Quiz questions Flashcards
Under HIPPA portability, which of the following are NOT protected under the required benefits?
1.Pregnant women
2. Mentally ill
3.self-employed
4. groups of one or more
- Groups of one or more
How does an employee retain creditable coverage so that there would be NO PRE-EXISTING CONDITION LIMITATION under a new medical plan?
The employee must have had coverage in the old group immediately prior to joining the new group with more than 12 months of creditable coverage.
True or False-
A characteristic of a group health insurance plan:
The parties that hold a group health insurance contract are the employees and the employer.
FALSE- Employer holds contract
REINSTATEMENT PROVISION:
A health insurance policy covers ACCIDENTS immediately upon reinstatement.. it can delay coverage for claims arising from ___ for ___ days after reinstatement
DELAY COVERAGE FOR SICKNESS UP TO 10 DAYS
TIME OF PAYMENT CLAIMS PROVISION:
Requires that the insurance company pay disability income benefits NO LESS frequently than ___?
Monthly
What is the name of the agreement on the first page of the policy that includes the losses that will be covered by the insurer?
the insuring clause
What is the purpose of a benefit schedule?
To state what and how much is covered.
What is the purpose of an impairment rider in a health insurance policy?
To exclude coverage for a specific impairment.
The future increase option is also referred to as the __?
Guaranteed purchase option or guaranteed insurability
What are two facts with the Non-cancellable health insurance policy?
The insurer cannot cancel or increase the premium.
A guaranteed renewable policy will remain renewable (as long as premiums are paid) until when?
until the insured reaches age 65
The anniversary date for a health insurance policy that is optionally renewable is usually on what date?
the 1st
What is the term for when a healthcare provider agrees to accept the approved amount from medicare?
assignment
Medicare part B provides coverage for the following except:
1.outpatient hospital services
2.home health visits
3.long-term care services
4.Doctors services
- long-term care services
Core benefits are included in all medicare supplemental policies. What percentage of Part B coinsurance is required?
20%
A medicare supplement policy must have a “free-look” provision of at least ___?
30 days
Which of the following is NOT a Medicaid qualifier?
1.Residency
2.age
3.insurability
4. income level
- insurability
Coverage for social security disability benefits requires a worker to be “fully insured”. How many quarters of coverage (credits) are needed to be considered “fully insured”?
40 credits
Are benefits in a Medical expense insurance policy taxable?
yes
When are health insurance disability benefits taxed?
When paid by employer
The grace period provision allows within how many days to pay the premium after the due date?
31 days
What is the minimum number of employees that a company must have to be eligible for group health insurance in Florida?
There is no minimum
-Florida does not require a minimum # of employees for group health insurance
What is the name of the plan that provides access to health insurance to Florida residents who are denied coverage by at least 2 insurers b/c of health reasons?
The Florida Health insurance plan
To operate as an HMO in Florida, is a license of certification required?
NO
Presumptive disability - says a person is considered disabled upon the PERMANENT loss of __?
any TWO - limbs, eyes, ears(hearing), or speech
Keywords** PERMANENT & TWO
Recurrent disability means what in lamens terms?
disability comes and goes -usually every 3-6 months.
You dont have to have a new elimination period every time
