing home care for people who cannot afford it themselves?
A

Medi-Cal.

54
Q
  1. Benefits under Social Security are available only for workers who are:
A

Fully insured.

55
Q
  1. Group health plans obligated by the Consolidated Omnibus Budget Reconciliation Act (COBRA) cover groups of at least:
A

20 employees.

56
Q
  1. With Medicare coverage:
A

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

57
Q
  1. 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?
A

80%.

58
Q
  1. According to the California Insurance Code, all of the following Long- Term Care (LTC) insurance sales are considered unnecessary EXCEPT:
A

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

59
Q
  1. All of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT:
A

medical expense.

60
Q
  1. The most common type of specified disease insurance policy is:
A

Cancer.

61
Q
  1. After the deductible is satisfied, what percentage of a reasonable charge does Medicare Part B pay?
A

80%.

62
Q
  1. Which of the following statements concerning the usual coordination of benefits provision is correct?
A

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

63
Q
  1. Which health insurance provision protects an insured from the expense of a catastrophic illness?
A

Stop-loss.

64
Q
  1. Which health insurance contract provision addresses the problem of overinsurance?
A
  1. Which health insurance contract provision addresses the problem of overinsurance?

EXAM CRAM - Life Agent Test Questions - Bonus Exam Questions (6 decks)

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