Section 12 - Health And accident Insurance

Question 1

Mark continues working after the age of 65 and it’s covered through his employers group health plan. Which of the following statements is TRUE?
A. He’s not eligible for Medicare
B His group health plan and Medicare pay 50/50.
C. Medicare is the secondary payer
D. Medicare is the primary payer

Answer 1

Medicare is the secondary payer

Question 2

And employer is issued a group medical insurance policy. This single contract is known as a(n)
A. Entire contract
B. Master policy
C. Certificate of coverage
D. Employer contract.

Answer 2

Master Policy

Question 3

Key person disability insurance pays benefits to the
A. Hospital
B. Employee
C. Employer
D. Employee’s creditors

Answer 3

Employer

Question 4

When our group disability benefits considered to be tax free to the insured?
A. When the recipient pays the premiums
B. When the employer pays the premium’s
C. When both the employer and recipient pay the premiums
D. With benefits paid or equal to or lower than the recipient’s salary

Answer 4

When the recipient pays the premium

Question 5

Which of the following would be considered a possible applicant in contract policyholder for group health benefits?
A. Human resource department
B. Employer
C. Insured employee
D. Insurance company

Answer 5

Employer

Question 6

A master contract and certificate of coverage can be found in which type of policy?
A. Long-term
B. Medicaid
C. Group
D. Medicare

Answer 6

Group

Question 7

Under a disability income policy, which provision would be payable, if the cause of an injury is unexpected, an accidental?
A Presumptive disability provision
B Absolute accidental provision
C Accidental death benefit provision
D Accidental bodily injury provision

Answer 7

Accidental bodily injury provision

Question 8

What is the contract called that is issued to an employer for a group medical insurance plan?
A. Master policy
B. Certificate of coverage
C. Provisional policy
D Document of coverage

Answer 8

Master policy

Question 9

Susan is insured through her Group Health insurance plan and changed her coverage to an individual plan with the same insurer after her employment was terminated. This change is called a(n)
A. Crossover
B. Conversion
C. Exchange
D. Extension of benefits

Answer 9

Conversion

Question 10

A common exclusion with vision plans is
A. Eyeglass frames
B. The examination
C. Contact lenses
D. Lasik surgery

Answer 10

Lasik surgery

Question 11

Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?
A. Partially taxable income
B. Non-taxable income
C. Taxable income
D. Conditionally taxable income

Answer 11

Taxable income

Question 12

What is issued to each employee of an employer health plan?
A. Provision
B. Receipt
C. Policy
D. Certificate

Answer 12

Certificate

Question 13

Sonia applied for a health insurance policy on April 1. Her Agent submitted the information to the insurance company on April 6. She pay the premium on May 15 with the policy indicating the effective date being May 30. On which date with Sonya have coverage?
A. April 1
B. April 6
C. May 15
D. May 30

Answer 13

May 30

Question 14

According to HIPAA when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual
A. Is eligible for coverage upon hire
B. Must wait 360 days to be eligible for coverage
C. Must continue coverage with the previous employer
D. Is eligible for only health insurance. not life or dental insurance

Answer 14

Is eligible for coverage upon hire

Question 15

The purpose of the Coordination of Benefits provision in group accident and health plans is to
A. Avoid over payment of claims
B. Reduce out-of-pocket costs
C. Reduce adverse selection
D. Lower the cost of premiums

Answer 15

Avoid over payment of claims

Question 16

Group health plans may deny participation based upon the
A. Member’s claims history,
B. Member’s current age
C. Member’s pre-existing condition
D. Member’s part time employment status

Answer 16

Members part time employment status

Question 17

Under group, health insurance, a certificate of coverage is issued to the
A. Employer
B. Employee
C. Producer
D. Sponsor

Answer 17

Employee

Question 18

Continued coverage under cobra would be provided to all of the following EXCEPT
A Former dependent of employee no longer of dependent status
B. Terminated employee,
C. Divorced spouse of employee
D. A covered employee is terminated for gross misconduct

Answer 18

A covered employee is terminated for gross misconduct

Question 19

Coordination of benefits regulation applies to all of the following plans EXCEPT
A. Group vision plan
B. Preferred provider organization plan
C. Self funded group health, plan
D. Group health plan

Answer 19

Preferred provider organization plan

Question 20

In an employer, sponsored contributory group, disability income plan, the employer pays 60% of the premium and each employee pays 40% of the premium. Any income benefits, paid or text to the employee at
A. Employee has no tax liability
B. 40% of the benefit
C. 60% of the benefit
D. 100% of benefit

Answer 20

60% of the benefit