KENTUCKY HEALTH INSURANCE UPDATED
COMPREHENSIVE EXAM QUESTIONS AND ANSWERS
GRADED A+
✔✔What is the difference between conventional and modified fully-insured plan? - ✔✔A
conventional fully-insured plan requires that the premiums be paid on a yearly basis and
this premiums pay for exactly one year of coverage. Under modified fully-insured plans,
the employer has several options for payment of premiums that may help to reduce the
total cost of health insurance.
✔✔What does a third-party administrator do? - ✔✔Helps administer a self-insured plan
by performing activities such as record keeping, auditing, and processing claims.
✔✔What is a multiple employer trust? in your answer describe the feral circumstances
of the people/groups who tend to comprise MET's - ✔✔A multiple employer trust (MET)
is made up of a number of individuals or small groups of individuals who do not qualify
for group insurance.
✔✔Define prosthodontics - ✔✔Prosthodontics means the replacement of missing teeth
with artificial devices like bridgework or dentures.
✔✔Describe the difference between scheduled and nonscheduled plans - ✔✔With
nonscheduled plans, benefits are paid on a reasonable and customary basis and are
subject to deductibles and coinsurance
✔✔Describe the difference between basic and major dental services - ✔✔Basic
services such as fillings, oral surgery, periodontics, and endodontics may require the
insured to pay a deductible or 20% of the balance (the insurer would pay the other 80%)
Major services like inlays, crowns, dentures and orthodontics, could either have large
deductibles or pay around 50% for services provided.
✔✔List 3 things that are commonly excluded from dental plans - ✔✔Cosmetic services
(unless requires by an accident) , replacement of lost dentures, and oral hygiene
instruction.
✔✔To prevent adverse selection, late enrollees for dental insurance may get what type
of benefits? - ✔✔There may be a limitation of benefits for late enrollees where benefits
may be reduced for the first year.
✔✔How are dread disease policies different from other types of policies? - ✔✔A Dread
Disease policy provides a variety of benefits for a specific disease such as cancer or
heart disease.
, ✔✔What is included under the definition of activities of daily living? - ✔✔ADL's include
mobility or transferring, bathing, dressing, toileting, continence, and eating.
✔✔Where is skilled nursing care generally provided? - ✔✔Skilled care is almost always
provided in an institutional setting.
✔✔Describe an individual who would be a candidate for custodial care. Who would
provide it? - ✔✔Custodial care is for meeting personal needs, and must be given under
doctors orders.
✔✔Who would be eligible for adult day care? What services would be provided? -
✔✔Adult day care is provided for functionally impaired adults on less than a 24-hour
basis. Care includes transportation to and from the day care center, and a variety of
health, social and related activities. Meals are usually included as part of the service.
✔✔Before a long-term care policy will be issued to an applicant age 80 or older, what
must the insurer obtain? - ✔✔The insurer must obtain the following: a report of a
physical examination; an assessment of functional capacity; an attending physicians
statement; and copies of medical records.
✔✔What is cold lead advertising? Under what circumstances (if any) is it legal? - ✔✔In
"cold lead advertising" one fails to disclose in a conspicuous manner that solicitations of
an insurance contract are a purpose of the marketing method. Its use is prohibited.
✔✔To whom is Medicare available? - ✔✔Medicare is a federal medical expense
insurance program for people age 65 and older even if the individual continues to work.
✔✔What does Medicare Part A cover? - ✔✔Medicare Part A helps pay for inpatient
hospital care, inpatient care in a skilled nursing facility, home health care, and hospice
care.
✔✔How is Part B of Medicare funded? - ✔✔Part B is funded by monthly premiums and
from the general revenues of the federal government.
✔✔Who is eligible for Part B of Medicare? - ✔✔Part B is optional and offered to
everyone who enrolls in Part A.
