INS Health Insurance Plans Exam Study Guide

Transcription

1 INS Health Insurance Plans Exam Study Guide This document contains the questions that will be on the exam. When you have studied the course materials, reviewed the questions in this document, and feel that you are ready to take the exam, return to the login page to take the online exam. A Center for Continuing Education 1465 Northside Drive, Suite 213 Atlanta, Georgia (404) (800) Fax: (404) /2013 Page 1

2 Health Insurance Plans Final Exam 1. Hospitalization insurance: a. is also known as AD&D insurance b. pays a specified amount on a daily, weekly or monthly basis, based on the number of days the insured spends in the hospital. c. reimburses insureds based on the amount of actual hospitalization expenses incurred. d. combines basic and major medical coverage into one plan. 2. Basic medical expense coverage: a. includes benefits for hospitalization, other hospital charges, surgical expenses and physician expenses. b. is also known as comprehensive medical insurance. c. generally includes a deductible that must be paid by the insured. d. are designed to provide benefits not covered by a major medical plan. 3. An association of private physicians in private offices who contract through the association to provide care for managed care plan members is known as a(n): a. HMO b. IPA c. PPO d. EPO 4. Group disability policies may include: a. short- and long-term benefits. b. business overhead expense benefits payable under a buy-sell agreement. c. tax free loans. d. much higher benefit limits than individual disability insurance. 5. Income as defined in group long-term disability policies generally does not generally include income from: a. pensions only. b. bonuses only. c. profit sharing only. d. pensions, bonuses or profit sharing 4/2013 Page 2

3 6. The period under a disability income policy that is the maximum time frame benefits will be or are paid is the: a. waiting period. b. elimination period. c. benefit period. d. residual period. 7. Group health insurance policies: a. are not subject to any federal laws or regulations. b. offered through employers do not require a physical prior to coverage. c. are only available through employers. d. always require an applicant to take a physical prior to offering coverage. 8. Individual health: a. plans may require a physical prior to coverage. b. plan coverage is generally less expensive than is group health plan coverage. c. plans are not subject to any state laws or regulations. d. plans do not require the furnishing of any medical history to the plan provider prior to coverage. 9. The Uniform Policy provision that restricts the time period during which legal action may be sought by an insured against the insurance company is the: a. Legal Actions provision b. Grace Period provision c. Payment of Claims provision d. Time Limit on Certain Defenses Clause 10. The type of disabilities that are automatically considered to equate to total disability in terms of applied policy benefits are called: a. equal disabilities. b. automatic disabilities. c. total disabilities. d. presumptive disabilities. 11. The health insurance clause that establishes the necessity of premium payment in order for the policy to be and remain in force is the: a. consideration clause b. renewability clause c. free look clause d. insuring clause 4/2013 Page 3

4 12. The type of renewability provision that does not allow the insurer to cancel the policy is a(n): a. noncancelable provision b. guaranteed renewable provision c. cancelable provision d. optionally renewable provision 13. Although the ACA requires counseling and screening for some of these conditions, intoxication, attempted suicide, cosmetic surgery and dental work are all examples of: a. excluded benefits or excluded causes of loss under health policies. b. optional coverages under health policies. c. covered benefits or covered causes of loss under health policies. d. mandatory coverages under health policies. 14. The geographic area in which a managed care organization may offer care is known as the: a. enrollment area b. open area c. restricted area d. HMO area 15. Medicare Part A coverage includes care for: a. hospital care only b. home health care only c. hospice care only d. hospital care, home health care and hospice care 16. The payment method a managed care system may use with physicians that involves payment of a flat fee per month per patient is called: a. flat-fee payment. b. copayment. c. capitation. d. head count. 17. Case management provisions are generally found in: a. fee-for service plans b. AD&D policies c. disability income insurance policies d. managed care plans 4/2013 Page 4

5 18. An HSA is basically a personal savings account used to pay for: a. health expenses not paid for by insurance. b. higher education expenses. c. health insurance. d. retirement. 19. The optional Change of Occupation provision is generally found in policies including: a. accident coverage b. hospitalization coverage c. medical expense coverage d. disability income insurance coverage 20. Under HSA rules, the definition, with respect to an account holder, amounts paid by such holder for medical care (as defined in section 213(d)) for such individual, the spouse of such individual, and any dependent of such individual, but only to the extent such amounts are not compensated for by insurance or otherwise, defines a. qualified medical care b. HMO's c. medical insurance d. tax free distribution 21. The type of insurance that protects against the loss of income due to disability is: a. life insurance b. disability income insurance c. accident insurance d. health insurance 22. An own occupation disability definition will pay benefits if the insured: a. is disabled due to a sickness incurred due to the insured s occupation. b. is unable to perform substantial and material duties of his or her regular occupation. c. is disabled due to an occupational accident. d. is unable to work in any gainful occupation. 23. The Uniform Policy provision that ensures that the policy owner has a copy of the entire contract is the: a. Time Limit on Certain Defenses clause b. Reinstatement clause c. Entire Contract and Changes clause d. Grace Period clause 4/2013 Page 5

