Deck 9: Insuring Your Health

Question 1

A deductible clause in major medical insurance plans is most often on a per year basis.

Answer 1

True

Question 2

Advances in medical technology,prescriptions drugs and treatments have substantially reduced the costs health care in recent decades.

Answer 2

False

Question 3

Hospital insurance policies will pay for all hospital expenditures most of the time.

Answer 3

False

Question 4

You would have a better chance to choose your own doctor with a PPO rather than an HMO.

Question 5

Your bill for consultation with a specialist would ordinarily be paid by physician's expense insurance.

Question 6

If you lose your job,COBRA permits you to continue your group health insurance coverage permanently as long as you pay the premium within 36 months of the termination of employment.

Question 7

Blue Cross provides hospital coverage and Blue Shield provides prescription pharmacy coverage.

Question 8

Millions of Americans are not covered by health insurance.

Question 9

Some surgical expense insurance pays a specific amount for a list of various types of surgery.

Question 10

Health Maintenance Organizations (HMOs)provide pre-paid health care to participants.

Question 11

Supplementary Medical Insurance is a voluntary participatory program,commonly known as Medicare Part B.

Question 12

A comprehensive health insurance usually covers the cost of anesthetics and their administration.

Question 13

Group health insurance premiums are usually lower than individual health insurance premiums.

Question 14

Large employers are less likely to offer health insurance to their employees than small employers.

Question 15

Hospital insurance will pay daily room and board charges up to a specified number of days and reimbursement for ancillary charges up to a specified dollar amount.

Question 16

Medicare and Medicaid are hospital and physicians coverage,respectively.

Question 17

Major medical often supplements the basic coverage of hospital,surgical,and physician's expense insurance.

Question 18

A preferred provider organization has characteristics of both managed care and an indemnity plan.

Question 19

Typically group health insurance plans provide substantially less comprehensive coverage than the average individually underwritten policy.

Question 20

When you are hospitalized for surgical care,surgical expense coverage will pay the hospital bill.

Question 21

Comprehensive major medical simply increases the policy limits of major medical insurance without changing the coverage.

Question 22

Most disabilities are permanent.

Question 23

Long-term care insurance can cover both nursing home and home health care.

Question 24

Terms of payment and terms of coverage are two sets of provisions that should be carefully scrutinized when evaluating an insurance program.

Question 25

Mental illness is normally not covered in health insurance policies.

Question 26

Workers compensation may trigger coverage in a disability income policy.

Question 27

Increasing the stop loss provision is likely to lower the premium on a comprehensive major medical policy.

Question 28

Disability occurs only when someone is completely incapable of returning to work.

Question 29

Your health insurance has an 80% co-insurance clause.Once the deductible is satisfied,your insurance company will pay 80% of your covered losses up to the stated limits.

Question 30

Internal limits are constraints placed on insurance agents stipulating the level of risk for which they can write a policy.

Question 31

Long-term care insurance provides protection against the cost of extended hospital stays.

Question 32

Major medical plans will usually cover the cost of nursing home care.

Question 33

The major emphasis of dental insurance is to cover only extractions and x-rays.

Question 34

An elimination period is a term that applies to disability insurance and does not have any meaning in long-term care insurance.

Question 35

In insurance terminology,"participation" and "coinsurance" mean the same thing.

Question 36

Increasing the deductible is likely to lower the premium on a comprehensive major medical policy.

Question 37

Health insurance policies automatically cover all family members.

Question 38

Hospital expense coverage is adequate for long-term or catastrophic medical needs of most people.

Question 39

An elimination period is the number of days that must pass before disability policies pay proceeds.

Question 40

Most group insurance policies require a second opinion for non-surgical procedures.

Question 41

The medicare coinsurance payment is usually 20%.

Question 42

The fastest growing segment of the health care industry is

A) fee for service plans.
B) Medicaid.
C) managed care plans.
D) All of these are growing at the same rate.
E) none of these.

Question 43

Which of the following types of plans pay for some medical costs even when the insured decides to go out of the provider network (without a referral)for services?

A) HMO
B) IPA
C) PPO
D) POS
E) c and d

Question 44

Disability income benefits under social security are automatically adjusted periodically for cost of living increases.

Question 45

Generally,insurance is more reasonably priced through group plans than as individual policies.

Question 46

Disability income benefits under social security will be paid as long as you cannot perform the duties of the job you were holding when the disability began.

Question 47

Blue Cross / Blue Shield plans are really hybrid HMOs that allow members to go outside of network.

Question 48

A group HMO employs a group of doctors to provide healthcare services to members in a central facility.

Question 49

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

Question 50

Payments under workers compensation are more readily available than are social security disability benefits.

Question 51

All Americans are required to have or buy health insurance beginning in 2014 or pay a penalty.

Question 52

Medicare Advantage policies require payment from the policyholder in the form of a deductible.

Question 53

A managed care plan is a healthcare plan that emphasizes cost control and preventative treatment.

Question 54

The definition of "disability" is standardized in disability income policies.

Question 55

If you are trying to keep your disability income premiums reasonably priced but still appropriate for insuring your financial needs,select a short elimination period and a short duration of benefits.

Question 56

Jackie pays $20 every time she visits her doctor.She is covered by a(n)

A) HMO
B) IPA
C) PPO
D) Indemnity plan
E) Could be any of these except the indemnity plan.

Question 57

Insurers are required under the law to cover the children of those they insure up to the age of 21.

Question 58

Insurers are required to cover people with pre-existing medical conditions without limiting or setting unrealistically high insurance rates.

Question 59

Eating healthy and exercising is an acceptable substitute for comprehensive health care coverage.

Question 60

HMOs require members to pick one primary care physician.

Question 61

Which of the following statements is true about the means (income)testing for Medicare?

