Final Exam 3

Question 1

Notice of claim is required within \_\_\_\_\_ days of loss.
A) 90
B) 15
C) 20
D) 10

Answer 1

C) 20

Question 2

Which federal act defined rules pertaining to protected health information? 
A HIPAA 
B ACA
C ERISA 
D COBRA

Answer 2

A) HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge.

Question 3

What is the purpose of a benefit schedule?
A to include the cover charges for procedures
B to provide the dates for the payment of benefits
C to list the insurance copayments and deductibles
D to state what and how much is covered in the plan

Answer 3

D to state what and how much is covered in the plan

Question 4

What is the proper procedure for license renewal?
A Continue to remain in good standing
B submit proper renewal forms along with fees and proof of CE completion
C submit CE completion in appropriate fees
D pay the appropriate fee

Answer 4

B submit proper renewal forms along with fees and proof of CE completion

Question 5

Which of the following is required to provide a notice of information practices to applicants and policyholders? 
A the department of insuracne 
B the NAICC 
C the underwriter 
D the producer

Answer 5

D the producer

Question 6

Specify disease policy will cover which of the following?
A broken leg
B illness caused by exposure to chemicals
C infection due to liposuction
D cancer

Answer 6

D cancer

Question 7

Which of the following is not part of the genetic information and nondiscrimination act of 2008?
A prohibits the collection of genetic information before enrollment
B limits genetic testing requirements the issuer of a health plan can put in place
C establishes guidelines under which the result of genetic test can be used for underwriting purposes
D limits the request of health plan issue we can make regarding genetic testing

Answer 7

C establishes guidelines under which the result of genetic test can be used for underwriting purposes

Question 8

A major medical expense policy would exclude coverage for all the following treatments except 
A dental care 
B cosmetic surgery 
C drug addiction 
D eye infractions

Answer 8

C drug addiction

Question 9

All of the following are features of a health insurance plan purchase on the health insurance marketplace except 
A coverage for emergency services 
B coverage for pre-existing conditions 
C dollar limit on essential benefits 
D guaranteed renewability

Answer 9

C dollar limit on essential benefits

Question 10

In some cases in order for insurer to legally disclose privileged information to appropriate sources, the insured must sign an authorization form. What is the maximum amount of time that can legally pass between the completion of the form in the disclosure of information? 
A one month 
B 6 months
C one year 
D two years

Answer 10

C one year

Question 11

Which of the following statements is incorrect regarding the definition of total disability
A total disability can be the inability to perform the duties of ones own occupation
B total disability is the inability to perform partial duties of any occupation for which a person is suited by reason of education, training or experience
C disability is defined differently under the certain disability income policies
D the total disability can be the inability to perform any occupation for which a person is reasonably suited by

Answer 11

B total disability is the inability to perform partial duties of any occupation for which a person is suited by reason of education, training or experience

Question 12

Under the mandatory uniform provision proof of loss, the claimant must submit proof of loss within what time. After the loss? 
A 60 days 
B 90 days 
C 2 years 
D 30 days

Answer 12

B 90 days

Question 13

Which of the following is a daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician? 
A assisted living 
B skilled care 
C intermediate care 
D custodial care

Answer 13

B skilled care

Question 14

Employees on an extended leave of absence when the employer group health plan changes from one carrier to another. Before the employee returns to work, what might be employed most likely notice? 
A suspended coverage 
B limited coverage 
C increased benefits 
D no change in coverage

Answer 14

B limited coverage

Question 15

In group health insurance, what is experience rating?
A within larger group gets lower rates because it’s median age is fairly low
B when an insurer uses the experience of the group as a whole to determine the premiums
C the larger the group, the more experience the agent assigned to the policy
D when a larger group gets higher premiums due to his relatively higher health costs

Answer 15

B when an insurer uses the experience of the group as a whole to determine the premiums

Question 16

HMOs are known as what type of planes 
A service 
B health savings 
C consumer driven 
D reimbursement

Answer 16

A service

Question 17

All the following are excluded from coverage in an individual health insurance policy except
A purely cosmetic surgery
B treatment received in a government hospital
C mental illness
D experimental procedures

Answer 17

C mental illness

Question 18

And insured hospital policy states that it will pay him a flat fee of $79 per day for each day he is hospitalized. The policy pays benefits on what basis? 
A indemnity 
B reimbursement 
C expense 
D service

Answer 18

A indemnity

Question 19

What is the limiting dependent child age limit in Utah under which a child may be covered by disability policy? 
A 26
B 25
C 19 
D 18

Answer 19

A 26

Question 20

Employer is no longer able to afford the group health insurance plan and the plan terminates. However, one of the employees continue to receive coverage under the plan. Which of the following explains the reason for the continued coverage?
A a nonforfeiture value as a place
B the employee is totally disabled
C the employee is an executive covered under the plan
D the employees health savings account pays for the coverage

Answer 20

B the employee is totally disabled

Question 21

Ethan shared the size reduce the coinsurance amount on her major medical insurance, what can insured expect? 
A a lower lifetime benefit payout 
B stop loss increase 
C a higher monthly premium 
D a higher deductible

Answer 21

C a higher monthly premium