Types of Health Policies

Question 1

In what type of health plans are providers paid for services in advance, regardless of the services provided?

Answer 1

Prepaid Plans

Question 2

What are the three types of basic medical expense insurance?

Answer 2

Hospital, Surgical, Medical

Question 3

What do individual insureds receive as proof of their group health coverage?

Answer 3

Certificate of Insurance

Question 4

What is the main principle of an HMO plan?

Answer 4

Preventive care

Question 5

Under what type of care do insurers negotiate contracts with health care providers to allow subscribers access to health care at a favorable cost?

Answer 5

Preferred Provider Organization (PPO)

Question 6

How are HMO territories typically divided?

Answer 6

Geographic areas

Question 7

Who are the parties in a group health contract?

Answer 7

The employee and the insurer

Question 8

What is the capital sum in Accidental Death and Dismemberment (AD&D) coverage?

Answer 8

A percentage of the principal sum

Question 9

What does the amount of disability benefit that an insured can receive depend on?

Answer 9

The insured’s income at the time of policy application

Question 10

Why do HMOs encourage members to get regular check ups?

Answer 10

To help catch health problems early when treatment has the greatest chance of success (preventive care)

Question 11

In health insurance, what is considered a sickness?

Answer 11

An illness that first arises while the policy is in force

Question 12

What type of hospital policy pays a fixed amount each day that the insured is in the hospital?

Answer 12

Hospital indemnity

Question 13

What type of injuries and services will be excluded from major medical coverage?

Answer 13

Injuries caused by war, intentionally self-inflicted injuries, injuries covered by workers compensation, regular dental/vision/hearing care, custodial care, and cosmetic surgery

Question 14

What is a fee-for-service health plan?

Answer 14

Under a fee-for-service plan, providers receive payments for each service provided

Question 15

How can an HMO member see a specialist?

Answer 15

Referral by the primary care physician

Question 16

Who chooses a primary care physician in an HMO plan?

Answer 16

The individual member

Question 17

What is the purpose of respite care in long-term care insurance?

Answer 17

To provide relief for a major caregiver (usually a family member)

Question 18

With key person disability insurance, who pays the policy premiums?

Answer 18

The business (employer)

Question 19

What are the two types of flexible spending accounts?

Answer 19

Health care accounts and dependent care accounts

Question 20

What is the purpose of COBRA?

Answer 20

To allow continuation of health coverage for terminated employees (up to 18 months)

Question 21

What type of health insurance would pay for hiring replacement for an important employee who becomes disabled?

Answer 21

Key-persons disability insurance

Question 22

What is the purpose of a buy-sell agreement for health insurance policies?

Answer 22

To specify how the business will pass between owners when one of them dies or becomes disabled

Question 23

Can an insured who belongs to a POS plan use an out-of-network physician?

Answer 23

Yes, but the copays and deductibles may be higher

Question 24

Can Alzheimer’s disease be excluded from coverage under a long-term care policy?

Answer 24

No, organic cognitive disorders, such as Alzheimer’s or Parkinson’s must be covered

Question 25

What is the term for a period of time immediately following a disability during which benefits are not payable?

Answer 25

Elimination period

Question 26

In order to be eligible for coverage by an HSA, an individual must also be covered by what type of health plan?

Answer 26

High Deductible Health Plan (HDHP)

Question 27

What is the primary purpose of disability income insurance?

Answer 27

To replace income lost due to a disability

Question 28

What is the role of the gatekeeper in an HMO plan?

Answer 28

To control costs for the services of specialists

Question 29

In group insurance, what is the name of the policy?

Answer 29

Master Policy

Question 30

What types of groups are eligible for group health insurance?

Answer 30

Employer-sponsored and association-sponsored groups