Question 1

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.

Accepted Answer

Reasonable and customary fees refer to the amount determined by insurers based on the analysis of prevailing fees in a geographical area for specific medical services or procedures.

Question 2

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.

Accepted Answer

Disability income insurance is specifically designed to provide income to individuals who are unable to work due to sickness or injury, ensuring they have financial support during their period of disability.

Question 3

Match the descriptions with their terms:
-The _________________ definition is the most liberal definition of disability.

Accepted Answer

The "own occupation" definition of disability is considered the most liberal because it allows individuals to receive benefits if they are unable to perform the duties of their specific occupation, even if they might be able to work in a different job.

Question 4

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.

Accepted Answer

MThe correct match for the description is "nonscheduled basis" and "reasonable and customary." In a nonscheduled basis policy, covered surgical procedures are paid up to the full amount considered to be reasonable and customary, without a fixed schedule of benefits.

Question 5

Match the descriptions with their terms:
-A/An _________________ limits the amount that the insured has to pay for both coinsurance and deductibles.

Accepted Answer

An out-of-pocket cap limits the amount that the insured has to pay for both coinsurance and deductibles, ensuring that there's a maximum limit to their financial responsibility for healthcare costs within a policy period.

Question 6

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.

Accepted Answer

A guaranteed renewable contract ensures that the insurer cannot terminate coverage before a specified age as long as premiums are paid on time.

Question 7

Match the descriptions with their terms:
-_________________ policies usually have higher limits and fewer exclusions than do hospital, surgical, and regular medical expense contracts.

Accepted Answer

Major medical insurance policies typically offer broader coverage with higher limits and fewer exclusions compared to basic hospital, surgical, and regular medical expense contracts.

Question 8

Match the descriptions with their terms:
-_________________ describe the contractual rights regarding the renewal of a health insurance policy.

Accepted Answer

Continuation provisions describe the contractual rights regarding the renewal of a health insurance policy.

Question 9

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.

Accepted Answer

The description matches the "any occupation" definition of disability, which considers an individual disabled only if they cannot perform the duties of any job for which they are qualified by education, training, or experience.

Question 10

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

Accepted Answer

Physicians are not generally obligated by law to participate in a PPO if solicited by an insured participant. Participation in a PPO is typically voluntary for healthcare providers, and they choose to join based on agreements regarding payment rates and other terms, not a legal requirement.

Question 11

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

Accepted Answer

The answer of Which of the following is not a...

Question 12

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

Accepted Answer

A typical elimination period for a short-term disability policy is usually around 7 days. This period is the time between when an injury or illness begins and when benefits from the disability policy start to be paid.

Question 13

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

Accepted Answer

Lowering the payment period from until age 70 to until age 65 reduces the insurer's risk and potential payout, thus decreasing the premium.

Question 14

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

Accepted Answer

Continually renewable is not a standard term used in health insurance policies. The common provisions are optionally renewable, guaranteed renewable, and noncancellable.

Question 15

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

Accepted Answer

Blue Cross and Blue Shield organizations were originally nonprofit organizations that allowed their subscribers to prepay some health care expenses. These organizations were among the first to establish the concept of prepayment for healthcare services, aiming to make healthcare more accessible and affordable for their members.

Question 16

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

Accepted Answer

The misstatement-of-age clause in a health insurance contract typically allows the insurer to adjust the benefits to what would have been provided if the correct age had been known, rather than voiding the policy or refusing to pay benefits. This ensures that the benefits paid are in line with the premiums that should have been paid for the insured's actual age.

Question 17

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

Accepted Answer

HMOs (Health Maintenance Organizations) often limit the selection of physicians and healthcare providers to those within their network, which can be a significant disadvantage for insured individuals who prefer more freedom in choosing their healthcare providers.

Question 18

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

Accepted Answer

Cost sharing for routine examinations is often waived in dental insurance plans to encourage preventive care, making statement A not true.

Question 19

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

Accepted Answer

First, subtract the deductible from the claim: $10,000 - $200 = $9,800. Then, apply the 80% coinsurance: 80% of $9,800 = $7,840. The out-of-pocket cap does not affect this calculation because the total out-of-pocket expenses (deductible + coinsurance) do not exceed the cap.

Question 20

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

Accepted Answer

The answer of A health insurance policy contains a $200...

Quiz 17: Loss of Health

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.

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.

Match the descriptions with their terms: -The _________________ definition is the most liberal definition of disability.

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.

Match the descriptions with their terms: -A/An _________________ limits the amount that the insured has to pay for both coinsurance and deductibles.

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.

Match the descriptions with their terms: -_________________ policies usually have higher limits and fewer exclusions than do hospital, surgical, and regular medical expense contracts.

Match the descriptions with their terms: -_________________ describe the contractual rights regarding the renewal of a health insurance policy.