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Which of the following is NOT a typical type of long-term care
coverage?
A. skilled nursing care
B. home health care
C. hospice care
d. residential care - ANSWER-C. Long term care services are
designed for senior citizens, while hospice services are for
terminally ill persons and their families.
All of the following are mandatory provisions in health
insurance policies
EXCEPT
A. proof of loss
B. entire contract
C. change of beneficiary
D. misstatement of age - ANSWER-D. Misstatement of age is an
optional provision of health insurance policies.
,Under the notice of claims provision of a health insurance
policy, a policyowner
must provide notification of loss within a reasonable period
of time, usually
A. 10 days after an occurrence or commencement of a loss
B. 20 days after an occurrence or a commencement of a loss
C. 1 month after an occurrence or a commencement of a loss
D. no later than 3 months after an occurrence or a
commencement of a loss - ANSWER-B. Under the notice of
claims provision, an insured must provide notification of loss
20 days after an occurrence or a commencement of a loss.
Paul is hospitalized with a back injury and, upon checking his
disability income
policy, learns that he will not be eligible for benefits for at
least 60 days. This
would indicate that his policy probably
has a 60-day
A. elimination period
B. probationary period
C. disability period
D. blackout period - ANSWER-A. Similar in concept to a
deductible, the elimination period is the time immediately
following the start of a disability when benefits are not
payable.
,Major risk factors in health insurance underwriting include all
of the following
ECEPT
A. physical condition
B. habits or lifestyle
C. marital status
D. occupation - ANSWER-C. Physical condition, habits or
lifestyle (moral hazards), and occupation are major risk
factors in health insurance. Marital status is not a risk factor.
Which of the following is known for stressing preventive health
care?
A. administrative-services-only providers
B. Lloyd's of London
C. health maintenance organizations
D. commercial insurers - ANSWER-C. Health maintenance
organizations stress preventive care to promote patient
health and to control the use of health care resources,
particularly expensive resources like hospitals.
Leonard owns a major medical health policy which requires
him to pay the first
$200 of covered expenses each year before the policy pays
its benefits. The
$200 is the
policy's
, A. coinsurance amount
B. deductible
C. stop-loss amount
D. annual premium - ANSWER-B. A deductible is a stated initial
dollar amount that the individual insured is required to pay
before the insurance benefits are paid.
Basic hospital expense insurance provides coverage for all
of the following
EXCEPT
A. hospital room and board
B. anesthesia and use of the operating room and supplies
C. physician services
D. drugs and x-rays - ANSWER-C. Physicians' services are not
covered under a basic hospital expense policy, even in the
case of surgery. The cost for a physician is covered under a
basic surgical expense or basic physician's (nonsurgical)
expense policy.
All of the following approaches are used by insurers to
determine benefits
payable under basic surgical expense
insurance EXCEPT
A. relative value scale approach
B. traditional net cost method
C. reasonable and customary approach