Question 1

Blue Cross is:

Accepted Answer

A)  owned by the doctors 
B)  owned by Blue Shield 
C)  not sold on a group basis 
D)  a hospital service prepayment plan 
A)  owned by the doctors 
B)  owned by Blue Shield 
C)  not sold on a group basis 
D)  a hospital service prepayment plan D

Question 2

Which of the following is false?

Accepted Answer

A)  Within the next two decades, about 50 million people born between 1946 and 1964 will retire. 
B)  Medicaid insurance currently finances over 60 percent of all long-term nursing home care expenses. 
C)  The mobility of American families means that many disabled elderly persons will not have children living close enough to assist them. 
D)  As our society ages and health care costs increase, long-term care facilities will become more necessary. 
A)  Within the next two decades, about 50 million people born between 1946 and 1964 will retire. 
B)  Medicaid insurance currently finances over 60 percent of all long-term nursing home care expenses. 
C)  The mobility of American families means that many disabled elderly persons will not have children living close enough to assist them. 
D)  As our society ages and health care costs increase, long-term care facilities will become more necessary. B

Question 3

The term "HMO" means:

Accepted Answer

A)  Health Maintenance Organization 
B)  Health Management Organization 
C)  Healthy Mamas Organization 
D)  Hospital Management Organization 
A)  Health Maintenance Organization 
B)  Health Management Organization 
C)  Healthy Mamas Organization 
D)  Hospital Management Organization A

Question 4

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 term 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 term care facility such as custodial care, skilled nursing care, intermediate care, or hospice care

Question 5

When a hospital performs preadmission testing, in which it determines the most optimal treatment before the patient actually enters the hospital, it is considered to be performing:

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 6

Which of the following is not a type of health insurance coverage?

Accepted Answer

A)  Basic medical expense insurance 
B)  Medicare supplemental coverage insurance 
C)  Double indemnity insurance 
D)  Major medical insurance 
A)  Basic medical expense insurance 
B)  Medicare supplemental coverage insurance 
C)  Double indemnity insurance 
D)  Major medical insurance

Question 7

Which of these health insurers normally rewards its doctors through profit sharing?

Accepted Answer

A)  Traditional Health Insurers 
B)  Blue Cross/Blue Shield Organizations 
C)  Health Maintenance Organizations 
D)  Preferred Provider Organizations 
A)  Traditional Health Insurers 
B)  Blue Cross/Blue Shield Organizations 
C)  Health Maintenance Organizations 
D)  Preferred Provider Organizations

Question 8

HMOs are health insurers specializing in cancer insurance.

Accepted Answer

A) True 
 B)False

Question 9

Your personal health insurance policy provides the following coverage: For all covered medical bills, you must pay a $100 annual aggregate deductible.
After meeting that deductible, you must share in all additional expenses on a 90/10
Basis. In any one year, your out-of-pocket maximum expenditure will not exceed $1,000.
In 2009 you fall and crack your skull. The covered medical bills you incur total $7,100. How much will you have to pay for this loss, and how much will the insurer pay?

Accepted Answer

A)  You pay $100, your insurer pays $7,000. 
B)  You pay $800, your insurer pays $7,000. 
C)  You pay $800, your insurer pays $6,300. 
D)  You pay $1,000, your insurer pays $6,100. 
A)  You pay $100, your insurer pays $7,000. 
B)  You pay $800, your insurer pays $7,000. 
C)  You pay $800, your insurer pays $6,300. 
D)  You pay $1,000, your insurer pays $6,100.

Question 10

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

Accepted Answer

A) True 
 B)False

Question 11

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 12

Granny Clampett's health insurance policy has a $500 annual aggregate deductible, and 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 $122,721. How much will her insurer pay for this claim?

Accepted Answer

A)  $5,500 
B)  $97,777 
C)  $98,177 
D)  $117,721 
A)  $5,500 
B)  $97,777 
C)  $98,177 
D)  $117,721

Question 13

Which of the following is a cost shifting technique in health insurance?

