Group medical expense policies must cover all of the following except

D. Work related injuries covered under Workers’ Compensation

14. Regardless of your expenses, this policy pays a flat amount per day in the hospital. What is it called?

D. Hospital Indemnity or Hospital Income Plan

19. A major medical insurance policy would cover expenses for all of the following except

B. Charges covered under Worker’s Compensation Insurance

A. Doctor’s fees for an operation

C. Hospital Room and Board Charges

D. Charges for cosmetic surgery necessitated by an accident

21. In Major Medical and Comprehensive policies, a coinsurance provision

B. Provides for a percentage participation by the insured

A. Helps to satisfy the deductible

D. Does not apply until benefit amounts exceed $25,000

24. Common exclusions on health policies include all of the following except

D. Injury which occurred while being held hostage during a bank robbery

A. Expenses covered under Workers’ Compensation

B. Cosmetic surgery unless necessitated by an accident

C. Expenses incurred while in a government owned or operated hospital

25. The words “reasonable and customary” found in a health policy mean what?

C. The policy will pay what most doctors and hospitals charge for similar services in the same geographic area

A. The policy will always pay 100% of the charges

B. The policy will not pay if surgery is of an unusual nature

D. The policy rarely pays anything at all

26. All of the following statements apply to deductible provisions in medical expense policies except

C. Such provisions are not used in group insurance

A. Deductible provisions eliminate a large number of small claims

B. Deductible clauses provide that initial covered medical expenses up to a specified amount must be paid by the insured

D. Such provisions help to maintain the lowest possible premium rates

32. Which of the following would not affect disability benefits receive under a group plan? Disability benefits received from a/an

A. Government plan such a social security

33. X is receiving disability benefits for injuries sustained in a fire. It is later proven that X set the fire. What action will the insurer take?

C. Discontinue any further benefits and make X repay the benefits that he has already received

B. Stop the benefits and void X’s policy

D. Continue to pay the benefits to the end of the benefit period

34. If a disability is treated as a reoccurrence, the insured

B. Does not have to satisfy the elimination period again but only has whatever time was left on the benefit period

A. Has to satisfy the elimination period again but has an entire benefit period available to receive benefits

C. Has to satisfy the elimination period gain and only has whatever time was left on the benefit period

D. Does not have to satisfy the elimination period again and has the entire benefit period available to receive benefits

36. Which of the following is true regarding the probationary period?

C. It is designed to protect the company against adverse selection

A. It applies to both accidents and sickness

B. It must be satisfied each and every time there is a sickness or accident

D. It applies to accidents only

37. The disability benefit in a disability income policy is usually based on

B. 50 to 70% of the insured’s gross income at the time of the purchase

A. 50 to 70% of the insured’s net income at the time of the purchase

C. 50 to 70% of the insured’s net income at the time of disability

D. 50 to 70% of the insured’s gross income at the time of disability

38. When does the Cost-of-living rider on a disability income policy kick in?

C. After the insure has been disabled for 12 months

A. After the insured has been disabled for 5 months

B. After the insured has been disabled for 6 months

D. After the insured has met his elimination period

39. If X has a disability income policy with a $2,000 monthly benefit, and X becomes partially disabled, the benefit that X would be eligible for is

B. The full amount only if X is disabled for a full year

D. $1,000 if he is disabled for at least a year

43. X is disabled and has a disability policy that will cover him for more than 2 years. At what interval does X have to provide notice of continuing loss to insurer?