✔✔What is the initial enrollment period for Medicare Part A? - ✔✔Initial enrollment
period is when an individual first becomes eligible for Medicare (3 months before turning
age 65 to 3 months after the month of birth)
✔✔When is general enrollment period for Medicare Part B? - ✔✔January 1 through
March 31 of each year
COMPREHENSIVE EXAM QUESTIONS AND ANSWERS
GRADED A+
✔✔What is the difference between conventional and modified fully-insured plan? - ✔✔A
conventional fully-insured plan requires that the premiums be paid on a yearly basis and
this premiums pay for exactly one year of coverage. Under modified fully-insured plans,
the employer has several options for payment of premiums that may help to reduce the
total cost of health insurance.
✔✔What does a third-party administrator do? - ✔✔Helps administer a self-insured plan
by performing activities such as record keeping, auditing, and processing claims.
✔✔What is a multiple employer trust? in your answer describe the feral circumstances
of the people/groups who tend to comprise MET's - ✔✔A multiple employer trust (MET)
is made up of a number of individuals or small groups of individuals who do not qualify
for group insurance.
✔✔Define prosthodontics - ✔✔Prosthodontics means the replacement of missing teeth
with artificial devices like bridgework or dentures.
✔✔Describe the difference between scheduled and nonscheduled plans - ✔✔With
nonscheduled plans, benefits are paid on a reasonable and customary basis and are
subject to deductibles and coinsurance
✔✔Describe the difference between basic and major dental services - ✔✔Basic
services such as fillings, oral surgery, periodontics, and endodontics may require the
insured to pay a deductible or 20% of the balance (the insurer would pay the other 80%)
Major services like inlays, crowns, dentures and orthodontics, could either have large
deductibles or pay around 50% for services provided.
✔✔List 3 things that are commonly excluded from dental plans - ✔✔Cosmetic services
(unless requires by an accident) , replacement of lost dentures, and oral hygiene
instruction.
✔✔To prevent adverse selection, late enrollees for dental insurance may get what type
of benefits? - ✔✔There may be a limitation of benefits for late enrollees where benefits
may be reduced for the first year.
✔✔How are dread disease policies different from other types of policies? - ✔✔A Dread
Disease policy provides a variety of benefits for a specific disease such as cancer or
heart disease.
, ✔✔What is included under the definition of activities of daily living? - ✔✔ADL's include
mobility or transferring, bathing, dressing, toileting, continence, and eating.
✔✔Where is skilled nursing care generally provided? - ✔✔Skilled care is almost always
provided in an institutional setting.
✔✔Describe an individual who would be a candidate for custodial care. Who would
provide it? - ✔✔Custodial care is for meeting personal needs, and must be given under
doctors orders.
✔✔Who would be eligible for adult day care? What services would be provided? -
✔✔Adult day care is provided for functionally impaired adults on less than a 24-hour
basis. Care includes transportation to and from the day care center, and a variety of
health, social and related activities. Meals are usually included as part of the service.
✔✔Before a long-term care policy will be issued to an applicant age 80 or older, what
must the insurer obtain? - ✔✔The insurer must obtain the following: a report of a
physical examination; an assessment of functional capacity; an attending physicians
statement; and copies of medical records.
✔✔What is cold lead advertising? Under what circumstances (if any) is it legal? - ✔✔In
"cold lead advertising" one fails to disclose in a conspicuous manner that solicitations of
an insurance contract are a purpose of the marketing method. Its use is prohibited.
✔✔To whom is Medicare available? - ✔✔Medicare is a federal medical expense
insurance program for people age 65 and older even if the individual continues to work.
✔✔What does Medicare Part A cover? - ✔✔Medicare Part A helps pay for inpatient
hospital care, inpatient care in a skilled nursing facility, home health care, and hospice
care.
✔✔How is Part B of Medicare funded? - ✔✔Part B is funded by monthly premiums and
from the general revenues of the federal government.
✔✔Who is eligible for Part B of Medicare? - ✔✔Part B is optional and offered to
everyone who enrolls in Part A.
✔✔What is the initial enrollment period for Medicare Part A? - ✔✔Initial enrollment
period is when an individual first becomes eligible for Medicare (3 months before turning
age 65 to 3 months after the month of birth)
✔✔When is general enrollment period for Medicare Part B? - ✔✔January 1 through
March 31 of each year
