Health Ins Flashcards
What type of bus ins is meant to cover the cost of continuing to do biz while owner is disabled?
Business over head expense policy designed to cover the actual cost of continuing to do biz while biz owner is disabled
Disability income benefits from a group policy paid for by an employer how are these benefits treated for tax purposes?
Taxable income
Disability income benefits
I consider tax-free if the individual insured paid the premiums
Health insurance involves two perils
Accident and sickness
Sole proprietors are permitted tax deductions for Health cost paid from their earnings in the amount of
100% of the cost 100% of health cost paid by sole proprietors are tax deductible
Credit accident and health plans are designed to
Help pay off existing loans during periods of disability
Employees switching from group health insurance to an individual plan with the same insure due to termination are performing a
Conversion
common exclusion with vision plans
Lasik surgery
In an employer, sponsored group, accident and health plan, a master contract is issued to the
Employer
Coordination of benefits regulation applies to all of the following plans except
Preferred provider organization plan. Coordination of benefits, regulation and group health policy does not apply to individual health insurance policies.
A group disability income plan that pays tax-free benefits to covered employees is
Fully contributory
Who is not eligible for coverage in a group health policy?
Temporary employee
An employer issued a Group medical insurance policy. The single contract is known
A master policy is provided to the employer
An employer issued a Group medical insurance policy. The single contract is known
A master policy is provided to the employer
Key person disability insurance pays benefits to the
Employer
Which of the following does coordination of benefits allow
Secondary pair to reduce their benefit payment so no more than 100% of the claim is paid
Coordination of benefits, provision found only in group health plans
Exist to avoid duplication of benefit payments and over insurance regardless of coverage only 100% of the medical expense benefit would be collected
Individuals continuing to work after age 65 that participate in a group plan have coverage
Primarily from their group insurance plan, which makes Medicare their secondary payer
Cobra
Is a federal law that guarantees a continuation of Group insurance coverage to employees terminated for reasons other than gross misconduct
Cobra
Consolidated omnibus budget reconciliation act of 1985
What does Cobra require of employers?
Minimum of 20 or more employees to continue Group medical expense coverage for terminated workers for up to 18 months following termination
Medicare part B covers
Doctors charges
Medicare part B covers
Part B covers doctor’s appointments, emergency room visits, urgent care visits, lab work, X-rays, and many other outpatient services.
How is Medicare part B
General tax revenue, and User premiums
Medicare part a does not pay for medical benefits, provided for treatment in a skilled nursing facility beyond
100 days 100% from one to 20 days then 21 to 100 days will be a flat dollar amount per day. must be provided by skilled and licensed nurses or coverage stops
A Doctor Who is accepts a Medicare assignment
Is the green team not charge more than the amount of Medicare pays for the service performed?
Preferred provider organizations allow for out of network care to be provided, but
At a lower percentage compared to treatment from an in network provider
The role of federal government was expanded when Medicaid was established by allowing the state
Purchase health insurance from the federal government
Medicaid is
Title XIX of the Social Security act added to the Social Security program in 1995
Purpose of Medicaid
To provide matching federal funds to states for their medical public assistance plans to help needy person, regardless of age
An HMO that involves a partnership of physicians and other providers who practice out of a central facility is called
A group HMO
Under a close network plan if a subscriber chooses a primary care physician out of network, they will have to pay
Up to 100% of the bill amount
What is a disease unique to the trade that can affect employees?
Occupational disease
At what age will person normally enroll with an insurance carrier underpar C Medicare advantage plan
Age 65, upon becoming eligible for Medicare
What happens when an insured goes out of the PPO network?
The insure will pay a reduced amount
When is the enrollment period for Medicare part B
January one through March 31
How is Medicare part be funded?
General tax revenue, and User premiums
What does Medicare part B cover?
After the annual deductible is that Medicare part B will cover 20% of the remaining covered expenses and 80% of the coverage charges 
How does one obtain eligibility for part D Medicare?
By being eligible for Medicare
Worker’s Comp. covers all work related accidents
Workers comp will only cover injury on the job, not injuries that might occur from misconduct on the job
What type of injury would not be covered under health insurance policy?
