Question 1

Very few group health policy contracts have a coordination of benefits provision.

Accepted Answer

A) True 
 B)False

Question 2

What should you do when an HMO denies treatment or coverage?

Accepted Answer

A)  Ask for a letter detailing the clinical reasons for the denial.
B)  Refer to the plan document or contact your HMO's member services department to gather information on the appeals process.
C)  Make copies of any correspondence,including payments,and any reimbursements.
D)  Enlist the help of your doctor,employer,and state insurance department to lobby your case before the HMO.
E)  You should do everything included in the other answers.F) A) and B)
G) A) and C)

Question 3

The number of Americans without basic health insurance has been decreasing since the 1980s.

Accepted Answer

A) True 
 B)False

Question 4

Julie Cumbie is playing softball and gets hurt sliding into second base.She gets an x-ray at her doctor's office to make sure her ankle isn't broken.Which part of her basic insurance coverage should help pay for this x-ray?

Accepted Answer

A)  hospital expense
B)  surgical expense
C)  physician expense
D)  major medical
E)  Medicare Part BF) A) and B)
G) A) and D)

Question 5

Joe Johnson needs surgery for appendicitis.Which part of his basic insurance coverage should help pay for this surgery?

Accepted Answer

A)  hospital expense
B)  surgical expense
C)  physician expense
D)  major medical
E)  Medicare Part BF) All of the above
G) B) and C)

Question 6

A good health insurance plan should offer basic coverage for hospital and doctor bills.

Accepted Answer

A) True 
 B)False

Question 7

Title XIX of the Social Security Act provides for a program of medical assistance to certain low-income individuals and families.

Accepted Answer

A) True 
 B)False

Question 8

In 2009,the largest percentage of U.S.health care dollars was spent on:

Accepted Answer

A)  hospital care.
B)  dental care.
C)  physician/clinical services.
D)  prescription drugs.
E)  nursing carE.F) A) and B)
G) All of the above

Question 9

Each year,Sophie Bennett must pay $500 for doctor's visits before her insurance company will make any payments for doctor's visits.What is this requirement called?

Accepted Answer

A)  coordination of benefits
B)  deductible
C)  coinsurance
D)  stop-loss provision
E)  waiver of premiumF) C) and D)
G) B) and D)

Question 10

Health insurance includes both medical expense insurance and disability income insurance.

Accepted Answer

A) True 
 B)False

Question 11

People often buy surgical expense insurance in combination with hospital expense insurance.

Accepted Answer

A) True 
 B)False

Question 12

Generally,disability income policies with shorter waiting periods have lower premiums.

Accepted Answer

A) True 
 B)False

Question 13

Medicaid is financed by both state and federal funds.

Accepted Answer

A) True 
 B)False

Question 14

Medicare does not cover the expenses of private-duty nursing care.

Accepted Answer

A) True 
 B)False

Question 15

Marcia Fuller has an insurance policy that lists that she and her three daughters,ages 6,10,and 12,are covered under this policy.Which provision in her insurance policy is defined by this list?

Accepted Answer

A)  eligibility
B)  assigned benefits
C)  benefit limits
D)  guaranteed renewable
E)  exclusions and limitationsF) A) and E)
G) A) and C)

Question 16

Which one of the following provisions requires that the policyholder pay a basic amount before the policy benefits begin?

Accepted Answer

A)  coinsurance
B)  stop loss
C)  deductible
D)  self insurance
E)  incontestableF) B) and E)
G) B) and C)

Question 17

Which of the following is not a key provision of the Patient Protection and Affordable Care Act of 2010?

Accepted Answer

A)  Offers tax credits for small businesses to make employee coverage more affordable
B)  Eliminates co-payments for preventive services
C)  Encourages insurance companies to drop people from coverage when they get sick
D)  Restricts the annual limits to ensure access to needed care in all plans
E)  Increases funds for Community Health CentersF) A) and D)
G) A) and E)

Question 18

Which type of health insurance pays part or all of an insured's hospital bills for room,board,and other charges?

Accepted Answer

A)  surgical expense
B)  hospital expense
C)  physician's expense
D)  Medicare Part B
E)  major medicalF) C) and D)
G) A) and E)

Question 19

____________ is a type of major medical insurance that has a very low deductible amount and is offered without any separate basic plan.

Accepted Answer

A)  Comprehensive major medical insurance
B)  Major Medical expense insurance
C)  Physician's expense insurance
D)  Hospital expense insurance
E)  Surgical expense insuranceF) A) and B)
G) C) and E)

Question 20

Nathanial Drummond has three different insurance policies.He has been injured in an accident and has incurred $30,000 in medical bills.There is a clause in all of his insurance contracts that ensures he receives no more than a total of $30,000 in payments from his insurance companies.What is this clause called?