Accepted Answer

A)  Utilization review 
B)  Generic drugs 
C)  Second opinions 
D)  Increased deductibles 
A)  Utilization review 
B)  Generic drugs 
C)  Second opinions 
D)  Increased deductibles

Question 14

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

Accepted Answer

A) True 
 B)False

Question 15

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 16

Granny Mayberry's health insurance policy has a $500 annual aggregate deductible, 80/20 cost sharing deductible, and a 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 17

Disability income insurance generally requires an elimination or waiting period before benefits begin.

Accepted Answer

A) True 
 B)False

Question 18

Explain how a typical major medical contract works.

Accepted Answer

After a deductible is paid by the insure

Question 19

Major medical insurance usually requires the insured to pay a percentage of all losses after a deductible up to an out-of-pocket limit.

Accepted Answer

A) True 
 B)False

Question 20

Because people sometimes forget to pay their premiums on time, health insurance policies normally contain a/an ________ to prevent unnecessary termination of the insured.

Accepted Answer

A)  grace period clause 
B)  reinstatement clause 
C)  pro-rata clause 
D)  entire contract 
A)  grace period clause 
B)  reinstatement clause 
C)  pro-rata clause 
D)  entire contract

Blue Cross is:

Which of the following is false?

The term "HMO" means:

The purpose of long term care insurance is to:

When a hospital performs preadmission testing, in which it determines the most optimal treatment before the patient actually enters the hospital, it is considered to be performing:

Which of the following is not a type of health insurance coverage?

Which of these health insurers normally rewards its doctors through profit sharing?

HMOs are health insurers specializing in cancer insurance.

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

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

Which of the following is a cost shifting technique in health insurance?

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

HMOs:

Disability income insurance generally requires an elimination or waiting period before benefits begin.

Explain how a typical major medical contract works.

Major medical insurance usually requires the insured to pay a percentage of all losses after a deductible up to an out-of-pocket limit.

Because people sometimes forget to pay their premiums on time, health insurance policies normally contain a/an ________ to prevent unnecessary termination of the insured.

Introduction to Enterprise Risk Management and Insurance

Risk Identification

Risk Assessment and Pooling

Risk-Handling Techniques: Loss Control, Risk Transfer, and Loss Financing

Risk-Handling Techniques: Diversification and Hedging

Fundamentals of Insurance

Insurable Perils and Insuring Organizations

Insurance Functions

Insurance Markets: Economics and Issues

Insurance Regulation

Insurance Contracts

The Personal Auto Policy

Homeowners Insurance

Professional Financial Planning

Life Insurance Policies

Standard Life Insurance Contract Provisions and Options

Annuities

Employee Benefits

Social Security

Unemployment and Workers Compensation Insurance

Commercial Property Insurance

Commercial Liability Insurance

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Exam 18: Health Insurance and Disability Income

Blue Cross is:

Which of the following is false?

The term "HMO" means:

The purpose of long term care insurance is to:

When a hospital performs preadmission testing, in which it determines the most optimal treatment before the patient actually enters the hospital, it is considered to be performing:

Which of the following is not a type of health insurance coverage?

Which of these health insurers normally rewards its doctors through profit sharing?

HMOs are health insurers specializing in cancer insurance.

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

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

Which of the following is a cost shifting technique in health insurance?

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

HMOs:

Disability income insurance generally requires an elimination or waiting period before benefits begin.

Explain how a typical major medical contract works.

Major medical insurance usually requires the insured to pay a percentage of all losses after a deductible up to an out-of-pocket limit.

Because people sometimes forget to pay their premiums on time, health insurance policies normally contain a/an ________ to prevent unnecessary termination of the insured.

Introduction to Enterprise Risk Management and Insurance

Risk Identification

Risk Assessment and Pooling

Risk-Handling Techniques: Loss Control, Risk Transfer, and Loss Financing

Risk-Handling Techniques: Diversification and Hedging

Fundamentals of Insurance

Insurable Perils and Insuring Organizations

Insurance Functions

Insurance Markets: Economics and Issues

Insurance Regulation

Insurance Contracts

The Personal Auto Policy

Homeowners Insurance

Professional Financial Planning

Life Insurance Policies

Standard Life Insurance Contract Provisions and Options

Annuities

Employee Benefits

Social Security

Unemployment and Workers Compensation Insurance

Commercial Property Insurance

Commercial Liability Insurance

Filters