Work related injuries as they would be covered by Worker’s Compensation
Medicare does not cover
Custodial care, which is care provided by a private duty, nurse or attendant
A waiver of premium writer
Is generally included with guaranteed renewable and noncancelable
A waiver of premium writer
Is generally included with guaranteed renewable and noncancelable
A waiver of premium writer is
To exempt the policy owner from paying the policies premium doing periods of total disability; require a specific. Of time to be met and will backdate to date of disability does not extend past the insured age of 60 or 65.
What is the purpose of the rehabilitation benefit
To help the person with disability gain new training to be able to return back to work in a different way that is an encumber them in their disability
How to define total disability
Requires that the insured be able to perform his insurance current occupation as a result of an accident or sickness
What type of disability is not considered total impairment, but still equal to permanent impairment
Permanent Partial disability
What percentage of a participants income or group long-term disability benefits amounts limited to
Typically 60% of their income
Long-term disability benefits are coordinated with which benefit plan
Social Security
What type of disability would allow claims to be payable when the insured can continue to work?
Presumptive disability, which specify that certain conditions automatically qualify the insured for full-time benefit because of the severity of the conditions presume the insured is totally disabled, even if they are able to work
What is the primary factor that determines benefits paid under disability income
Wages
Group disability income insurance
Provides benefits for non-occupational illnesses and injuries as Worker’s Compensation covers, occupational illnesses, and injuries
When an insured has a major medical plan with first dollar coverage that is that impact the benefits paid
No deductible payment is required
All of the following are qualifications for establishing a health savings account except…. Enrolled in a high deductible health plan , be under the age of 65 and not with Medicare , enrolled in a health plan with a prescription drug benefit , a health plan that limits out of pocket expenses.
Enrolled in a health plan with a prescription drug benefit as HSA does not require enrollment in a prescription drug plan
What is the tax liability for employer contributions and HSA accounts?
No tax payment needed
Which health insurance plan requires the payment of a specific sum out of pocket before any benefits are paid in a calendar year
Calendar year deductible
The focus of major medical insurance is providing coverage for
Medical and hospitalization expenses
A fee for service health insurance plan will normally cover 
A disease 
What is not a characteristic of a major medical expense policy
Elimination.m
Health insurance policies, providing limited coverage for specific accidents or sickness
Limited policies which provide a notice to the insured of the limited benefit policy
a health plan that pays establish amounts and accordance with a list of injuries, surgical procedures, or losses this list
Benefits schedule
Which of the following is not included under your health benefit plan
Hospital indemnity plan
What is an integrated deductible
A deductible applied to both medical and dental insurance coverage
The IRS states that a taxpayer medical expenses that exceeds 7.5% of their adjusted gross income is tax deductible, which premium would be considered a medical expense under this rule
Long-term care insurance premiums
Managed healthcare plans for seniors are offered under which part of Medicare
Part C as it serves as a substitute for part a and part B Medicare benefits
For patients that have home healthcare benefits, and are confined to their home benefit is not typically covered
Full-time nursing care 
What situation will qualify an individual for receiving benefits from a qualified long-term care policy?
Becoming cognitively, impaired mentally ill
A Medicare supplement plan can be canceled by the insurance
For nonpayment of premiums
Generally speaking, which three levels of care are long-term care policies provided with
Skilled nursing intermediate and custodial care
What is the difference between a long-term care partnership plan and a non-partnership plan?
Asset protection which is allowed by long term care partnership plan, which is a federally supported state operated initiative that allows individuals who purchased a qualified, long-term care, insurance policy or coverage to protect a portion of their assets to qualify for Medicaid coverage
A Medicare supplement policy must not contain benefits, which
That duplicate Medicare benefits
Premiums paid that exceed 7 1/2% of an insured adjusted gross income. AGI are tax deductible when paid for which of the following plans
Qualified, long-term care plan
Which factor is not taken into consideration when determining the cost of long-term care policy
Personal income
What is the Medigap policy designed to pay costs associate it with?
Medicare parts a and B
What does Medicare part D cover?
Prescription drugs
That typical long-term care insurance policies designed to provide a minimum of how many years of coverage
One year normally more than 90 days
Which of the following is not a type of Medicare advantage plan? HMOPPO private fee for service Social Security disability income.