A) there are strictly enforced income limits that are based on federal standards but may vary slightly by state.
B) limits apply to the amount of counted assets individuals can have, but they are routinely overlooked.
C) means testing is intended to ensure that only the truly needy get access to Medicare.
D) there is an asset test and an income test.
E) Medicare is not income tested.

Question 62

Major medical plans are characterized by deductibles,internal limits,and

A) benefit levels.
B) participation or coinsurance.
C) illness or injury frequency limits.
D) maximum surgical medical benefits.
E) sliding or decreasing premiums.

Question 63

Surgical expenses now generally are reimbursed on the basis of

A) actual surgical expense.
B) listed benefit schedules.
C) specific percentage of actual surgical expense.
D) average national cost of the surgery.
E) usual, reasonable and customary expenses.

Question 64

Gabe is 58 years old and has been dependent on a cane for a couple of years.Gabe fears that he may need long term care services some day in the future.His net worth is $400,000 and he receives $50,000 per year in a pension.He considers himself to be in excellent health and has never had a serious health scare like a heart attack,stroke,or cancer.He eats lots of bran and exercises regularly.Which of the following policies would you recommend to Gabe?

A) Gabe needs a disability income policy.
B) Gabe should buy a long term care policy with a long elimination period, lifetime benefits, and a COLA.
C) Gabe should buy a long term care policy with a five-year limit, short elimination period without a COLA.
D) Gabe doesn't need disability insurance and probably can't qualify for long term care insurance.
E) Gabe can qualify for Medicaid if and when he needs long term care services.

Question 65

If your employment is terminated,COBRA provides for

A) cancellation of all group insurance benefits.
B) continuation of group insurance benefits until you are reemployed.
C) permanent continuation of group health insurance.
D) temporary continuation of group insurance benefits; you pay premiums.
E) temporary continuation of group insurance benefits; employer pays premiums.

Question 66

The "O" in COBRA stands for which of the following words?

A) optical
B) opportunity
C) ordinary
D) omnibus
E) occupational

Question 67

A comprehensive major medical insurance would not

A) have a large deductible.
B) include basic hospital coverage.
C) provide surgical expense coverage.
D) include medical expense coverage.
E) include a per diem while in the hospital .

Question 68

Medicare is a government-sponsored health care plan composed of Part A and Part B.Part B covers

A) hospital expenses.
B) doctor's bills.
C) custodial nursing home expenses.
D) prescription drugs.
E) all of the above.

Question 69

The majority of employers pay

A) the entire health care insurance premium for workers.
B) the entire health care insurance premium for dependents.
C) the entire health care premium for workers and dependents.
D) part of the premium for workers and dependents.
E) none of the premium for workers and dependents.

Question 70

Most employees select ____ for their health insurance needs.

A) indemnity plans
B) preferred provider organizations
C) health maintenance organizations
D) individual practice associations
E) point of service plans

Question 71

Social security provides health care coverage to persons age ____ and those who are ____.

A) 55 and over; collecting disability under Social Security
B) 60 and over; collecting disability under Social Security
C) 65 and over; collecting disability under Social Security
D) 60 and over; low income
E) 60 and over; low income

Question 72

Hospital indemnity policies would make payment for

A) surgery.
B) care at the doctor's office.
C) private duty nursing care.
D) prescriptions when not in hospital.
E) per day hospital charges.

Question 73

Supplementary Medical Insurance (SMI)provides health care protection beyond basic hospital coverage for

A) all Medicare recipients.
B) all social security recipients.
C) Medicare recipients who pay for SMI on a compulsory basis.
D) Medicaid recipients.
E) Medicare recipients who pay for SMI on a voluntary basis.

Question 74

Medicare is a government-sponsored health care plan composed of Part A and Part B.Part A covers

A) hospital expenses.
B) doctor's bills.
C) custodial nursing home expenses.
D) prescription drugs.
E) all of the above.

Question 75

Ben's health coverage charges a low ($15)deductible each time he visits the doctor or hospital.Other than the low per-service deductible,there is very little cost sharing.However,Ben must go to the health care providers listed by the provider of the health coverage.If he goes to a provider that is not on the list,there is very little coverage.Which of the following types of entity most likely provides Abe's health coverage?

A) HMO
B) Blue Cross/Blue Shield association
C) commercial insurer (major medical)
D) PPO
E) fee-for-service indemnity plan

Question 76

Nick has a comprehensive health care policy with a $250 per calendar year deductible and 80%-20% with a maximum $1,000 copayment cap per calendar year.In January,Nick had a $600 claim which the insurance company paid $280.Nick experiences another unrelated claim in October resulting in total bills of $5,000.How much will Nick have to pay for the second claim?

A) $5,000
B) $3,930.
C) $1,800
D) $ 930.
E) none of the above.

Question 77

Suppose a person has a health insurance policy with a $500 calendar year deductible,a $2,000 out-of-pocket cap,and an 80% coinsurance provision.If this person suffers a $600 covered loss,how much will the insurance company pay? (Assume no previous losses have occurred.)

A) $ 80
B) $100
C) $480
D) $600
E) some other amount

Question 78

Workers' compensation is a state program that provides benefits for

A) unemployed workers.
B) workers suffering injury or illness on the job.
C) any injury suffered by a worker at any time.
D) injuries resulting from employer's negligence.
E) only b and d.

Question 79

An Individual Practice Association differs from a HMO in that

A) you have no choice of the physician.
B) they are located in a central facility.
C) associated doctors operate from their own offices.
D) they are less likely to be found in small communities.
E) none of these.

Question 80

Health insurance coverage can include

A) group plans.
B) workers' compensation.
C) social security.
D) veteran's benefits.
E) all of the above.