Deck 3: Health: Health and Dental

Question 1

An example of an "alternative treatment" that would not likely be covered by a health insurance policy is:

A)Annual check-up
B)Chemotherapy for cancer treatment
C)Cosmetic surgery for elective reasons
D)Emergency heart surgery

Answer 1

Cosmetic surgery for elective reasons

Question 2

If an individual suffers an injury due to an act of war that requires several months of rehab therapy, will this therapy likely be covered under his or her individual health insurance policy?

A)No, as the rehab therapy is not considered to be an emergency
B)No, as injuries that result from an act of war are not covered
C)Yes, because all members of the military are eligible for free health insurance coverage
D)Yes, because the rehab will restore the insured back to health

Answer 2

No, as injuries that result from an act of war are not covered

Question 3

In most cases, unless it is otherwise stated, it is assumed that the applicant on a health insurance policy is also the __________.

A)Beneficiary
B)Decedent
C)Insured
D)None of the above

Answer 3

Insured

Question 4

The __________ in an insurance policy is the statement that sets out the element of insurance to pay for losses that are covered in the policy by the issuing insurance company.

A)Premium clause
B)Exclusion clause
C)Insuring clause
D)Rider clause

Question 5

Insurance policies are considered to be __________, meaning that they are dependent on an uncertain or chance event or outcome so that one of the parties may receive more in value than they give in value to the other party to the contract.

A)Aleatory
B)Unilateral
C)Commutative
D)All of the above

Question 6

The type of health plan that allows insureds to choose which doctor and other medical services providers they will use is:

A)HMO
B)PPO
C)Fee-for-service
D)Managed care

Question 7

Once the out-of-pocket maximum has been reached in a given year, an insured's health insurer will compensate them for __________ of their health care costs.

A)50%
B)80%
C)100%
D)None - the insured will then be responsible for all remaining costs during that calendar year

Question 8

A(n) __________ is considered to be an official request for money from an insurer.

A)Policy
B)Application
C)Rider
D)Claim

Question 9

Doctors and other health care providers that accept an insured's health insurance plan are considered to be __________ providers.

A)In-network
B)Out-of-network
C)Current
D)Non-participating

Question 10

When an insured visits their doctor for an annual check-up, typically the cost of their __________ will be paid at the time of the office visit.

A)Copayment
B)Deductible
C)Premium
D)Corridor

Question 11

Health insurance policies that have __________ provisions will require their policy holders to share a certain percentage of the cost of their medical or health care treatment.

A)Deductible
B)Corridor
C)Reimbursement
D)Coinsurance

Question 12

When putting together a major medical insurance plan, what factors must be established?

A)The maximum out-of-pocket amount
B)Deductible amount
C)Both A and B
D)Neither A or B

Question 13

Insurance policy __________ help(s) to protect insurers from having to pay for small losses.

A)Copayments
B)Coinsurance
C)Deductibles
D)Premiums

Question 14

The limitation of coverage to in-network providers and non-payment of claims for self-inflicted injuries are examples of policy __________.

A)Exclusions
B)Limitations
C)Deductibles
D)Copayments

Question 15

Individuals who are covered by an HMO will have their __________ serve as their provider for all basic healthcare services.

A)POS
B)PPO
C)PCP
D)POD

Question 16

What type of plan does not require that a participant obtain a referral prior to visiting another provider in the network?

A)HMO
B)PPO
C)Fee-for-service
D)All managed care plans require referrals

Question 17

__________ plans focus a great deal on preventive care and early detection and treatment.

A)PPO
B)HMO
C)POS
D)PCP

Question 18

The type of long-term care insurance policy that pays a policy holder a fixed amount of dollars per day, up to a specific amount of total benefits, regardless of the expense that is incurred is considered a(n) __________ plan.

A)Indemnity
B)Reimbursement
C)Managed care
D)PPO

Question 19

With regard to group health insurance, a company must have at least __________ employees in order to qualify as a "group"

A)One
B)Two
C)Ten
D)Twenty-five

Question 20

Which type(s) of policies fall under the health insurance category?