Social Security disability income
A Medicare supplement policy is designed
To fill in the gaps of part eight and part B Medicare
Respite care is able to provide
Temporary relieved to the patient’s primary caregiver
Respite care is able to provide
Temporary relieved to the patient’s primary caregiver
Which type of plan would be most appropriate for an individual on Medicare that is concerned that Medicare will not pay for charges exceeding the approved amount
Medicare supplement plans FNG are the only only Medicare supplement insurance plans that cover cost. No one has Medicare part B access charges an excess charges the difference between what a doctor provider charges in the amount Medicare will pay.
A long-term care policy typically provides all except skilled care intermediate care, acute care, custodial care
Acute care
Which of the following provides Medicare supplement policies?
Private insurance companies
The purpose of Medicare supplement insurance insurance is to address apps and Medicare coverage, which can include
Medicare in hospital deductible
Long-term care policies may provide coverage for claims rising from
Senile dementia
This mandatory health provision states that the policy, including endorsements and attached papers constitutes
The entire Insurance contract between the parties. Required by the entire contract policy provision that is mandatory which states that nothing outside of the contract which is the signed application and attached policy writers can be considered part of the contract
And ensure must furnished to clear a claimant forms for proof of loss within… upon receiving a notice of a claim
15 days
After he lost occurs or the company becomes liable for periodic payments, the claimant has how many days to submit proof of loss
90
When an insured changes to a more hazardous occupation, which disability provision allows an insurer to adjust policy, benefits, and rates
Change of occupation provision, which allows the insurer to reduce the maximum benefit payable under the policy of the insured switches to a more hazard occupation or to reduce the premium rate charged if the insured changes to a less hazardous occupation
The reinstatement provision and a health insurance policy is
Mandatory
The reinstatement provision and a health insurance policy is
Mandatory
After an insured gives notice of the loss what must they do if the insurer does not furnish forms
File written proof of loss; Insured can submit the claim in any form which must be accepted by the company is adequate proof of loss so long as all necessary information is provided
A health insurance policy that allows an insurer to change the policy owner premiums, but not cancel. The policy is called
Guaranteed renewable policy
All of the following are functions of an insurance clause except… states the conditions under which the policy will pay, outlines the kind of benefits provided, provides the policy, scope and limits of coverage, primarily describes the free look.
Primarily describes the free look.
A beneficiary change can occur
Normally at any time during the policy term, so long as it’s not a beneficiary, that is a ir hello good evening this is Jackie revocable
What is the provision that allows the past due amount owed for insurance premium to be deducted from an insurer claim?
Unpaid provision, unpaid, premium provision
What is the gatekeeper role when used by an HMO?
Obtaining referrals to specialist from primary care physicians
an insurer overseeing the insured’s hospital stay to confirm, everything is going according to schedule and that the insure will be released as planned is known as
Concurrent care AK utilization review, which is part of a manage care program, which involves monitoring the appropriateness of care the setting and length of time spent in hospital meant to keep slow as possible, and ascertaining effectiveness care
In contrast to a guaranteed renewable policy and noncancellable policy
May never raise premiums
Customer pays a monthly premium on their health insurance policy. How long is the Grace period
10 days
According to HIPAA, the health insurance portability and accountability act when can a group health policy renewal will be denied
Participation or contribution rules have been violated
How long is the contestable. For health insurance policy sold in New Jersey
Two years
Which of the following statements about Medicaid?
It is funded by federal, state, and local taxes
When an insurer changes to a more hazardous occupation which disability policy provision allows an insurer to adjust policy, benefits, and rates
Change of occupation provision, which allows an insurer to adjust policy benefits in order if the insured has changed to a more hazardous occupation
What type of business insurance is meant to cover the cost of continuing to do business while the owner is disabled
Business overhead expense policy, which is a form of business disability insurance that is designed to cover the actual cost of continuing to do business while an insured business owner is disabled
What percentage of may participants income are group long-term disability benefit amounts typically limited to
60% of the participants income
What type of policy would only provide coverage for specific types of illnesses like cancer stroke, etc.
Dread disease insurance
New Jersey health insurance advertisements are required to contain
Insurance companies name
He dread disease policy is considered to be a type
Limited health insurance policy
A policy owner suffers an injury that renders him in capable of performing one or more important job duties. Any decrease in income, resulting from his injury, would make him eligible for benefits, under which provision.
