insurance license

a commonly used cost containment measure for emergency hospital care under a major medical expense plan is

deductible

in order to obtain group insurance without providing evidence of insurability, what do eligible individuals generally have to do?

enroll within a specified eligibility period

the type of health care provider that provides both the health care services and health care coverage is called

a health maintenance organization HMO

two of the long term care chronically ill activities of daily living (ADLs) are

eating and dressing

all of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT

medical expense

what happens if an insurer violates the medical loss ratio rules and spend too much money on administrative costs

insurers that do not meet the medical loss ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs

in the absence of a coordination of benefits clause, all of the following circumstances might result in recovery of more than 100% of actual health care expenses EXCEPT

a workers medical plan includes a carryover deductible provision

which program is designed to provide medical assistance to people with low incomes ?

medi-cal

all of the following are optional group medical coverages EXCEPT

maternity

as established by PPACA, an adult child may be covered by a parent’s health insurance plan until what age?

26 years old

residual disability income insurance payments are based on

the amount of the insured’s income is reduced by the disability

the insurer can do which of the following under a non-cancelable health insurance policy?

cancel the policy for nonpayment of premium

during the solicitation of a long term care insurance rider, a life agent must consider all of the following EXCEPT the applicant’s

attending physician statement

under a disability income insurance policy with an own occupation clause, an individual who can no longer perform the tasks of the job held at the time of injury is considered

totally disabled

why is an injury caused by an accident at an employee’s workplace excluded from individual health insurance coverage?

it is covered by the state worker’s compensation program

Health insurance, counseling, and advocacy program (HICAP) counselors can do all of the following EXCEPT

charge for their services

all of the following statements are true regarding health insurance, counseling advocacy program (HICAP) counselors EXCEPT HICAP counselors

Are qualified to give legal advice

provisions in a disability in income policy include all of the following EXCEPT

Deductible and coinsurance amounts

when medical expense policies do not state specific dollar benefit amounts, but instead base payment upon the charges for like services in the same geographical area, benefits are designated as

Usual, customary, and reasonable charges

vision care insurance usually covers all of the following EXCEPT

Eye surgery

A Medicare coverage

Part B provides benefit for diagnostic tests and x-rays performed on an outpatient basis

for Social Security purposes, a person with 40 quarters of coverage is considered

Fully insured

what is the purpose of social insurance?

To protect certain vulnerable segments of the population

characteristics of preferred provider organizations (PPOs) include all of the following except

Primary physicians serve as gatekeepers

which program pays the cost of nursing home care for people who cannot afford themselves

Medi-Cal

Which health insurance contract provision, addresses the problem of over insurance

Coordination of benefits

which plan covers the medical expenses that are not covered by Medicare

Medicare supplement

after the deductible is satisfied what percentage of a reasonable charge does Medicare part B pay

80%

The group medical plan, pro provision that applies when a claimant has coverage under more than one plan as known as

Coordination of benefits

The premium of a proposal disability income policy could be lowered by increasing the

Elimination period

The adult care coverage level of long-term care policy provides for

Part-time nursing at a facility for elderly, who live at home

which health plan pays more for care received from a network provider then it pays for care from a non-network provider

Preferred provider organization (PPO)

traditional comprehensive major medical plans include all of the following, except

First dollar coverage

an individual is allowed to enroll in individual health insurance under the following circumstances except

Within 30 days of being diagnosed with an illness

Group health plans, obligated by the consolidated, omnibus budget reconciliation act (cobra) cover groups of at least

20 employees

which statement about Medicare is not correct

Medicare part C covers long-term care

The initial enrollment period for Medicare part B and how many months after the 65th birthday month

Three months

under PPACA, which medical enrollment here is 80% actuarial value

Gold

which of the following is not an example of costs sharing in a health insurance policy?

Coordination

in health insurance, the coinsurance is

A percentage paid for covered expenses by the insured, and ensure after the deductible is satisfied

in medical expense insurance, what serves the same purpose as the elimination period and disability income insurance

Deductible

The family and medical leave act FMLA covers all of the following except

Traveling with a spouse who has been transferred oversee

A supplemental insurance policy that pays a set amount for each day that an individual is hospitalized is known as

Hospital confinement indemnity

after the deductible, what portion does a patient pay for covered expenses under Medicare part B?

20%

Providers of coverage for all of the following types of care are subject to the jurisdiction of the California Department of insurance CDI except

Lasik

an example of a third-party administrator is an

Outside organization, that processes claims for an employees self funded group plan

according to the California insurance code, all of the following long-term care, insurance sales are considered unnecessary except

A replacement LTC policy with equal benefits for a lower premium

medicare part a provides coverage for all of the following except

Physicians services

regarding the health benefit exchanges as created by PPACA, all of the following statements are true except

An individual enrolling in a bronze level plan is not eligible for reduced cost sharing

which group provides information about health related issues to the elderly in California

The health insurance counseling and advocacy program HICAP

which of the following statement concerning the usual coordination of benefits provision is correct

When two plans both have the provision coverage as an employee is primary to coverage as a dependent

what is the cost of service from the health insurance counseling advocacy program HICAP

No charge

which health insurance provision, protect, protects an insured from the expense of a catastrophic illness

stop loss

What rights do individuals have if they disagree with the decision on the amount, Medicare will pay

They can ask a Medicare career to review the decision

All of the following may opt for a self-insured medical and disability plan except

Individuals

benefits under Social Security are available only for workers who are

Fully insured

The most common type of specified disease insurance policy is

Cancer

what is the first step in submitting Medicare claims?

The medical provider submits expenses to Medicare

A long-term care insurance writer can include coverage for all of the following, except

Hospital acute care

under group disability insurance and employee is eligible for a partial display benefit when they can

Perform some of their job activities on a part-time basis injury

A health insurance issuer offering coverage in the individual market must provide premium rebates. If it’s medical loss ratio MLR is less than what percentage.

80%

The employee retirement income security act of 1974 ERISA regulate group insurance in the area of

Disclosure and reporting

vision insurance usually limits coverage in all of the following ways except

A specific dollar amount for examination

part-time nursing that follows a hospitalization and can be provided in a patient’s home is covered under

Home healthcare benefit

which type of insurance can be purchased at airports bus terminals, and railroad stations

Travel accident insurance

in California, a child may obtain individual health coverage through all of the following except

Healthy family

The additional premium charged by an insurer for adding the accidental death benefit to a whole life policy

Does not affect the policies cash value