Life & Health Chapter 14 | Health Chapter 5 Exam: Health Insurance Providers

Which of the following reimburses its insureds for covered medical expenses?

  1. Commercial insurers

  2. Service providers

  3. Preferred provider organizations

  4. Health maintenance organizations

Which statement is TRUE regarding a group accident & health policy issued to an employer?

  1. Neither the employer or employee are policyowners

  2. Both the employer and employee are policyowners

  3. The employer is issued a certificate of coverage and each employee receives a policy

  4. The employer receives the policy and each employee is issued a certificate

Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?

  1. Typically not subject to deductibles

  2. More physicians to choose from

  3. More benefits available

  4. Not regulated by the federal government

Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?

  1. Sign a liability waiver from the insurer prior to receiving medical care

  2. Take a physical examination prior to leaving the primary area

  3. Obtain prior approval from the NAIC for the medical service

  4. Obtain prior approval from the insurer for the medical service

When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans?

  1. Participating

  2. Contributory

  3. Noncontributory

  4. Joint

The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the:

  1. Postponement Period

  2. Elimination Period

  3. Grace Period

  4. Waiting Period

P is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period?

  1. Sign an enrollment card

  2. Register with her state of residency

  3. Authorize for payroll deductions

  4. Agree to a physical examination

How does group insurance differ from individual insurance?

  1. Premiums are lower

  2. Premiums are higher

  3. Evidence of insurability is required

  4. Pre-existing conditions not covered

A characteristic of Preferred Provider Organizations (PPOs) would be:

  1. Not allowed to see out-of-network physicians

  2. Discounted fees for the patient

  3. A primary care physician is required

  4. Physicians are paid on a capitation basis

A departing employee has decided to continue his group coverage through COBRA. Who pays the premium in this situation?

  1. Previous employer

  2. Employee

  3. New employer

  4. Workers' Compensation