Accepted Answer

A)  coordination of benefits
B)  deductible
C)  coinsurance
D)  stop-loss provision
E)  waiver of premiumF) A) and B)
G) A) and E)

Exam 11: Health, Disability, and Long-Term Care Insurance

Marcia Fuller has an insurance policy that lists that she and her three daughters,ages 6,10,and 12,are covered under this policy.Which provision in her insurance policy is defined by this list?

Correct Answer
verified

What should you do when an HMO denies treatment or coverage?

Correct Answer
verified

A good health insurance plan should offer basic coverage for hospital and doctor bills.

Correct Answer
verified

Joe Johnson needs surgery for appendicitis.Which part of his basic insurance coverage should help pay for this surgery?

Correct Answer
verified

Generally,disability income policies with shorter waiting periods have lower premiums.

Correct Answer
verified

The number of Americans without basic health insurance has been decreasing since the 1980s.

Correct Answer
verified

Each year,Sophie Bennett must pay $500 for doctor's visits before her insurance company will make any payments for doctor's visits.What is this requirement called?

Correct Answer
verified

Which of the following is not a key provision of the Patient Protection and Affordable Care Act of 2010?

Correct Answer
verified

Which type of health insurance pays part or all of an insured's hospital bills for room,board,and other charges?

Correct Answer
verified

Correct Answer
verified

Medicaid is financed by both state and federal funds.

Correct Answer
verified

____________ is a type of major medical insurance that has a very low deductible amount and is offered without any separate basic plan.

Correct Answer
verified

Which one of the following provisions requires that the policyholder pay a basic amount before the policy benefits begin?

Correct Answer
verified

Julie Cumbie is playing softball and gets hurt sliding into second base.She gets an x-ray at her doctor's office to make sure her ankle isn't broken.Which part of her basic insurance coverage should help pay for this x-ray?

Correct Answer
verified

Health insurance includes both medical expense insurance and disability income insurance.

Correct Answer
verified

Title XIX of the Social Security Act provides for a program of medical assistance to certain low-income individuals and families.

Correct Answer
verified

Very few group health policy contracts have a coordination of benefits provision.

Correct Answer
verified

Medicare does not cover the expenses of private-duty nursing care.

Correct Answer
verified

In 2009,the largest percentage of U.S.health care dollars was spent on:

Correct Answer
verified

People often buy surgical expense insurance in combination with hospital expense insurance.

Correct Answer
verified

Exam 11: Health, Disability, and Long-Term Care Insurance

Marcia Fuller has an insurance policy that lists that she and her three daughters,ages 6,10,and 12,are covered under this policy.Which provision in her insurance policy is defined by this list?

Correct AnswerverifiedShow Answer

What should you do when an HMO denies treatment or coverage?

Correct AnswerverifiedShow Answer

A good health insurance plan should offer basic coverage for hospital and doctor bills.

Correct AnswerverifiedShow Answer

Joe Johnson needs surgery for appendicitis.Which part of his basic insurance coverage should help pay for this surgery?

Correct AnswerverifiedShow Answer

Generally,disability income policies with shorter waiting periods have lower premiums.

Correct AnswerverifiedShow Answer

The number of Americans without basic health insurance has been decreasing since the 1980s.

Correct AnswerverifiedShow Answer

Each year,Sophie Bennett must pay $500 for doctor's visits before her insurance company will make any payments for doctor's visits.What is this requirement called?

Correct AnswerverifiedShow Answer

Which of the following is not a key provision of the Patient Protection and Affordable Care Act of 2010?

Correct AnswerverifiedShow Answer

Which type of health insurance pays part or all of an insured's hospital bills for room,board,and other charges?

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Medicaid is financed by both state and federal funds.

Correct AnswerverifiedShow Answer

____________ is a type of major medical insurance that has a very low deductible amount and is offered without any separate basic plan.

Correct AnswerverifiedShow Answer

Which one of the following provisions requires that the policyholder pay a basic amount before the policy benefits begin?

Correct AnswerverifiedShow Answer

Julie Cumbie is playing softball and gets hurt sliding into second base.She gets an x-ray at her doctor's office to make sure her ankle isn't broken.Which part of her basic insurance coverage should help pay for this x-ray?

Correct AnswerverifiedShow Answer

Health insurance includes both medical expense insurance and disability income insurance.

Correct AnswerverifiedShow Answer

Title XIX of the Social Security Act provides for a program of medical assistance to certain low-income individuals and families.

Correct AnswerverifiedShow Answer

Very few group health policy contracts have a coordination of benefits provision.

Correct AnswerverifiedShow Answer

Medicare does not cover the expenses of private-duty nursing care.

Correct AnswerverifiedShow Answer

In 2009,the largest percentage of U.S.health care dollars was spent on:

Correct AnswerverifiedShow Answer

People often buy surgical expense insurance in combination with hospital expense insurance.

Correct AnswerverifiedShow Answer

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