Health Ins

Question 1

What type of bus ins is meant to cover the cost of continuing to do biz while owner is disabled?

Answer 1

Business over head expense policy designed to cover the actual cost of continuing to do biz while biz owner is disabled

Question 2

Disability income benefits from a group policy paid for by an employer how are these benefits treated for tax purposes?

Answer 2

Taxable income

Question 3

Disability income benefits

Answer 3

I consider tax-free if the individual insured paid the premiums

Question 4

Health insurance involves two perils

Answer 4

Accident and sickness

Question 5

Sole proprietors are permitted tax deductions for Health cost paid from their earnings in the amount of

Answer 5

100% of the cost 100% of health cost paid by sole proprietors are tax deductible

Question 6

Credit accident and health plans are designed to

Answer 6

Help pay off existing loans during periods of disability

Question 7

Employees switching from group health insurance to an individual plan with the same insure due to termination are performing a

Answer 7

Conversion

Question 8

common exclusion with vision plans

Answer 8

Lasik surgery

Question 9

In an employer, sponsored group, accident and health plan, a master contract is issued to the

Answer 9

Employer

Question 10

Coordination of benefits regulation applies to all of the following plans except

Answer 10

Preferred provider organization plan. Coordination of benefits, regulation and group health policy does not apply to individual health insurance policies.

Question 11

A group disability income plan that pays tax-free benefits to covered employees is

Answer 11

Fully contributory

Question 12

Who is not eligible for coverage in a group health policy?

Answer 12

Temporary employee

Question 13

An employer issued a Group medical insurance policy. The single contract is known

Answer 13

A master policy is provided to the employer

Question 14

An employer issued a Group medical insurance policy. The single contract is known

Answer 14

A master policy is provided to the employer

Question 15

Key person disability insurance pays benefits to the

Answer 15

Employer

Question 16

Which of the following does coordination of benefits allow

Answer 16

Secondary pair to reduce their benefit payment so no more than 100% of the claim is paid

Question 17

Coordination of benefits, provision found only in group health plans

Answer 17

Exist to avoid duplication of benefit payments and over insurance regardless of coverage only 100% of the medical expense benefit would be collected

Question 18

Individuals continuing to work after age 65 that participate in a group plan have coverage

Answer 18

Primarily from their group insurance plan, which makes Medicare their secondary payer

Question 19

Cobra

Answer 19

Is a federal law that guarantees a continuation of Group insurance coverage to employees terminated for reasons other than gross misconduct

Question 20

Cobra

Answer 20

Consolidated omnibus budget reconciliation act of 1985

Question 21

What does Cobra require of employers?

Answer 21

Minimum of 20 or more employees to continue Group medical expense coverage for terminated workers for up to 18 months following termination

Question 22

Medicare part B covers

Answer 22

Doctors charges

Question 23

Medicare part B covers

Answer 23

Part B covers doctor’s appointments, emergency room visits, urgent care visits, lab work, X-rays, and many other outpatient services.

Question 24

How is Medicare part B

Answer 24

General tax revenue, and User premiums

Question 25

Medicare part a does not pay for medical benefits, provided for treatment in a skilled nursing facility beyond

Answer 25

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

Question 26

A Doctor Who is accepts a Medicare assignment

Answer 26

Is the green team not charge more than the amount of Medicare pays for the service performed?

Question 27

Preferred provider organizations allow for out of network care to be provided, but

Answer 27

At a lower percentage compared to treatment from an in network provider

Question 28

The role of federal government was expanded when Medicaid was established by allowing the state

Answer 28

Purchase health insurance from the federal government

Question 29

Medicaid is

Answer 29

Title XIX of the Social Security act added to the Social Security program in 1995

Question 30

Purpose of Medicaid

Answer 30

To provide matching federal funds to states for their medical public assistance plans to help needy person, regardless of age

Question 31

An HMO that involves a partnership of physicians and other providers who practice out of a central facility is called

Answer 31

A group HMO

Question 32

Under a close network plan if a subscriber chooses a primary care physician out of network, they will have to pay

Answer 32

Up to 100% of the bill amount

Question 33

What is a disease unique to the trade that can affect employees?

