NC - Health Insurance - Practice Exam Questions with Complete Answers, Rated A+

All of the following are true regarding Key Employee Disability Income insurance EXCEPT A) Premiums are not tax deductible for the employer. B) Benefits are taxable to the employer. C) The employer owns the policy. D) Benefits are paid to the employer to retrain a new person. - B) Benefits are taxable to the employer. Key person disability income premiums are not deductible to the business, but the benefits are received income tax free by the business. How is emergency care covered for a member of an HMO? A) A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area. B) A member of an HMO may receive care at any emergency facility, at the same cost as if in his or her own service area. C) HMOs have salaried member physicians, but they do not cover emergency care. D) An HMO emergency specialist will cover the patient. - A. A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area. Emergency care must be provided for the member in or out of the HMO's service area. If emergency care is being provided for a member outside the service area, the HMO will be eager to get the member back into the service area so that care can be provided by salaried member physicians. After appointing an agent, how long does an insurer have to file with the Commissioner the form detailing the agent's name, address, and other needed information? A) 15 days B) 30 days C) 45 days D) 60 days - B) 30 days Insurers have 30 days to file, in a form prescribed by the Commissioner, the names, addresses, and other information required by the Commissioner for its newly appointed agents. Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives? - None Which of the following are the main factors taken into account when calculating residual disability benefits? a)Present earnings and earnings prior to disability b)Earnings prior to disability and the length of disability c)Employee's full-time status and length of disability d)Present earnings and standard cost of living - a)Present earnings and earnings prior to disability Residual disability will help pay for loss of earnings by making up the difference between the employee's present earnings and what they were earning prior to disability. How can a new physician be added to the PPO's approved list? a)Fill out the appropriate paperwork and wait the 12 month pre-certification period. b)Pay an annual fee for being on the PPO list. c)New physicians are only added once a year, and are selected by the PPO's Board of Directors. d)Agree to follow the PPO standards and charge the appropriate fees. - d)Agree to follow the PPO standards and charge the appropriate fees. Any physician or hospital that qualifies for and agrees to follow the PPO's standards and charges the established fees can be added to the PPO's approved list at any time. The providers may withdraw their name from the list at any time, as well. Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within a)90 days of a loss. b)20 days of a loss. c)30 days of a loss. d)60 days of a loss. - a)90 days of a loss.