A)Disability insurance
B)Long-term care insurance
C)Group health insurance plans
D)All of the above

Question 21

All of the following are types of health insurance policies EXCEPT:

A)Vision insurance
B)Dental insurance
C)Annuities
D)Fee-for-service health plans

Question 22

A __________ may be used in conjunction with a high-deductible health insurance policy for the purpose of saving and paying for unreimbursed health care related expenses.

A)HSA
B)HMO
C)PPO
D)PCP

Question 23

A __________ may provide discounted health coverage to members on services such as medical care, vision, dental, hearing, and prescriptions - although they are not considered to be true insurance plans.

A)Major medical plan
B)HMOs
C)PPOs
D)Discount health plan

Question 24

_____ allows continued access to group health insurance coverage for former employees and/or other eligible family members for a certain amount of time.

A)TEFRA
B)HIPAA
C)COBRA
D)ERISA

Question 25

If, due to serious health conditions, an individual is not eligible for a traditional individual health insurance policy, they may be able to obtain coverage through __________.

A)A PPO
B)An HMO
C)COBRA
D)A guaranteed issue policy

Question 26

Even if an individual owns a health insurance policy, it is likely that there will be "gaps" in coverage and other expenses that are not covered. In order to help fill in some of these gaps with additional coverage, an individual may wish to purchase __________.

A)A guaranteed issue policy
B)A supplemental insurance policy
C)A major medical policy
D)A COBRA policy

Question 27

Because the cost of health care services may oftentimes be substantial, health insurance policies may contain a type of stop-loss provision that helps in preventing medical bills from financially devastating policy holders. This feature is known as the __________ provision.

A)Coinsurance
B)Deductible
C)None of the above

Question 28

The parties to an insurance contract include the __________ and the __________.

A)Underwriters / Actuaries
B)Applicant / Insurer
C)Applicant / Underwriters
D)Insurer / Underwriters

Question 29

HMOs and PPOs are both types of __________ plans.

A)Point of service
B)Managed care
C)Preferred provider
D)None of the above

Question 30

If an individual is seeking a health insurance policy that will cover them in the event of a major illness or accident, yet does not want coverage for regular check-ups, has a low premium in return for a high deductible, but does not cover regular check-ups, what type of plan should they consider?

A)Catastrophic coverage
B)Guaranteed issue
C)Fee-for-service
D)Temporary health insurance

Question 31

COBRA coverage includes which of the following:

A)Disability insurance coverage
B)Medical insurance coverage
C)Life insurance coverage
D)All of the above

Question 32

Most dental insurance policies will cover __________ procedures completely or require just a small payment from the patient.

A)Cosmetic
B)Diagnostic and preventive care
C)Orthodontics
D)Porcelain tooth veneer

Question 33

The __________ fee is the amount that an insurance company will actually pay a dentist for a particular procedure.

A)Yearly maximum
B)Usual, customary, and reasonable
C)Deductible
D)Coinsurance

Question 34

The type of dental insurance coverage that offers dental care from a network of dental care providers in exchange for some type of prepayment from the insured in is known as a(n) __________.

A)Dental HMO
B)Dental PPO
C)Dental fee-for-service plan
D)None of the above

Question 35

Dentists who are part of a __________ typically agree to serve patients at reduced rates.

A)Dental HMO
B)Dental PPO
C)Dental fee-for-service
D)None of the above

Question 36

The __________ is known as the dollar amount that a participating dentist has agreed to accept as payment in full from an insurance provider and the patient.

A)Reduced rate
B)Accepted fee
C)Annual maximum
D)Bill balance

Question 37

The __________ is the total dollar amount that a dental insurance policy will pay out for care that is incurred by an insured within a set benefit period.

A)Accepted fee
B)Bill balance
C)Annual maximum
D)Copayment

Question 38

In a(n) __________ dental plan, enrollees are required to use the services of either pre-selected dentists or an assigned network dentist in order to receive benefits from the plan.