Answer 33

Occupational disease

Question 34

At what age will person normally enroll with an insurance carrier underpar C Medicare advantage plan

Answer 34

Age 65, upon becoming eligible for Medicare

Question 35

What happens when an insured goes out of the PPO network?

Answer 35

The insure will pay a reduced amount

Question 36

When is the enrollment period for Medicare part B

Answer 36

January one through March 31

Question 37

How is Medicare part be funded?

Answer 37

General tax revenue, and User premiums

Question 38

What does Medicare part B cover?

Answer 38

After the annual deductible is that Medicare part B will cover 20% of the remaining covered expenses and 80% of the coverage charges 

Question 39

How does one obtain eligibility for part D Medicare?

Answer 39

By being eligible for Medicare

Question 40

Worker’s Comp. covers all work related accidents

Answer 40

Workers comp will only cover injury on the job, not injuries that might occur from misconduct on the job

Question 41

What type of injury would not be covered under health insurance policy?

Answer 41

Work related injuries as they would be covered by Worker’s Compensation

Question 42

Medicare does not cover

Answer 42

Custodial care, which is care provided by a private duty, nurse or attendant

Question 43

A waiver of premium writer

Answer 43

Is generally included with guaranteed renewable and noncancelable

Question 44

A waiver of premium writer

Answer 44

Is generally included with guaranteed renewable and noncancelable

Question 45

A waiver of premium writer is

Answer 45

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.

Question 46

What is the purpose of the rehabilitation benefit

Answer 46

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

Question 47

How to define total disability

Answer 47

Requires that the insured be able to perform his insurance current occupation as a result of an accident or sickness

Question 48

What type of disability is not considered total impairment, but still equal to permanent impairment

Answer 48

Permanent Partial disability

Question 49

What percentage of a participants income or group long-term disability benefits amounts limited to

Answer 49

Typically 60% of their income

Question 50

Long-term disability benefits are coordinated with which benefit plan

Answer 50

Social Security

Question 51

What type of disability would allow claims to be payable when the insured can continue to work?

Answer 51

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

Question 52

What is the primary factor that determines benefits paid under disability income

Answer 52

Wages

Question 53

Group disability income insurance

Answer 53

Provides benefits for non-occupational illnesses and injuries as Worker’s Compensation covers, occupational illnesses, and injuries

Question 54

When an insured has a major medical plan with first dollar coverage that is that impact the benefits paid

Answer 54

No deductible payment is required

Question 55

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.

Answer 55

Enrolled in a health plan with a prescription drug benefit as HSA does not require enrollment in a prescription drug plan

Question 56

What is the tax liability for employer contributions and HSA accounts?

Answer 56

No tax payment needed

Question 57

Which health insurance plan requires the payment of a specific sum out of pocket before any benefits are paid in a calendar year

Answer 57

Calendar year deductible

Question 58

The focus of major medical insurance is providing coverage for

Answer 58

Medical and hospitalization expenses

Question 59

A fee for service health insurance plan will normally cover 

Answer 59

A disease 

Question 60

What is not a characteristic of a major medical expense policy

Answer 60

Elimination.m

Question 61

Health insurance policies, providing limited coverage for specific accidents or sickness

Answer 61

Limited policies which provide a notice to the insured of the limited benefit policy

Question 62

a health plan that pays establish amounts and accordance with a list of injuries, surgical procedures, or losses this list

Answer 62

Benefits schedule

Question 63

Which of the following is not included under your health benefit plan

Answer 63

Hospital indemnity plan

Question 64

What is an integrated deductible

Answer 64

A deductible applied to both medical and dental insurance coverage

Question 65

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

Answer 65

Long-term care insurance premiums

Question 66

Managed healthcare plans for seniors are offered under which part of Medicare

Answer 66

Part C as it serves as a substitute for part a and part B Medicare benefits

Question 67

For patients that have home healthcare benefits, and are confined to their home benefit is not typically covered

Answer 67

Full-time nursing care 

Question 68

What situation will qualify an individual for receiving benefits from a qualified long-term care policy?

