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My health ins basics
health insurance basics
| Question | Answer |
|---|---|
| Sally sees her policy has no maximum benefit for life, but she will not receive more that $100,000 in benefits in any one calendar year. This is known as: | annual maximum |
| An annual maximum benefit will provide: | No specified life time amount but a limited benefit for each year |
| Horace owns a health insurance policy that will not pay benefits unless he is confined to the hospital. This type of contract is known as a: | conditional contract |
| A participating policy (par) usually pays dividends. Most health insurance policies: | Do not pay any dividends |
| t or f Individual health policies are almost always non-participating. | true |
| All of the following would be included in the outline of coverage EXCEPT: Contractual provisions Renewal and cancellation provisions Benefits and coverage Exclusions and limitations | contractual provisions |
| The contractual provisions will appear in the: | policy |
| Cafeteria plans may offer which of the following? Flexible spending accounts Tax shelter for premiums paid on chosen coverage Options to choose coverage that meets the individual's needs All of the above | all of the above |
| Ajax Manufacturing has a self-funded group health plan and believes it can lower administrative costs from those charged by an insurance company for processing claims. Which type of organization should Ajax use to process claims? | Third Party administrator (TPA) |
| An outline of coverage will include all of the following EXCEPT: Exclusions and limitations Renewal and cancellation provisions Calculation of premium Benefits and coverages | calculation of premium |
| t of f Blue Cross and Blue Shield Plans are exempt from state insurance regulations | false |
| Does Blue Cross plans typically cover hospital benefits | yes |
| What does Blue Shield plans typically cover | doctors services |
| t or f Blue Cross and Blue Shield plans were organized as nonprofits | true |
| Eddie has an accidental death and dismemberment policy for $100,000 principal amount. He is involved in a logging accident and his hand is severed. What benefit should he expect? | $50,000 since this is the benefit for losing a hand |
| James is in an auto accident and breaks his arm and has blurred vision for a short period of time. He has a $100,000 Accidental Death and Dismemberment policy. What benefit can he expect from this accident? | $0 since he did not die or lose a limb, and his vision loss was temporary |
| The outline of coverage in a policy contains: | Policy benefits Limitations and exclusions Conditions of renewability |
| Jennifer's employer offers her the opportunity to choose from a variety of group benefits. She can choose the plans that best meet her needs while declining to participate in components of the plan. The type of plan she is being offered is called: | cafeteria plan |
| describes a TPA? | An organization that processes claims for a self-funded group plan |
| An accidental death and dismemberment policy will cover: | severed limbs, loss of vision, and death |
| Final Rest Mutual is an insurance company that processes and pays claims for ABC Company's self-funded health plan. This arrangement is know as: | administrative services only (ASO) |
| Jack has an accidental death and dismemberment policy. Can he expect benefits for an emergency appendectomy | no |
| Health insurance will provide benefits for all the following EXCEPT: Living too long Surgery Illness Heart attack | living too long |
| Larry is in an accident and he loses one hand and one eye. He has an Accidental Death and Dismemberment policy for $200,000 principal sum. What should he expect for his benefit? | $200,000 since this is the principal sum |
| Leon has decided to self-insure his medical plan through an insurance company. This will pay his claims and administer the other features of the plan for a set fee plus claims paid. This arrangement is known as: | administrative services only (ASO) |
| in regards to a participation policy t or f Dividends amounts are guaranteed | false |
| in regards to a participation policy t or f Dividends are paid year to year and the amount of the payment is not guaranteed | true |
| in regards to a participation policy t or f The insured has a choice of whether his policy will be participating or not | false |
| t or f Statistics indicate that women under age 55: Have a greater frequency of disability than men | true |
| is it true that deductibles vary on a employer group plan depending on the risk of the individual employee | no |
| y or n Higher deductibles limit smaller claims | yes |
| t or f Higher deductibles tend to lower premiums | true |
| is it true that deductibles continue to increase as the cost of healthcare services increase | yes |
| State University will offer what kind of plan to enrolled students? | blanket health plan |
| A representation is: | A statement that all information is true to best of the applicant's knowledge. |
| Carl has been in the hospital. When he is discharged, the accounting department agrees to file his claims as long as he executes an assignment. This means that Carl: | Has authorized the provider to bill the insurance company on his behalf and the insurance company will pay the provider directly |
| The factor most often used in the calculation of health rates is: | morbidity |
| A moral hazard can be any of the following EXCEPT: Poor credit history Drug or alcohol abuse Riding motorcycles Criminal history | riding motorcycles |
| In calculating premiums for health insurance, actuaries use which information? | Morbidity |
| Simon has a special risk policy. The policy will only pay a benefit if Simon suffers: | An unusual hazard not covered on other policies |
| Mary-Margaret has applied for a new health insurance policy. When must Mary-Margaret be given an outline of coverage? | At the time the policy is delivered to the applicant |
| what is a preexisting condition? | A preexisting condition is a condition that exists prior to the effective date of the policy. |
| what benefits are provided by a health service provider? | Both hospitals and physician services directly to the provider |
| Can a health insurance company refuse coverage or charge a higher premium for Poor moral history | yes |
| Can a health insurance company refuse coverage or charge a higher premium for Previous medical problems, Ethnic background, and or Marital Status | no |
| Blanket health insurance covers: | An ever-changing group of people, like students |
| What are participants called in a Blue Cross and Blue Shield plan? | subscribers |
| Bill receives a check directly from the insurance company for his recent hospital stay. He has a Hospital Expense Policy. This type of policy is referred to as | reimbursement contract |
| Happy Hills, a day camp, wants to offer a health insurance policy to its campers. The type of policy they will offer is: | blanket policy |
| All of the following are examples of limited policies EXCEPT: Travel Accident Vision Care Hospital indemnity Long Term Care | long term care |
| Is AD&D considered a health policy | no |
| is hospital indemnity considerd a health policy | yes |
| Which contract is considered a reimbursement contract? Accidental Death and Dismemberment Term Life Monthly disability income Medical Expense | medical expense |
| David applies for a health insurance policy. He is not aware that he has a heart condition at the time, and he answers NO to question concerning heart issues. His answer is considered: | A Representation, since he was telling the truth to the best of his knowledge |
| What does NAIC stand for? | national association of insurance commissioners |
| The application was signed, but he did not submit a premium with the application. Before the policy was issued he was admitted to the hospital for a condition that was covered under the policy. His claim would most likely be denied because: | no consideration |
| All of the following Government benefit programs will provide benefits for medical benefits Except: OASDI Social Security disability Medicare Medicaid | Social Security disability only pays income benefits. |
| Julia has a basic medical expense plan through her employer. This can also be referred to as: | First dollar insurance |
| what does first dollar insurance mean | there is no initial deductible. |
| How long is the "free look" period for a health insurance policy? | all health policies are 10 days |
| A representation is: | A statement that all information is true to best of the applicant's knowledge. |
| Which of the following limits coverage under an insurance policy? Waivers Exclusions Conditions Declarations | exclusions |
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