AD Banker Ch 6 & 7

Quiz
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Professional Development, Education
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Professional Development
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Medium
Tricky Ricky
Used 208+ times
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20 questions
Show all answers
1.
MULTIPLE CHOICE QUESTION
45 sec • 1 pt
Employers are the most common sponsors of this insurance.
Probationary Period
Blanket Insurance
Mandatory Uniform Provisions
Group Health Insurance
2.
MULTIPLE CHOICE QUESTION
45 sec • 1 pt
The review that determines whether provided or proposed health care services are or were medically necessary. This does not apply to emergency services but involves "before, during and after" medical services.
Restrospective Review
Precertification
Utilization Review
Concurrent Review
3.
MULTIPLE CHOICE QUESTION
45 sec • 1 pt
A review of claims for services already received. This review may be used to confirm medical necessity of services, identify coordination of benefits opportunities, and to determine if a non-pre-certification penalty applies.
Prospective Review
Utilization Review
Retrospective Review
Concurrent Review
4.
MULTIPLE CHOICE QUESTION
45 sec • 1 pt
This Act states employers with 20 or more employees must provide a health coverage continuation option to all covered employees and dependents up to 18 months in the event of:
Termination of employee (unless it is for cause as defined by federal law)
Reduction of hours for employee, so they no longer qualify as a full-time employee
Coverage may continue up to 29 months if an employee or dependent is totally disabled at the time of a qualifying event
MEWAs
Labor Unions
COBRA
PPACA
5.
MULTIPLE CHOICE QUESTION
45 sec • 1 pt
These were developed by the NAIC and must, by law, be included in every individual accident and health insurance policy. Different wording may be used as long as it is at least as favorable as the original wording. No additional provisions may be included which otherwise restrict or modify a uniform provision. There are 12 of these that are designed to protect the insured's interests.
Mandatory Uniform Provisions
Probationary Period
Group Health Insurance
HIPPA
6.
MULTIPLE CHOICE QUESTION
45 sec • 1 pt
A utilization review conducted prior to the delivery of the requested medical service. They include the initial review conducted before treatment starts, and the initial review for treatment to a different body part. During this review, copies of medical records may be required only when necessary to verify that the health care services being considered are medically necessary.
Retrospective Review
Prospective Review
Concurrent Review
Preventative Care
7.
MULTIPLE CHOICE QUESTION
45 sec • 1 pt
Covers a group of individuals whose membership changes frequently, such as students, passengers traveling on a common carrier, sports teams, volunteer firefighters, or other groups of people while being exposed to a specific risk. Blanket policies do not name specific individuals as insureds, the insured organization/business must certify a covered person's claim as legitimate. The term for a policy cannot exceed one year.
Blanket Insurance
Probationary Period
Mandatory Uniform Provisions
Group Health Insurance
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