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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. Surgical expense insurance will pay for cosmetic surgery [ if so desired by the insured  | if deemed medically necessary ].

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. [ Men | Women ] are more likely to need long-term care.

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A preferred provider organization (PPO) has characteristics of both an individual practice association (IPA) and an indemnity plan.

A) True
B) False

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An elimination period is the number of days that must pass after you meet the eligibility requirements before your policy pays the benefits.

A) True
B) False

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An exclusive provider organization (EPO) is a:


A) hybrid form of health maintenance organization (HMO) that reimburses members a specified percentage of the cost.
B) managed care plan that reimburses members only when affiliated providers are used.
C) managed care plan in which subscribers receive services from physicians practicing from their own offices.
D) hybrid form of health maintenance organization (HMO) that allows members to go outside the HMO network for care.
E) prepaid hospital and medical expense plan that allows members to use nonaffiliated providers.

F) A) and B)
G) A) and C)

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Which of the following statements about disability income insurance is true?


A) Most individual disability income policies pay a fixed percentage of gross income.
B) Any disability stemming from an illness or injury that occurs during the probationary period is covered.
C) Typical waiting periods for disability insurance range from 30 days to a year.
D) Policies with a guaranteed renewability provision are generally more expensive initially than noncancelable policies.
E) Typical probationary periods for disability insurance range from 90 days to a year.

F) B) and C)
G) A) and E)

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Living a healthy lifestyle is an example of loss prevention and control.

A) True
B) False

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In addition to financing medical expenses, lost income, and replacement services, a good health insurance plan incorporates:


A) Social Security benefits.
B) flexibility in insurance premium payment on the lapse of the insurance policy.
C) lifetime limited dollar insurance coverage on pre-existing conditions.
D) other means of risk reduction, such as risk avoidance and risk assumption.
E) life insurance.

F) None of the above
G) C) and E)

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Which of the following statements regarding the Patient Protection and Affordable Care Act (ACA) is true?


A) The ACA eliminates lifetime limits on total health care insurance payments by insurers.
B) The ACA limits the total number of surgeries for the insurers.
C) The ACA requires employers to reimburse the cost of hospital stays of the insured.
D) The ACA decides the insurance payments for dependents.
E) The ACA provides major medical insurance with low deductibles to protect against catastrophic illnesses.

F) A) and B)
G) B) and D)

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. All Medicare recipients are eligible for [ Part C | Part D ].

Correct Answer

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Which of the following is a public assistance program that provides health insurance benefits only to those who are unable to pay for health care?


A) Medicare
B) Medicaid
C) Blue Cross/Blue Shield plan
D) Point-of-service (POS) plan
E) Workers' compensation insurance

F) A) and D)
G) A) and E)

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Blue Cross/Blue Shield payments for health care services are made directly to the subscriber rather than to the hospital or physician.

A) True
B) False

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A coordination of benefits provision in a health insurance policy _____ by collecting benefits from more than one policy.


A) prohibits collecting more than 100% of covered charges
B) allows the collection of only 75% of covered charges
C) prohibits collecting more than 80% of covered charges
D) allows the collection of only 50% of covered charges
E) allows the collection of 200% of covered charges

F) A) and E)
G) B) and D)

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Medicare's supplementary medical insurance (SMI) provides health care protection beyond the basic hospital coverage for:


A) all Medicare recipients.
B) all Social Security recipients.
C) all workers' compensation insurance recipients.
D) Medicaid recipients who pay for SMI on a voluntary basis.
E) anyone age 65 or over who pays premiums on a voluntary basis.

F) D) and E)
G) B) and E)

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. Your health insurance will usually pay [ the same | less ] for mental health problems compared to physical problems.

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Ben (age 40) pays a low ($15) co-payment each time he visits a doctor or hospital. Other than the low per-service deductible, there is very little cost sharing. However, Ben has a relatively low deductible, has no exclusions, and does not have to file insurance claims. Which of the following most likely provides Ben's health coverage?


A) Health maintenance organization (HMO)
B) Blue Cross/Blue Shield plan
C) Preferred provider organization (PPO)
D) Medicare
E) Fee-for-service indemnity plan

F) B) and E)
G) C) and E)

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Which of the following statements regarding medical insurance costs in the United States is true?


A) Advances in medical technology have decreased medical insurance costs.
B) Health insurance does not pay for routine medical costs.
C) A poor demand-and-supply distribution of health care facilities and services has increased health care costs.
D) Increased regulation and decreased administrative costs have reduced medical insurance costs in the United States.
E) Due to the financial importance of health insurance, nearly 50% of the U.S. population has health insurance.

F) A) and B)
G) All of the above

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. A [ flexible spending account (FSA) | health savings account (HSA) ] is a tax-free savings account-funded by employees, employers, or both-to spend on routine medical costs.

Correct Answer

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Which of the following statements regarding long-term-care insurance is true?


A) Long-term-care policies do not reimburse the insured for the cost of services incurred on a day-to-day basis.
B) The maximum duration of benefits is only 1 year.
C) There is no waiting period to receive the benefits.
D) Most long-term-care insurance policies are non-renewable in nature.
E) Many policies offer inflation protection riders for an additional premium.

F) A) and C)
G) A) and B)

Correct Answer

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INSTRUCTIONS: Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. Most commonly, the deductible in a health insurance policy is on a [ calendar-year | per-incident ] basis.

Correct Answer

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