2024/2025 Health Insurance Exam | Questions and Answers

2024/2025 Health Insurance Exam | Questions and Answers Which type of policy with paying employees salary if the employer was injured in a bicycle accident and out of work for six weeks? Business Overhead Expense On an accidental death and dismemberment insurance policy (AD&D) who is qualified to change the beneficiary designation? Policyowner Which of the following statements does not accurately describe the tax treatment of premiums and benefits of individual accident and health insurance? Disability income policy premiums are tax deductible All of the following statements regarding group health insurance are true, EXCEPT an individual policy is given to each member P is insured under a basic cancer plan which of the following conditions would be covered under this plan? Operation for a malignant tumor A policy owners rice are limited under which beneficiary designation Irrevocable Which of the following would be a likely candidate for disability income insurance on a key employee? Company executive Which of the following characteristics is associated with a large group disability income policy? No medical underwriting A business overhead expense policy Where is business expenses such as rent and utilities Many small business owners worry how their business will survive financially if the owner becomes disabled. The policy which best addresses this concern is Business overhead expense Which type of policy pays benefits to a policyholder covered under a hospital expense policy? Reimbursement P loses an arm and a farm accident and has paid $10,000 from his accidental death and dismemberment policy. This benefit is known as the Capital Sum The federal income tax treatment of employer provided group medical expense insurance can be accurately described as Employee premiums paid by the employer is tax deductible to the employer as a business expenditure T is covered by an accidental death and dismemberment policy that has an irrevocable beneficiary. What action will the insurance company take if T request a change of beneficiary? Request of the change will be refused The benefits under a disability buy-out policy are Payable to the company or another shareholder Accidental death coverage is provided to commercial airline passengers and which of the following types of policies? Blanket Accident policy The provision in a group health policy that allows the insurer to post phone coverage for a covert illness 30 days after the policies a better day is referred to as the Waiting Period The difference between group insurance and blanket health policies is Blanket health policies do not issue certificates G is an accountant who has 10 employees and is concerned about how the business with survive financially if he became disabled. The type of policy which best address this concern is Business Overhead Expense Consolidated Omnibus Budget Reconciliation Act (COBRA) Gives workers and their families whose employment has been terminated the right to continue group health benefits Group health plan typically contain a coordination of benefits provision. This provisions purpose is to Avoid the duplication of benefit payments Which of the following best describes how a policy that uses the "accidental bodily injury" definition of an accident differs from the one that uses the "accidental means" definition Less restrictive The coordination of benefits provision Prevents and insured covered by two health plans from making a profit on a covered loss Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services to a prearranged cost to the insured? PPO The percentage of an individual's primary insurance amount determines the benefits paid and which of the following programs? Social Security disability income Which of these statements is incorrect regarding a preferred provider organization (PPO) PPO's are NOT a type of managed care systems Which of the following types of organizations are prepaid group health plans were members pay in advance for the services are participating physicians in hospitals that have agreements? HMO What type of provider is no for stressing preventative medical care and routine physical examinations? HMO Which of the following organizations will make reimbursement payments directly to the insured individual for covering medical expenditures? Commercial Insurer Which of the following does Social Security NOT provide benefits for? Dismemberment Which of the following actions as required by an insured who leave the primary area of medical coverage and seeks medical care? Obtain prior approval from the insurer for the medical service A medical care provider which typically delivers health services edits on local medical facility is known as a HMO C was injured while deep sea diving and requires a hospital stay. C has a major medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C Will pay if the covered medical expenses are $2000? $720 Which of the following services is not included under hospitalization expense coverage? Surgical fees Which of the following phrases refers to the fees charged by a healthcare professional? Usual, customary, and reasonable expenses Which of the following best describes a hospital indemnity policy? Coverage that pays a stated amount per day of a covered hospitalization Basic hospital and surgical policy benefits are lower than the actual expenses incurred Which of the following is not a limited benefit plan life insurance policies In order to establish a health reimbursement arrangement it must Be established by the employer Basic Medical Expense Insurance has lower benefit limits than Major Medical insurance The first portion of a covered major medical insurance expense that the insurance is required to pay is called the Initial deductible Which of the following statements best describes the intent of a coinsurance clause in a major medical policy? Discourages overutilization of the insurance coverage A major medical policy typically provides benefits for reasonable and necessary medical expenses, subject to policy limits Which of the following statements about health reimbursement arrangements is correct? If the employee paid for qualifying medical expenses the reimbursements may be tax-free Tee was treated for an element two months prior to applying for a health insurance policy. This condition was noted on the application in the policy was issued shortly afterwards. How are the insurer likely consider this condition? Insurer will likely treat as a pre-existing condition which may not be covered for one year When an insured has the same disability within a specified time. And the insurance company provides the same benefits without a new waiting. The second disability is covered under which of the following benefits Recurrent disability