1
Health Insurance Ohio Exam: |2025
ACTUAL EXAM QUESTIONS AND
VERIFIED ANSWERS /GET IT 100%
ACCURATE|ALREADY GRADED A+
Two major perils under a health insurance policy: - (ANSWER)Policies may cover
both accident and sickness or accident only.
Accidental bodily injury: - (ANSWER)An unforeseen and unintended injury that
resulted from an accident rather than a sickness.
Sickness: - (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: - (ANSWER)Loss of income caused by accident or
sickness causing an insured the inability to work and earn in come.
Limited Vs Comprehensive: - (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
A successful self funded plan will have the following characteristics: (5) -
(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): - (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: - (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): - (ANSWER)Made up of two or more employers
in similar or related businesses who do not qualify for group insurance on their
own.
Multiple Employer Welfare Associations (MEWAs): - (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.
,3
They pool their risks in order to self-insure
Accident only policies: - (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: - (ANSWER)This amount is usually equal to the amount of
coverage under the insurance contract, or the face amount.
Capital Sum: - (ANSWER)In case of loss of sight or accidental dismemberment, a
percentage of that principal sum will be paid by the policy.
Dread Disease (limited risk) policy: - (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: - (ANSWER)Provides a specific amount on a daily, weekly or
monthly basis while the insured is confined to a hospital.
Critical illness policy: - (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: - (ANSWER)Covers members of a particular group when they are
participating in a particular activity.
, 4
Routine and Preventive Maintenance: - (ANSWER)Covered up to an annual
maximum without a deductible or copayment.
Routine and Major restorative care: - (ANSWER)Includes treatment of cavities,
oral surgeries, bridges, and dentures. These are covered up to a specific
maximum, subject to an annual deductible per insured family member and a
coinsurance.
Outline of coverage: - (ANSWER)Must be delivered at the time of application or
upon delivery of the policy.
Ohio Life and Health Insurance Guaranty Association: - (ANSWER)Must create a
disclosure document describing their general purposes and current limitations. All
policies must include a copy of this document at or prior to the time of delivery.
Notice to the applicant: - (ANSWER)Must be issued to all participants for health
insurance coverage. This notice informs the applicant that a credit report will be
ordered concerning his or her past history and any other health insurance for
which they have previously applied.
Sales interview and the policy delivery: - (ANSWER)The most common occasions
for errors and omissions situations to occur that may result in providing
inadequate coverage or failure to maintain and service coverage.
Health Insurance Ohio Exam: |2025
ACTUAL EXAM QUESTIONS AND
VERIFIED ANSWERS /GET IT 100%
ACCURATE|ALREADY GRADED A+
Two major perils under a health insurance policy: - (ANSWER)Policies may cover
both accident and sickness or accident only.
Accidental bodily injury: - (ANSWER)An unforeseen and unintended injury that
resulted from an accident rather than a sickness.
Sickness: - (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: - (ANSWER)Loss of income caused by accident or
sickness causing an insured the inability to work and earn in come.
Limited Vs Comprehensive: - (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
A successful self funded plan will have the following characteristics: (5) -
(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): - (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: - (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): - (ANSWER)Made up of two or more employers
in similar or related businesses who do not qualify for group insurance on their
own.
Multiple Employer Welfare Associations (MEWAs): - (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.
,3
They pool their risks in order to self-insure
Accident only policies: - (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: - (ANSWER)This amount is usually equal to the amount of
coverage under the insurance contract, or the face amount.
Capital Sum: - (ANSWER)In case of loss of sight or accidental dismemberment, a
percentage of that principal sum will be paid by the policy.
Dread Disease (limited risk) policy: - (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: - (ANSWER)Provides a specific amount on a daily, weekly or
monthly basis while the insured is confined to a hospital.
Critical illness policy: - (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: - (ANSWER)Covers members of a particular group when they are
participating in a particular activity.
, 4
Routine and Preventive Maintenance: - (ANSWER)Covered up to an annual
maximum without a deductible or copayment.
Routine and Major restorative care: - (ANSWER)Includes treatment of cavities,
oral surgeries, bridges, and dentures. These are covered up to a specific
maximum, subject to an annual deductible per insured family member and a
coinsurance.
Outline of coverage: - (ANSWER)Must be delivered at the time of application or
upon delivery of the policy.
Ohio Life and Health Insurance Guaranty Association: - (ANSWER)Must create a
disclosure document describing their general purposes and current limitations. All
policies must include a copy of this document at or prior to the time of delivery.
Notice to the applicant: - (ANSWER)Must be issued to all participants for health
insurance coverage. This notice informs the applicant that a credit report will be
ordered concerning his or her past history and any other health insurance for
which they have previously applied.
Sales interview and the policy delivery: - (ANSWER)The most common occasions
for errors and omissions situations to occur that may result in providing
inadequate coverage or failure to maintain and service coverage.
