HSM 355 EXAM 2 QUESTIONS WITH ANSWERS
100% CORRECT
True or False? In the healthcare sector, when a patient's healthcare services are covered
under a voluntary healthcare insurance plan, the person who pays the remainder of a
healthcare bill, after the healthcare insurance company has paid, is called the guarantor.
- ANSWER true
In the healthcare sector, what is the term for a group of individual entities, such as
individual persons, employers, or associations, whose healthcare costs are combined for
evaluating financial history and estimating future costs? - ANSWER Risk pool
What healthcare organization is one of the most influential in the healthcare sector
because it insures nearly one in three Americans? - ANSWER BCBSA
True or False? In private or commercial healthcare insurance plans, covered conditions
are patient conditions, diseases, or injuries for which the healthcare plan will pay and,
correspondingly, covered services are services related to treating the covered conditions,
diseases, or injuries. - ANSWER True
The worker had group healthcare insurance coverage through her employer. The
worker's household included her spouse, two natural children (ages 28 and 12), an
adopted child (age 8), a 6-month infant in the waiting period prior to adoption, and the
worker's mother (age 58). Who may be included under dependent coverage in the
healthcare insurance policy? - ANSWER Spouse, natural child age 12, adopted child age
8, and 6-month infant in waiting period
, True or False? The female worker was just married on July 1, 2016. She had worked for
the organization for the past 8 years and has been covered under its group healthcare
insurance policy during the entire period. She is ONLY allowed to add her new spouse
during open enrollment which, for this organization, is October 1, 2016 through
November 1, 2016 becoming effective on January 1, 2017. - ANSWER False
All of the following phenomena are considered "life events" except:
a. birth
b. marriage
c. adoption of child
d. illness - ANSWER Illness
In the healthcare industry all of the following benefits terms mean the amount during a
timeframe beyond which all covered healthcare services for an insured or dependent are
paid 100 percent by the insurance plan except:
a. Catastrophic expense limit
b. Maximum out-of-pocket cost
c. Rider
d. Stop-loss benefit - ANSWER Rider
Which type of healthcare insurance policy offers the widest ranging coverage but
requires the insured to pay coinsurance until the maximum out-of-pocket costs are met?
- ANSWER Comprehensive
100% CORRECT
True or False? In the healthcare sector, when a patient's healthcare services are covered
under a voluntary healthcare insurance plan, the person who pays the remainder of a
healthcare bill, after the healthcare insurance company has paid, is called the guarantor.
- ANSWER true
In the healthcare sector, what is the term for a group of individual entities, such as
individual persons, employers, or associations, whose healthcare costs are combined for
evaluating financial history and estimating future costs? - ANSWER Risk pool
What healthcare organization is one of the most influential in the healthcare sector
because it insures nearly one in three Americans? - ANSWER BCBSA
True or False? In private or commercial healthcare insurance plans, covered conditions
are patient conditions, diseases, or injuries for which the healthcare plan will pay and,
correspondingly, covered services are services related to treating the covered conditions,
diseases, or injuries. - ANSWER True
The worker had group healthcare insurance coverage through her employer. The
worker's household included her spouse, two natural children (ages 28 and 12), an
adopted child (age 8), a 6-month infant in the waiting period prior to adoption, and the
worker's mother (age 58). Who may be included under dependent coverage in the
healthcare insurance policy? - ANSWER Spouse, natural child age 12, adopted child age
8, and 6-month infant in waiting period
, True or False? The female worker was just married on July 1, 2016. She had worked for
the organization for the past 8 years and has been covered under its group healthcare
insurance policy during the entire period. She is ONLY allowed to add her new spouse
during open enrollment which, for this organization, is October 1, 2016 through
November 1, 2016 becoming effective on January 1, 2017. - ANSWER False
All of the following phenomena are considered "life events" except:
a. birth
b. marriage
c. adoption of child
d. illness - ANSWER Illness
In the healthcare industry all of the following benefits terms mean the amount during a
timeframe beyond which all covered healthcare services for an insured or dependent are
paid 100 percent by the insurance plan except:
a. Catastrophic expense limit
b. Maximum out-of-pocket cost
c. Rider
d. Stop-loss benefit - ANSWER Rider
Which type of healthcare insurance policy offers the widest ranging coverage but
requires the insured to pay coinsurance until the maximum out-of-pocket costs are met?
- ANSWER Comprehensive
