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HEALTH INSURANCE OHIO EXAM
QUESTIONS AND ANSWERS 2025
Two major perils under a health insurance policy: - correct
answer- Policies may cover both accident and sickness or
accident only.
Accidental bodily injury: - correct answer- An unforeseen and
unintended injury that resulted from an accident rather than a
sickness.
Sickness: - correct answer- Normally defined as an illness,
which first manifests itself while the policy is in force. This is
where a majority of health insurance claims result from.
Loss of income from disability: - correct answer- Loss of income
caused by accident or sickness causing an insured the inability
to work and earn in come.
Limited Vs Comprehensive: - correct answer- Limited health
insurance policies only cover specific accidents or diseases.
Comprehensive plan would cover all sickness or accidents that
are not specifically excluded.
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A successful self funded plan will have the following
characteristics: (5) - correct answer- -A group large enough to
reasonably predict future loss experience.
-Sound statistical data to support the self-funding concept.
-A stop-loss contract to assume losses beyond the insured's
retention.
-A third party administrator who services claims.
-Flexibility in plan design and administrative procedures.
Employee Retirement Income Security Act of 1974 (ERISA): -
correct answer- A federal law that was enacted to ensure that
employees receive the pension and other benefits promised by
their employers.
Association (alumni or professional) group: - correct answer-
Can buy group insurance for its members. The group must
have at least 100 members, be organized for a reason other
than buying insurance, have been active for two years, have a
constitution, by-laws, and must hold at least annual meetings.
Multiple-Employer Trust (MET): - correct answer- Made up of
two or more employers in similar or related businesses who do
not qualify for group insurance on their own.
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Multiple Employer Welfare Associations (MEWAs): - correct
answer- Can be any entity, other than a duly admitted insurer,
that establishes an employee benefit plan for the purpose of
offering or providing accident and sickness or death benefits to
the employees of at least 2 employers, including self-employed
individuals and their dependents.
They pool their risks in order to self-insure
Accident only policies: - correct answer- Limited policies that
provide coverage for death, dismemberment, disability or
hospital and medical care resulting from an accident. Only pays
for losses from accidents not sickness.
Principal Sum: - correct answer- This amount is usually equal
to the amount of coverage under the insurance contract, or the
face amount.
Capital Sum: - correct answer- In case of loss of sight or
accidental dismemberment, a percentage of that principal sum
will be paid by the policy.
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Dread Disease (limited risk) policy: - correct answer- Provides a
variety of benefits for a specific disease such as cancer policy
or heart disease policy. Benefits usually paid as scheduled,
fixed dollar amount.
Hospital indemnity: - correct answer- Provides a specific
amount on a daily, weekly or monthly basis while the insured is
confined to a hospital.
Critical illness policy: - correct answer- Pays a lump sum to the
insured upon the diagnoses (and survival) of a critical illness.
The insured must survive the illness for a certain period of time
(30 days)
Blanket Policy: - correct answer- Covers members of a
particular group when they are participating in a particular
activity.
Routine and Preventive Maintenance: - correct answer-
Covered up to an annual maximum without a deductible or
copayment.
Routine and Major restorative care: - correct answer- Includes
treatment of cavities, oral surgeries, bridges, and dentures.
HEALTH INSURANCE OHIO EXAM
QUESTIONS AND ANSWERS 2025
Two major perils under a health insurance policy: - correct
answer- Policies may cover both accident and sickness or
accident only.
Accidental bodily injury: - correct answer- An unforeseen and
unintended injury that resulted from an accident rather than a
sickness.
Sickness: - correct answer- Normally defined as an illness,
which first manifests itself while the policy is in force. This is
where a majority of health insurance claims result from.
Loss of income from disability: - correct answer- Loss of income
caused by accident or sickness causing an insured the inability
to work and earn in come.
Limited Vs Comprehensive: - correct answer- Limited health
insurance policies only cover specific accidents or diseases.
Comprehensive plan would cover all sickness or accidents that
are not specifically excluded.
,2 | Page
A successful self funded plan will have the following
characteristics: (5) - correct answer- -A group large enough to
reasonably predict future loss experience.
-Sound statistical data to support the self-funding concept.
-A stop-loss contract to assume losses beyond the insured's
retention.
-A third party administrator who services claims.
-Flexibility in plan design and administrative procedures.
Employee Retirement Income Security Act of 1974 (ERISA): -
correct answer- A federal law that was enacted to ensure that
employees receive the pension and other benefits promised by
their employers.
Association (alumni or professional) group: - correct answer-
Can buy group insurance for its members. The group must
have at least 100 members, be organized for a reason other
than buying insurance, have been active for two years, have a
constitution, by-laws, and must hold at least annual meetings.
Multiple-Employer Trust (MET): - correct answer- Made up of
two or more employers in similar or related businesses who do
not qualify for group insurance on their own.
,3 | Page
Multiple Employer Welfare Associations (MEWAs): - correct
answer- Can be any entity, other than a duly admitted insurer,
that establishes an employee benefit plan for the purpose of
offering or providing accident and sickness or death benefits to
the employees of at least 2 employers, including self-employed
individuals and their dependents.
They pool their risks in order to self-insure
Accident only policies: - correct answer- Limited policies that
provide coverage for death, dismemberment, disability or
hospital and medical care resulting from an accident. Only pays
for losses from accidents not sickness.
Principal Sum: - correct answer- This amount is usually equal
to the amount of coverage under the insurance contract, or the
face amount.
Capital Sum: - correct answer- In case of loss of sight or
accidental dismemberment, a percentage of that principal sum
will be paid by the policy.
, 4 | Page
Dread Disease (limited risk) policy: - correct answer- Provides a
variety of benefits for a specific disease such as cancer policy
or heart disease policy. Benefits usually paid as scheduled,
fixed dollar amount.
Hospital indemnity: - correct answer- Provides a specific
amount on a daily, weekly or monthly basis while the insured is
confined to a hospital.
Critical illness policy: - correct answer- Pays a lump sum to the
insured upon the diagnoses (and survival) of a critical illness.
The insured must survive the illness for a certain period of time
(30 days)
Blanket Policy: - correct answer- Covers members of a
particular group when they are participating in a particular
activity.
Routine and Preventive Maintenance: - correct answer-
Covered up to an annual maximum without a deductible or
copayment.
Routine and Major restorative care: - correct answer- Includes
treatment of cavities, oral surgeries, bridges, and dentures.