6 24. All of the following statements regarding Medicaid Spousal Impoverishment rules are accurate, except: a. When determining Medicaid eligibility under spousal impoverishment rules, federal rules mandate that the couple s resources are their home, an automobile, burial funds and life insurance up to a face amount of $1,500 are exempt. b. The federal spousal impoverishment rules became effective September 30, c. Spousal impoverishment rules apply if the patient spouse is expected to remain in a nursing home or medical institution for at least thirty days. d. Individual states cannot use a resources standard higher than the federal minimum resource standard. 25. Traditionally, any gainful occupation disability income policies have more commonly been marketed to: a. lawyers b. higher income individuals c. middle income individuals d. doctors 26. The Uniform Policy provision that requires the insurer to furnish claim forms within fifteen days of being notified of a claim is the: a. Notice of Claim provision b. Proof of Loss provision c. Claim Forms provision d. Time of Payment of Claims provision 27. Group plans are typically than individual coverage. a. more convenient b. less desirable c. more expensive d. less expensive 28. Under a convertibility provision within group insurance, if an employee is terminated, his policy: a. may be converted to a policy for individual coverage. b. may not be converted to an individual policy but is kept by the company. c. is terminated. d. is kept as is. 29. Under Flexible Spending Account rules, employees may set aside up to $5,000 to help pay for: a. child care only. b. dependent care only. c. child care and dependent care. d. a spouse's insurance coverage only. 4/2013 Page 6

7 30. Competition in the marketplace, responsibility to employees, and tax benefits are common reasons: a. that employees change jobs. b. for the popularity of HMOs. c. that employers purchase group insurance. d. that employers decide not to purchase group insurance. 31. Coverage in group insurance plans is issued through a to the employer a. agent b. big policy c. master policy d. policy voucher 32. If an HSA holder makes contributions to his or her own HSA account, contributions are: a. non-deductible to the HSA holder. b. deductible to the HSA holder. c. deductible up to $1000 annually to the HSA holder. d. deductible to the HSA holder if he or she is above 50 years of age 33. The period of time in which a new member may enroll in a managed care plan offered through an employer is called the: a. sign-up period b. open enrollment period c. enrollment area d. subscription period 34. If a health plan pays for 50% to 80% of the cost of health services and the patient pays for the other 20% to 50%, the amount the patient must pay is called: a. a copayment b. coinsurance c. a copercent d. a deductible 35. Immunizations: a. are generally covered by managed care plans. b. are required to be covered by managed care plans under federal rules. c. are generally not covered by managed care plans. d. are covered by only a few managed care plans. 4/2013 Page 7

8 36. As defined within managed care plans, the two types of emergency care are: a. life threatening and catastrophic b. urgent and life threatening c. urgent and catastrophic d. serious and critical 37. Long-term skilled nursing care: a. is covered under most managed care plans. b. is covered under a managed care plan that includes home health care coverage. c. is not included under managed care plan coverage. d. is covered under a managed care plan that includes alternative medicine coverage. 38. Medicare was created with the intent to: a. supplement participants health insurance plans. b. replace private health insurance. c. cover all long-term care needs. d. cover all American s health care needs 39. Medigap Plan A the Basic Policy includes all of the following coverages, except: a. Coverage for the Part A coinsurance amount for the 61st through the 90th day of hospitalization in each Medicare benefit period. b. Coverage for 100% of Medicare Part A eligible hospital expenses after all Medicare hospital benefits are exhausted. c. Coverage for the Part A coinsurance amount for each of Medicare s 60 nonrenewable lifetime hospital inpatient reserve days used. d. Coverage for the Medicare Part A inpatient hospital deductible 40. AD&D insurance: a. pays only for accidental death or dismemberment that is work-related. b. generally requires that the cause of death or dismemberment be external, violent and accidental. c. is also known as disability income insurance. d. pays a specified amount if accidental death or dismemberment occurs. 41. The type of health plan that provides for payment to the health care provider each time a covered service is supplied is: a. a fee-for-service plan. b. a Blue Shield plan. c. a HMO plan. d. a Blue Cross plan. 4/2013 Page 8

9 42. Limited Liability Companies are hybrids between: a. sole proprietorships and partnerships. b. corporations and sole proprietorships. c. partnerships and corporations. d. limited liability proprietorships and limited liability corporations. 43. If an employee receives care from a doctor, hospital, or other health care organization that is considered a preferred provider the cost is generally than if care were received from a non-preferred provider. a. higher b. lower c. equal d. 2 times lower 44. If a family member contributions to an HSA account, contributions are: a. non-deductible to the HSA holder (the beneficiary). b. deductible to the HSA holder (the beneficiary). c. deductible up to $1000 annually to the HSA holder (the beneficiary). d. deductible to the HSA holder (beneficiary) if the HSA holder is under If an employer makes contributions to an HSA on behalf of an employee HSA holder, contributions are: a. non-deductible to the employer. b. excluded from the employee s taxable income. c. deductible from the employee s income, up to $1000 annually. d. includible in the employee s taxable income 46. EPO stands for: a. Excellent Physician Organization b. Excellent Provider Organization c. Exclusive Provider Organization d. Exclusive Physician Organization 47. The physician that provides most of the care for a managed care member and acts as advocate, consultant, caregiver and gatekeeper is called the: a. primary-care physician b. specialist c. pediatric physician d. presumed-care physician 4/2013 Page 9

10 48. In health insurance, insurance is any insurance that pays a set benefit on a daily, weekly or monthly basis or for services as they are rendered. a. managed care b. indemnity c. group d. individual 49. Under AD&D insurance, if dismemberment due to an accident occurs, an AD&D policy pays a specified amount, generally a percentage of the principal sum, to the insured. This specified amount is called the: a. secondary sum b. necessary sum c. capital sum d. dismemberment sum 50. The mandatory health insurance provision found in the Uniform Policy Provisions Law that gives the policyholder additional time in which to pay the premium is the: a. Time Limit on Certain Defenses clause b. Reinstatement clause c. Entire Contract and Changes clause d. Grace Period clause 4/2013 Page 10