A)Open panel
B)Closed panel
C)Coordinated
D)Capitated

Question 39

__________requires that medical or dental treatment must first be approved by the insurance plan prior treatment being rendered in order for the plan to pay out benefits for such services.

A)Deductible
B)Coinsurance
C)Pre-treatment estimate
D)Preauthorization

Question 40

A(n) __________ dental insurance policy typically allows the insured to choose their dental service provider from a list of providers and works in a similar fashion to the way in which a traditional fee-for-service health care policy works.

A)Managed care
B)HMO
C)PPO
D)Indemnity

Question 41

With a(n) __________ dental insurance plan, the insured will be reimbursed for a set dollar amount that is based upon a certain fee schedule for services.

A)Dental discount card
B)DHMO
C)Scheduled
D)Indemnity

Question 42

A statement addressed to a beneficiary and written by a third party payer, that indicates which benefits and charges will and will not be covered under a dental benefits plan after a claim has been reported, is known as a(n) __________.

A)Claim
B)Explanation of Benefits
C)Rider
D)Waiver of Premium

Question 43

Traditional dental insurance typically pays for three classes of treatment. These are:

A)Preventive, major, and restorative
B)Preventive, basic, and major
C)Basic, restorative, and major
D)Basic, major, and orthodontics

Question 44

Some dental insurance plans include a(n) __________ , which can be met by any or all covered members of a family dental plan.

A)Overall deductible
B)Member's deductible
C)Family deductible
D)None of the above

Question 45

The __________ allows the employees who are enrolled in a company's dental PPO plan to roll a portion of their unused annual maximum over into an account in case they should need more extensive dental care in the future.

A)Annual maximum
B)Out-of-pocket maximum
C)Calendar year maximum
D)Maximum rollover feature

Question 46

Some features of a dental indemnity plan include:

A)High deductibles before coverage begins
B)Probationary periods of up to one year on certain procedures
C)Annual dollar limit on benefits
D)All of the above

Question 47

Some features of dental PPO plans include:

A)No monthly premiums
B)No annual dollar cap on benefits
C)Services received at a reduced rate
D)A lower charge for services if the enrollee receives care outside of the approved network

Question 48

Most group health insurance plans will stipulate that if an employee is not considered to be __________ on the day that the policy goes into effect, then the coverage will not start until the employee returns to work.

A)Employed
B)Unemployed
C)Actively at work
D)None of the above

Question 49

The payment of health insurance benefits to the health care provider rather than to the insured is referred to as __________.

A)Assignment of benefits
B)Deducting benefits
C)Copayment of benefits
D)Transferring benefits

Question 50

The time referred to as the __________ begins with an insured's effective date of coverage and represents the time during which their health insurance will not provide benefits for pre-existing conditions.

A)Elimination period
B)Limitation period
C)Waiting period
D)Waiver of premium

Question 51

The __________ is the group of state officials that is charged with regulating insurance.

A)NASD
B)NAIC
C)FDIC
D)SIPC

Question 52

__________ is the process by which a health insurance company determines whether it will be the primary or secondary payer of benefits for an individual who is insured by more than one plan.

A)Capitation
B)Coordination of benefits
C)Approved amount
D)First payer rule

Question 53

Another term for in-network provider is __________.

A)Primary provider
B)Participating provider
C)Peer provider
D)None of the above

Question 54

When an individual is covered under more than one health insurance policy, _________ is the policy that provides claim payment after the primary coverage.

A)Secondary coverage
B)Preferred coverage
C)Self-funded coverage
D)Scheduled coverage

Question 55

The legislation that mandated certain privacy rules and practices for medical care providers and health insurance companies is known as __________. This was also created in an effort to streamline the health care and insurance industries and to protect the identity and privacy of consumers who receive such care.

A)TEFRA
B)TAMRA
C)ERISA
D)HIPAA