C. At least once every 6 months after having given notice of claim

B. At least once every 3 months after having given notice of claim

46. Which of the following is the most liberal definition of total disability?

B. Inability to do the duties of your own occupation

A. Inability to do any occupation

C. Inability to do the duties of an occupation that you are “reasonably suited” for

D. Inability to do the duties as defined by Social Security

48. Total disability could be defined by all of the following except

B. The inability to perform some of the duties of your occupation

A. The inability to perform the duties of your own occupation

C. The inability to perform the duties of any occupation

D. The inability to perform the duties of any occupation for which you are reasonably suited by education, training, or experience

49. The purpose of the probationary period is to

D. Help the insurer avoid paying benefits for losses due to illness contracted before the policy was issued

A. Provide a trial period of coverage for the insured at little cost

B. Limit the insurer’s risk related to accidental injuries

C. Give the insured an opportunity to cancel the policy and obtain a refund if not entirely satisfied

51. Any health policy which provides coverage and benefits to include minor children shall be effective, with respect to newborn children,

B. From 24 hours following birth

C. From the time when the insurer or its agent has been notified of the birth

Accident & Health Insurance Policies Disability, medical expense

Authored by Alberto Guzman

Specialty

Professional Development

Used 2+ times

Accident & Health Insurance Policies Disability, medical expense

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MULTIPLE CHOICE QUESTION

10 mins • 1 pt

X has an 80/20 major medical policy with a $250 deductible. Since X has not satisfied any of the deductible, if X incurs $1500 in medical expenses, how much of the bill will the insurer pay?

A. $500

B. $1000

C. $1200

D. $1500

MULTIPLE CHOICE QUESTION

10 mins • 1 pt

What is the feature that limits the amount of money that an insured has to pay out of pocket once he has paid a certain amount under the coinsurance clause?

A. Restoration of Benefits

B. Stop-Loss

C. Maximum Policy Benefit

D. Percentage Participation

MULTIPLE CHOICE QUESTION

10 mins • 1 pt

The deductible that an insured has to pay before benefits begin to be paid by the insurer in a major medical policy is known as the

A. Corridor Deductible

B. Initial Deductible

C. Integrated Deductible

D. First Dollar Deductible

MULTIPLE CHOICE QUESTION

10 mins • 1 pt

All of the following are features of a dental plan except

A. Deductibles

B. Preventive Care

C. Coinsurance

D. High Policy Limits

MULTIPLE CHOICE QUESTION

10 mins • 1 pt

How is coinsurance in an individual health policy regulated?

A. The insured can change the rates as long as they wish

B. There are no regulations

C. The insurer can change the rates as long as they don’t exceed 25%

D. The insurer must leave the rate after the first year but not to exceed 25%

MULTIPLE CHOICE QUESTION

10 mins • 1 pt

When a specialist within the insurance company reviews a file to assess whether an alternate treatment is available that might be cheaper, this is known as

A. A Pretreatment Review

B. A Second Surgical Opinion

C. Case Management

D. Stop-Loss

MULTIPLE CHOICE QUESTION

10 mins • 1 pt

What does the term First Dollar mean?

A. The company begins to pay as soon as the deductible is met

B. The company begins to pay as soon as the stop loss amount is reached

C. The policy does not have a deductible

D. The company will cover the entire amount of expenses incurred as long as the charges are within the inside limit

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Accident & Health Insurance Policies Disability, medical expense

X has an 80/20 major medical policy with a $250 deductible. Since X has not satisfied any of the deductible, if X incurs $1500 in medical expenses, how much of the bill will the insurer pay?

What is the feature that limits the amount of money that an insured has to pay out of pocket once he has paid a certain amount under the coinsurance clause?

The deductible that an insured has to pay before benefits begin to be paid by the insurer in a major medical policy is known as the

All of the following are features of a dental plan except

How is coinsurance in an individual health policy regulated?

When a specialist within the insurance company reviews a file to assess whether an alternate treatment is available that might be cheaper, this is known as

What does the term First Dollar mean?

Group medical expense policies must cover all of the following except

By adding the major medical to the basic, the insured now has the equivalent of comprehensive major medical coverage. The deductible which is in between the basic and the major medical coverage is known as

X incurs $1400 in eligible expenses. The policy is 80/20 with a $200 annual deductible. This is the first claim for the year. What is the maximum amount the insured will be required to pay on this claim?

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