Part 5

Which of the following is NOT an example of cost sharing in a health insurance policy? : Coordination

The insurer can do which of the following under a noncancelable health insurance policy? : Cancel the policy for nonpayment of premium

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 worker's medical plan includes a carryover deductible provision.

What rights do individuals have if they disagree on the amount Medicare will pay? : They can ask a Medicare carrier to review the decision

An individual is allowed to enroll in individual health insurance under the following circumstances EXCEPT : within 30 days of being diagnosed with an illness

Medicare Part A provides coverage for all of the following EXCEPT : physician's services

After deductible, what portion does a patient pay for covered expenses under Medicare Part B? : 80%

The premium of a proposed disability income policy could be lowered by increasing the : elimination period 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 Which plan covers the medical expenses that are NOT covered by Medicare? : Medicare supplement The type of health care provider that provides both the health care services and health care coverage is called : Health Maintenance Organization In medical expense insurance, what serves the same purpose as the elimination period in disability income insurance? : Deductible An example of a third-party administer is an : outside organization that processes claims for an employer's self-sunded group plan The Family and Medical Leave Act(FMLA) covers all of the following EXCEPT : traveling with a spouse who has been transferred overseas What is the purpose of social insurance? : To protect certain vulnerable segments of the population Which program pays the cost of nursing home care for people who cannot afford it themselves? : Medi-Cal Benefits under Social Security are available only for workers who are : fully insured Group health plans obligated by the Consolidated Omnibus Budget Reconciliation Act (COBRA) cover groups of at least : 20 employees With Medicare coverage : Part B provides benefits for diagnostic tests and X-rays performed on an outpatient basis A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ratio (MLR) is less than what percentage? : 80% According to the California Insurance Code, all of the following Long-Term Care(LTC) insurance sales are considered unnecessary EXCEPT : a replacement LTC policy with equal benefits for a lower premium 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 The most common type of specified disease insurance policy is : cancer After the deductible is satisfied, what percentage of a reasonable charges does Medicare Part B pay? : 80% Which of the following statements 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 Which health insurance provision protects an insured from the expense of a catastrophic illness? : Stop-loss Which health insurance contract provision addresses the problem of over insurance? : Coordination benefits Relevant factors in the health insurance principle of morbidity include all of the following EXCEPT : intelligence To reach currently insured status under the Social Security system, an individual must be credited with a MINIMUM of : 6 quarters of coverage during the last 13-quarter period In health insurance, the result of rising morbidity rates is : increased premiums Which health plan might apply 90% coinsurance to network providers and 70% coinsurance to non-network providers? : Preferred Provider Organization(PPO) The Family and Medical Leave Act(FMLA) covers all of the following EXCEPT : traveling with a spouse who has been transferred overseas A surviving spouse without dependent children is eligible for Social Security survivor benefits at age : 60 What happens if an insurer violates the Medical Loss Ratio rate and spends too much money on administrative costs? : Insurers that do not meet the Medical Less Ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs When an agent writes a replacing long-term care policy, the agent's first year sales commission will be determined based on the : difference between the new and original policy annual premiums 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 All of the following conditions must be met to qualify for residual disability benefits under a disability income policy EXCEPT : qualifies for Social Security disability benefits All of the following features of a Preferred Provider Organization (PPO) EXCEPT : primary care physicians act as gatekeepers In the Worker's Compensation policy, Part One, Workers' Compensation, pays for : sums the insured is required to pay under state Workers' Compensation law Under Social Security, the definition of disability is the inability to engage in : any substantial gainful activity At what age are individuals eligible for Medicare Part A benefits? : 65 The Employee Retirement Income Security Act of 1974 (ERISA) regulates group health insurance in the area of : disclosure and reporting Which plan covers the medical expenses that are NOT covered by Medicare? : Medicare supplement Which of the following conditions would NOT be included among the chronic illness triggers of a long-term care policy? : Deafness Insures are prohibited from denying claims based on misrepresentations in a disability policy application after the policy has been in force for : 2 years Which funded government program is jointly administered by the federal and state governments? : Medi-Cal What rights do individuals have if they disagree with a decision on the amount Medicare will pay? : They can ask the Medicare carrier to review the decision Which long-term care policy provision allows for a periodic increase in policy benefits? : Inflation protection All of the following statements about Medicare Part B are correct EXCEPT it : pays for virtually all drugs prescribed by a physician