Answer 68

Becoming cognitively, impaired mentally ill

Question 69

A Medicare supplement plan can be canceled by the insurance

Answer 69

For nonpayment of premiums

Question 70

Generally speaking, which three levels of care are long-term care policies provided with

Answer 70

Skilled nursing intermediate and custodial care

Question 71

What is the difference between a long-term care partnership plan and a non-partnership plan?

Answer 71

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

Question 72

A Medicare supplement policy must not contain benefits, which

Answer 72

That duplicate Medicare benefits

Question 73

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

Answer 73

Qualified, long-term care plan

Question 74

Which factor is not taken into consideration when determining the cost of long-term care policy

Answer 74

Personal income

Question 75

What is the Medigap policy designed to pay costs associate it with?

Answer 75

Medicare parts a and B

Question 76

What does Medicare part D cover?

Answer 76

Prescription drugs

Question 77

That typical long-term care insurance policies designed to provide a minimum of how many years of coverage

Answer 77

One year normally more than 90 days

Question 78

Which of the following is not a type of Medicare advantage plan? HMOPPO private fee for service Social Security disability income.

Answer 78

Social Security disability income

Question 79

A Medicare supplement policy is designed

Answer 79

To fill in the gaps of part eight and part B Medicare

Question 80

Respite care is able to provide

Answer 80

Temporary relieved to the patient’s primary caregiver

Question 81

Respite care is able to provide

Answer 81

Temporary relieved to the patient’s primary caregiver

Question 82

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

Answer 82

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.

Question 83

A long-term care policy typically provides all except skilled care intermediate care, acute care, custodial care

Answer 83

Acute care

Question 84

Which of the following provides Medicare supplement policies?

Answer 84

Private insurance companies

Question 85

The purpose of Medicare supplement insurance insurance is to address apps and Medicare coverage, which can include

Answer 85

Medicare in hospital deductible

Question 86

Long-term care policies may provide coverage for claims rising from

Answer 86

Senile dementia

Question 87

This mandatory health provision states that the policy, including endorsements and attached papers constitutes

Answer 87

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

Question 88

And ensure must furnished to clear a claimant forms for proof of loss within… upon receiving a notice of a claim

Answer 88

15 days

Question 89

After he lost occurs or the company becomes liable for periodic payments, the claimant has how many days to submit proof of loss

Answer 89

90

Question 90

When an insured changes to a more hazardous occupation, which disability provision allows an insurer to adjust policy, benefits, and rates

Answer 90

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

Question 91

The reinstatement provision and a health insurance policy is

Answer 91

Mandatory

Question 92

The reinstatement provision and a health insurance policy is

Answer 92

Mandatory

Question 93

After an insured gives notice of the loss what must they do if the insurer does not furnish forms

Answer 93

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

Question 94

A health insurance policy that allows an insurer to change the policy owner premiums, but not cancel. The policy is called

Answer 94

Guaranteed renewable policy

Question 95

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.

Answer 95

Primarily describes the free look.

Question 96

A beneficiary change can occur

Answer 96

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

Question 97

What is the provision that allows the past due amount owed for insurance premium to be deducted from an insurer claim?

Answer 97

Unpaid provision, unpaid, premium provision

Question 98

What is the gatekeeper role when used by an HMO?

Answer 98

Obtaining referrals to specialist from primary care physicians

Question 99

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

Answer 99

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

Question 100

In contrast to a guaranteed renewable policy and noncancellable policy

Answer 100

May never raise premiums

Question 101

Customer pays a monthly premium on their health insurance policy. How long is the Grace period

Answer 101

10 days

Question 102

According to HIPAA, the health insurance portability and accountability act when can a group health policy renewal will be denied

Answer 102

Participation or contribution rules have been violated

Question 103

How long is the contestable. For health insurance policy sold in New Jersey

Answer 103

Two years

Question 104

Which of the following statements about Medicaid?

