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.
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.
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.
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.
These are covered up to a specific maximum, subject to an annual
deductible per insured family member and a coinsurance.
Outline of coverage: - correct answer- Must be delivered at the time of
application or upon delivery of the policy.
Ohio Life and Health Insurance Guaranty Association: - correct 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: - correct 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: - correct 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.
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.
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.
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.
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.
These are covered up to a specific maximum, subject to an annual
deductible per insured family member and a coinsurance.
Outline of coverage: - correct answer- Must be delivered at the time of
application or upon delivery of the policy.
Ohio Life and Health Insurance Guaranty Association: - correct 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: - correct 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: - correct 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.
