Question 1

More than half of all health insurance in the U.S.is provided by:

Accepted Answer

A) Blue Cross Plans 
B) Traditional Health Insurers 
C) HMOs & PPOs 
D) HMOs only 
A) Blue Cross Plans 
B) Traditional Health Insurers 
C) HMOs & PPOs 
D) HMOs only C

Question 2

The participation provision is generally associated with major medical insurance.

Accepted Answer

A) True 
 B)False  True

Question 3

Major medical insurance:

Accepted Answer

A) always provides the same benefits as basic medical, but has higher limits 
B) is designed for low income consumers 
C) is sold only to groups 
D) has a high limit of coverage 
A) always provides the same benefits as basic medical, but has higher limits 
B) is designed for low income consumers 
C) is sold only to groups 
D) has a high limit of coverage D

Question 4

Because medical expenses may be covered by more than one policy,health insurance policies normally contain a ______________ clause to prevent overpayment to the insured.

Accepted Answer

A) coordination-of-benefits 
B) double indemnity 
C) pro-rata 
D) other insurance 
A) coordination-of-benefits 
B) double indemnity 
C) pro-rata 
D) other insurance

Question 5

HMOs:

Accepted Answer

A) are the same as PPOs but cover only groups of individuals 
B) collect a capitation payment for each insured and provide "comprehensive" health and preventive care 
C) tend to be found mostly in rural areas 
D) provide a reduced fee if the insured has zero claims during the preceding policy year 
A) are the same as PPOs but cover only groups of individuals 
B) collect a capitation payment for each insured and provide "comprehensive" health and preventive care 
C) tend to be found mostly in rural areas 
D) provide a reduced fee if the insured has zero claims during the preceding policy year

Question 6

Traditional Blue Cross benefits are expressed in terms of services rather than dollars.

Accepted Answer

A) True 
 B)False

Question 7

Which of the following clauses are associated with major medical coverage?

Accepted Answer

A) subrogation 
B) mortgagee 
C) replacement cost 
D) deductible 
A) subrogation 
B) mortgagee 
C) replacement cost 
D) deductible

Question 8

A "guaranteed renewable" health insurance policy is also known as a "noncancellable" policy.

Accepted Answer

A) True 
 B)False

Question 9

The term "PPO" means:

Accepted Answer

A) Preferred Participation Organization 
B) Participating Physician Organization 
C) Physicians Participation Organization 
D) Preferred Provider Organization 
A) Preferred Participation Organization 
B) Participating Physician Organization 
C) Physicians Participation Organization 
D) Preferred Provider Organization

Question 10

Disability income insurance replaces income that cannot be earned while a person is disabled according to the contract's definition of disability.

Accepted Answer

A) True 
 B)False

Question 11

Long-term care policies:

Accepted Answer

A) are not standardized 
B) are purchased by more than 70% of U.S. senior citizens 
C) provide coverage that is normally triggered by an inability of the insured to understand the ramifications of their actions 
D) legal in only 38 states 
A) are not standardized 
B) are purchased by more than 70% of U.S. senior citizens 
C) provide coverage that is normally triggered by an inability of the insured to understand the ramifications of their actions 
D) legal in only 38 states

Question 12

Explain how a typical major medical contract works.

Accepted Answer

After a deductible is paid by the insure

Question 13

Granny Mayberry's health insurance policy has a $500 annual aggregate deductible,80/20 cost sharing deductible,and a $5,000 maximum annual out-of-pocket cap of $5,000. She wrecks her Harley and breaks her hip,and her total medical bills for the injury are $12,890. How much will her insurer pay for this claim?

Accepted Answer

A) $7,890 
B) $10,312 
C) $9,912 
D) $12,890 
A) $7,890 
B) $10,312 
C) $9,912 
D) $12,890

Question 14

Preadmission testing in health insurance is a form of:

Accepted Answer

A) utilization review 
B)  cost containment 
C) catastrophe prevention 
D) adverse selection 
A) utilization review 
B)  cost containment 
C) catastrophe prevention 
D) adverse selection

Question 15

The purpose of long term care insurance is to:

Accepted Answer

A) pay supplemental Medicare benefits when 60 days of coverage has been exceeded 
B) pay for housekeeping services for elderly disabled retirees on Medicare or Medicaid 
C) pay for short stays in a hospital for the purpose of rehabilitation 
D) pay for services in a long tem care facility such as custodial care, skilled nursing care, intermediate care, or hospice care 
A) pay supplemental Medicare benefits when 60 days of coverage has been exceeded 
B) pay for housekeeping services for elderly disabled retirees on Medicare or Medicaid 
C) pay for short stays in a hospital for the purpose of rehabilitation 
D) pay for services in a long tem care facility such as custodial care, skilled nursing care, intermediate care, or hospice care

Question 16

Less than half of the U.S.population is covered by health insurance.

Accepted Answer

A) True 
 B)False

Question 17

An insured in a preferred provider organization pays less out of his pocket if he chooses to use:

Accepted Answer

A) an out-of-network physician 
B) a preferred provider 
C) his/her regular physician 
D) a chiropractor 
A) an out-of-network physician 
B) a preferred provider 
C) his/her regular physician 
D) a chiropractor

Question 18

Medigap policies must:

Accepted Answer

A) have a six-month open enrollment period 
B) provide a core group of minimum benefits 
C) not exclude pre-existing conditions for more than six months 
D) all of the above 
A) have a six-month open enrollment period 
B) provide a core group of minimum benefits 
C) not exclude pre-existing conditions for more than six months 
D) all of the above

Question 19

Which statement is true?

Accepted Answer

A) Spending for physicians' services in the U.S. has increased 
B) Spending for hospital services in the U.S. has increased 
C) Health care spending in the U.S. has increased 
D) All of the above 
A) Spending for physicians' services in the U.S. has increased 
B) Spending for hospital services in the U.S. has increased 
C) Health care spending in the U.S. has increased 
D) All of the above

Question 20

Medical expense insurance,such as that provided by Blue Cross,has relatively large deductible provisions.

Accepted Answer

A) True 
 B)False

Exam 16: Medical Expense and Disability Insurance

More than half of all health insurance in the U.S.is provided by:

The participation provision is generally associated with major medical insurance.

Major medical insurance:

Because medical expenses may be covered by more than one policy,health insurance policies normally contain a ______________ clause to prevent overpayment to the insured.

HMOs:

Traditional Blue Cross benefits are expressed in terms of services rather than dollars.

Which of the following clauses are associated with major medical coverage?

A "guaranteed renewable" health insurance policy is also known as a "noncancellable" policy.

The term "PPO" means:

Disability income insurance replaces income that cannot be earned while a person is disabled according to the contract's definition of disability.

Long-term care policies:

Explain how a typical major medical contract works.

Preadmission testing in health insurance is a form of:

The purpose of long term care insurance is to:

Less than half of the U.S.population is covered by health insurance.

An insured in a preferred provider organization pays less out of his pocket if he chooses to use:

Medigap policies must:

Which statement is true?

Medical expense insurance,such as that provided by Blue Cross,has relatively large deductible provisions.

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