Answer 104

It is funded by federal, state, and local taxes

Question 105

When an insurer changes to a more hazardous occupation which disability policy provision allows an insurer to adjust policy, benefits, and rates

Answer 105

Change of occupation provision, which allows an insurer to adjust policy benefits in order if the insured has changed to a more hazardous occupation

Question 106

What type of business insurance is meant to cover the cost of continuing to do business while the owner is disabled

Answer 106

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

Question 107

What percentage of may participants income are group long-term disability benefit amounts typically limited to

Answer 107

60% of the participants income

Question 108

What type of policy would only provide coverage for specific types of illnesses like cancer stroke, etc.

Answer 108

Dread disease insurance

Question 109

New Jersey health insurance advertisements are required to contain

Answer 109

Insurance companies name

Question 110

He dread disease policy is considered to be a type

Answer 110

Limited health insurance policy

Question 111

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.

Answer 111

Partial disability

Question 112

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

Answer 112

Personal income

Question 113

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

Answer 113

Personal income

Question 114

Which of the following is not a required provision and accident and health insurance policy: legal actions, grace period, Change of occupation, reinstatement

Answer 114

Change of occupation is considered an optional provision, not required

Question 115

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.

Answer 115

Modify application with a new signature all of these may be collected upon policy delivery, except a modified application with a new signature

Question 116

Group disability income plan that pays tax free benefits to covered employees is considered: noncontributory, partially contributory, Group contributory, fully contributory

Answer 116

Fully contributory group plans require the employee to pay all premium cost, which allow any benefits received by covered employees to be tax-free

Question 117

Which of the following is illegal entity created for the sole purpose of providing affordable group health coverage to its participants

Answer 117

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 

Question 118

The elimination. Under a hospital indemnity

Answer 118

Is the specified number of days and insured must wait before becoming eligible to receive benefits for each hospitalization

Question 119

Written notice for a health claim must be given to the insurer after the occurrence of a loss within

Answer 119

20 days

Question 120

Written notice for a health claim must be given to the insurer after the occurrence of a loss within

Answer 120

20 days

Question 121

He health insurance must be provided with written proof of loss within

Answer 121

90 days after the date of loss

Question 122

Disability income plans, which require that the insurer can never change or alter premium rates are usually considered

Answer 122

Noncancellable

Question 123

The purpose of the coordination of benefits provision in group accident and Health plans is to

Answer 123

Avoid overpayment of claims

Question 124

Medical expense insurance would cover

Answer 124

An injury occurring at the Insurance residence

Question 125

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

Answer 125

90 days

Question 126

Which of the following is not a required provision in an accident and health insurance policy

Answer 126

Change of occupation

Question 127

The focus of major medical insurance is providing coverage for

Answer 127

Medical and hospitalization expenses

Question 128

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

Answer 128

Receive matching funds to expand public assistance programs

Question 129

A company is looking to replace your existing Group health coverage with another plan. The replacing insurer is required to.

Answer 129

Accept all individuals eligible under the previous plan

Question 130

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

Answer 130

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

Question 131

What is the automatic continuance of insurance coverage referred to as

Answer 131

Renewal

Question 132

Long-term care policies may provide coverage for claims arising from

Answer 132

Senile dementia

Question 133

Someone needing custodial care at home would require which type of coverage

Major medical, disability, long-term care, Medicaid

Answer 133

Long-term care coverage would be most appropriate for an individual who needs custodial care at home

Question 134

Which three levels of care are long-term care policies provided with

Answer 134

Skilled nursing intermediate and custodial care

Question 135

A long-term care policy typically provides all of the following levels of care except

Skilled care, intermediate care, custodial care, acute care

Answer 135

Acute care

Question 136

Under the health insurance, portability and accountability act HIPPA The employees new Group health plan will verify credible coverage so that the

Answer 136

Employees waiting period for coverage of a pre-existing condition can be reduced under the new employers health plan

Question 137

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

Answer 137

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