Deck 17: Loss of Health

Question 1

The coverage offered by Blue Cross and Blue Shield associations and commercial insurers is similar from the perspective of those insured by these groups.

Answer 1

True

Question 2

A basic strength of HMOs is their ability to provide comprehensive health care services nationwide.

Answer 2

False

Question 3

Group practice HMOs and staff model HMOs tend to operate from only one or two main locations.

Answer 3

True

Question 4

Some PPOs offer a broad range of medical services, while others offer a narrowly focused set of services.

Question 5

The most common form of medical plan deductible is established on a per-occurrence basis.

Question 6

Long-term care insurance is rapidly decreasing in popularity.

Question 7

Due to standardization of disability insurance policies, the definition of disability rarely varies.

Question 8

An elimination period is a form of cost sharing that specifies an initial period of disability during which no benefits will accrue.

Question 9

Several contractual provisions are required by law to be included in individual health insurance policies.

Question 10

A staff model HMO does not typically have one or two main locations. Instead, the services are generally provided in physicians' own offices.

Question 11

The effect of the misstatement-of-age clause is very different in an individual health insurance contract than in an individual life insurance contract.

Question 12

PPOs cover over seventy-five percent of the U.S. population.

Question 13

HMOs generally charge a set fee each month.

Question 14

A reinstatement clause will allow a policy that has lapsed to be reinstated as long as premium payments are received by the insurer before the end of the grace period.

Question 15

Generally, health benefits are paid to the insured, although they are sometimes paid directly to the medical providers if the insured requests it and the insurer agrees.

Question 16

Match the descriptions with their terms:

-_________________ force health care networks to include all health care providers who agree to the networks' terms and fee structures.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 17

Match the descriptions with their terms:

-_________________ are programs in which the members, who live within a well-defined geographical area, are provided with comprehensive health services by physicians associated with the organization.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 18

Match the descriptions with their terms:

-In _________________, health care providers agree to give a discount in fees in exchange for promises from participating employers.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 19

Match the descriptions with their terms:

-A/An _________________ does not operate out of centralized locations; instead, the physicians operate out of their own offices.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 20

Match the descriptions with their terms:

-A/An _________________ operates out of one or a few locations, with employee doctors who are paid a salary by the HMO.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 21

Match the descriptions with their terms:

-Insurers determine _________________ fees by analyzing the range of fees prevailing in the relevant geographical area at the time that the surgery is performed.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 22

Match the descriptions with their terms:

-_________________ provides periodic income payments to the insured while the insured is unable to work as a result of sickness or injury.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 23

Match the descriptions with their terms:

-The _________________ definition is the most liberal definition of disability.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 24

Match the descriptions with their terms:

-Surgical policies written on a/an _________________ cover insured procedures up to the full amount of what is considered to be reasonable and customary.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 25

Match the descriptions with their terms:

-A/An _________________ limits the amount that the insured has to pay for both coinsurance and deductibles.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 26

Match the descriptions with their terms:

-A/An _________________ contract provides that termination of coverage is prohibited prior to a specified age as long as the premiums are paid when due.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 27

Match the descriptions with their terms:

-_________________ policies usually have higher limits and fewer exclusions than do hospital, surgical, and regular medical expense contracts.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 28

Match the descriptions with their terms:

-_________________ describe the contractual rights regarding the renewal of a health insurance policy.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 29

Match the descriptions with their terms:

-The _________________ definition of disability will result in a finding that the insured is disabled only if he or she is unable to perform the major duties of any occupation for which he or she is reasonably suited through education, training, or experience.

A) any occupation for which reasonably suited
B) Any willing provider laws
C) Continuation provisions
D) Disability income insurance
E) guaranteed renewable
F) Health maintenance organizations
G) individual practice HMO
H) Major medical insurance
I) nonscheduled basis
J) out-of-pocket cap
K) own occupation
L) preferred provider organizations
M) reasonable and customary
N) staff model HMO

Question 30

Which of the following statements is not true relating to preferred provider organizations?

A) Most PPOs involve a fee reduction of health care services in return for certain concessions by the sponsoring organization,
B) An insurer may sponsor a PPO,
C) Employers sometimes agree to supply the PPO with a minimum number of patients each month,
D) Physicians are generally obligated by law to participate in a PPO if solicited by an insured participant.