Partial disability
Which of these factors is not taken into consideration when determining the cost of a long-term care policy: health of applicant amount of benefits provided age of applicant personal income
Personal income
Which of these factors is not taken into consideration when determining the cost of a long-term care policy: health of applicant amount of benefits provided age of applicant personal income
Personal income
Which of the following is not a required provision and accident and health insurance policy: legal actions, grace period, Change of occupation, reinstatement
Change of occupation is considered an optional provision, not required
He producer delivering a specified disease insurance policy to a new policy. Owner upon delivery may be expected to collect all of the following except: initial premium, signed impairment, writer, acknowledgment, modified application with new signature, good health statement.
Modify application with a new signature all of these may be collected upon policy delivery, except a modified application with a new signature
Group disability income plan that pays tax free benefits to covered employees is considered: noncontributory, partially contributory, Group contributory, fully contributory
Fully contributory group plans require the employee to pay all premium cost, which allow any benefits received by covered employees to be tax-free
Which of the following is illegal entity created for the sole purpose of providing affordable group health coverage to its participants
MEWA multiple employer, welfare arrangement, which is a group of employers pulling their contributions together to purchase group health and other insurance benefits for their employees by pulling smaller employers are better position to offer the best benefit packages from insurance companies due to economies of scale can also be formed to allow a group of employers to self ensure their healthcare needs 
The elimination. Under a hospital indemnity
Is the specified number of days and insured must wait before becoming eligible to receive benefits for each hospitalization
Written notice for a health claim must be given to the insurer after the occurrence of a loss within
20 days
Written notice for a health claim must be given to the insurer after the occurrence of a loss within
20 days
He health insurance must be provided with written proof of loss within
90 days after the date of loss
Disability income plans, which require that the insurer can never change or alter premium rates are usually considered
Noncancellable
The purpose of the coordination of benefits provision in group accident and Health plans is to
Avoid overpayment of claims
Medical expense insurance would cover
An injury occurring at the Insurance residence
In New Jersey, a small group health plan requires a continuance of prior credible coverage provided that there has not been a gap in coverage for a period of
90 days
Which of the following is not a required provision in an accident and health insurance policy
Change of occupation
The focus of major medical insurance is providing coverage for
Medical and hospitalization expenses
The role of the federal government was expanded when Medicaid was established by allowing the state to
Form a large PPO and a state wide level, purchase health insurance from the federal government, receive matching funds to expand public assistance programs, deferral all cost to the federal government for public assistance programs
Receive matching funds to expand public assistance programs
A company is looking to replace your existing Group health coverage with another plan. The replacing insurer is required to.
Accept all individuals eligible under the previous plan
All of the following are core benefits of Medicare supplement plan a except
Deductible payments for the first 60 days of hospitalization under Medicare hospitalization insurance, Medicare part, a hospice coinsurance, or copayment, Medicare part B coinsurance copayment, the first 3 pints of blood received
Deductible payments for the first 60 days of hospitalization under Medicare hospitalization insurance Medicare supplement plan a does not cover the Medicare part eight deductible the remaining Medicare supplement plans cover 50 to 100% of this cost
What is the automatic continuance of insurance coverage referred to as
Renewal
Long-term care policies may provide coverage for claims arising from
Senile dementia
Someone needing custodial care at home would require which type of coverage
Major medical, disability, long-term care, Medicaid
Long-term care coverage would be most appropriate for an individual who needs custodial care at home
Which three levels of care are long-term care policies provided with
Skilled nursing intermediate and custodial care
A long-term care policy typically provides all of the following levels of care except
Skilled care, intermediate care, custodial care, acute care
Acute care
Under the health insurance, portability and accountability act HIPPA The employees new Group health plan will verify credible coverage so that the
Employees waiting period for coverage of a pre-existing condition can be reduced under the new employers health plan
A life insurance policy owner was injured in an automobile accident, which result in a total and permanent disability, which writer would pay a monthly amount because of this disability
Long-term care, writer, disability, income, writer, annuity, writer, waiver, premium
Disability income writer, which is a writer that pays a life insurance policy owner a monthly amount in the event of total and permanent disability