Question 31

Which of the following is not a form of cost sharing in relation to health or disability insurance?

A) out-of-pocket caps,
B) elimination periods,
C) deductibles,
D) coinsurance.

Question 32

A typical elimination period for a short-term disability policy would be

A) 90 days,
B) 60 days,
C) 7 days,
D) 1 day.

Question 33

A change that would tend to decrease the premium on a disability policy is

A) a shorter elimination period,
B) use of an any occupation definition of disability instead of an any occupation to which reasonably suited definition,
C) increasing the benefit level from 67 percent to 75 percent of prior earnings,
D) lowering the payment period from until age 70 to until age 65.

Question 34

A continuation provision in a health insurance policy that is not commonly used is

A) continually renewable,
B) optionally renewable,
C) guaranteed renewable,
D) noncancellable.

Question 35

Organizations that were originally nonprofit organizations that allowed their subscribers to prepay some health care expenses are

A) PPOs,
B) HMOs,
C) Blue Cross and Blue Shield organizations,
D) self-insured plans.

Question 36

The effect of a misstatement-of-age clause in a health insurance contract is that

A) no benefits will be paid if it is shown that the insured intentionally misrepresented his or her age,
B) benefits will be paid based on the age represented in the application if two years pass before the discovery of the misstated age,
C) the policy will be voidable at the option of the insurer, and if the insurer decides to void the policy it must return all premiums collected with reasonable interest,
D) the benefits will be adjusted to equal the benefits that could have been purchased had the true age been known.

Question 37

From the insured's perspective, a major disadvantage typically associated with an HMO is that

A) high deductibles and coinsurance percentages are typically associated with an HMO,
B) limitations are placed on the selection of physicians,
C) most medical specialties are not usually represented in an HMO,
D) surgical expenses are generally not covered by an HMO.

Question 38

Which of the following statements is not true in relation to dental insurance?

A) Cost sharing is rarely waived for routine examinations,
B) Cost sharing is commonly used for nonpreventive care,
C) Most policies have relatively low annual limits,
D) Deductibles and coinsurance provisions are common.

Question 39

A health insurance policy contains a $200 calendar-year deductible, an 80 percent coinsurance provision, and a $2,500 out-of-pocket cap. If a $10,000 covered claim is the only claim made this year, the insurance company will pay

A) $7,500,
B) $2,200,
C) $7,840,
D) $7,800.

Question 40

A health insurance policy contains a $200 per-cause deductible, a 75 percent coinsurance provision, and a $2,000 coinsurance cap. If a $10,000 covered claim is the only claim made this year, the insured would have to pay

A) $2,650,
B) $2,000,
C) $7,800,
D) $2,200.

Question 41

The recent increase in the need for long-term care insurance is not caused by

A) more people living to advanced ages,
B) a recent change in Medicaid law that exempts LTC insurance from the resources test for Medicaid eligibility,
C) the escalating costs of long-term care,
D) recent advances in medical technology.

Question 42

A situation for which a term health insurance policy is well suited is

A) a two-week hiking expedition,
B) a young family with minor children,
C) an elderly couple with a limited income,
D) a single worker with no dependents.

Question 43

A reduction or denial of benefits would typically not be the result of

A) a loss incurred while committing a felony or while engaged in an illegal occupation,
B) a change to a more hazardous occupation after the policy is issued,
C) an intentional misstatement of age by the insured,
D) a loss that occurs during the grace period of a policy if the late premium payment is made before the end of the period.

Question 44

Recent health care reforms enacted by several states include all of the following, except:

A) enacting a standard definition of a medical emergency,
B) prohibiting doctors who practice in a network from acting as advocates for their patients,
C) allowing patients direct access to some types of specialists without first seeing their primary care physician,
D) forcing health care networks to accept all physicians who agree to accept the networks' terms and fee structures.

Question 45

Health Saving Accounts are available to

A) anyone with health insurance
B) anyone with a low-deductible health insurance policy
C) anyone with a high-deductible health insurance policy
D) anyone who is uninsured

Question 46

Medicare prescription drug coverage

A) is optional
B) has been a part of Medicare since 1985
C) provides prescription drugs free to charge to Medicare beneficiaries
D) is available