ILLINOIS HEALTH INSURANCE CORE MAIN EXAM S
SET QUESTIONS AND ANSWERS SURE A+
✔✔60 day benefit period (spell of illiness) provision - ✔✔if a senior citizen has to go
back to the hospital within 60 days, it will be classified as the same spell of illness, not
as a new one. will pick up where left off on his or her benefit period
✔✔Medicare Supplementary Medical Insurance Plan (Part B) - ✔✔automatic when
enrolling in Part A; fed gov pays part of the cost and insured pays rest;
✔✔Part B after the annual deductible is satisfied - ✔✔Part B pays 80% of reasonable
and customary Medicare approved eligible medical expenses
✔✔Employed senior citizen has less than 20 members - ✔✔Medicare is primary and
group plan is secondary
✔✔Employed senior citizen has more than 20 members - ✔✔group plan primary and
medicare secondary
✔✔State insurance regulations authorize # - ✔✔14 Medicare supplement plans lettered
A through N
, ✔✔All insurance companies that offer Medicare Supplement Plans must offer - ✔✔Plan
A
✔✔Medicare Part C-Medicare Advantage Plans - ✔✔is an alternative to participating in
Part A and B and buying a supplement policy
✔✔Under Medicare Advantage Plan, Medicare pays - ✔✔Part A and B costs to the
insurance company
✔✔Medicare Advantage Plans usually charge - ✔✔a premium charge to the insured
✔✔Medicare Advantage Plans are often issued by - ✔✔HMO's
✔✔Medicaid - ✔✔federally funded, state administered program for anyone who is
medically in need and without income or financial resources; referred to as public aid
✔✔Long-Term Care (LTC) Insurance is to avoid - ✔✔significantly depleting assets in
the case of a long-term nursing home stay
✔✔LTC pays - ✔✔benefit amount for each day of service for a set benefit period
✔✔LTC pays if insured is unable to perform 2 or more - ✔✔Activities of Daily Living
such as Bathing, Dressing, Toileting, Transferring, Continence, and Eating
✔✔LTC with a pre-existing condition provision can - ✔✔go back no more than 6 months
and forward no more than 6 months
✔✔LTC must be - ✔✔Guaranteed Renewable; the insurance company cannot refuse to
renew but can rase rates only by broad classification
✔✔LTCs and cancellation provisions - ✔✔usually does not have and is referred to as
noncancelable
✔✔Inflation Protection riders - ✔✔must be offered for an extra premium charge;
guarantees the insured the option to purchase additional amounts of insurance at the
premium rate for the insured's attained age without evidence of insurability
✔✔LTC policies are usually - ✔✔non-coordinating and have waiting period provisions
✔✔HIPAA (Health Insurance Portability and Accountability Act) - ✔✔is a federal law that
established federal health insurance standards and assures portability
SET QUESTIONS AND ANSWERS SURE A+
✔✔60 day benefit period (spell of illiness) provision - ✔✔if a senior citizen has to go
back to the hospital within 60 days, it will be classified as the same spell of illness, not
as a new one. will pick up where left off on his or her benefit period
✔✔Medicare Supplementary Medical Insurance Plan (Part B) - ✔✔automatic when
enrolling in Part A; fed gov pays part of the cost and insured pays rest;
✔✔Part B after the annual deductible is satisfied - ✔✔Part B pays 80% of reasonable
and customary Medicare approved eligible medical expenses
✔✔Employed senior citizen has less than 20 members - ✔✔Medicare is primary and
group plan is secondary
✔✔Employed senior citizen has more than 20 members - ✔✔group plan primary and
medicare secondary
✔✔State insurance regulations authorize # - ✔✔14 Medicare supplement plans lettered
A through N
, ✔✔All insurance companies that offer Medicare Supplement Plans must offer - ✔✔Plan
A
✔✔Medicare Part C-Medicare Advantage Plans - ✔✔is an alternative to participating in
Part A and B and buying a supplement policy
✔✔Under Medicare Advantage Plan, Medicare pays - ✔✔Part A and B costs to the
insurance company
✔✔Medicare Advantage Plans usually charge - ✔✔a premium charge to the insured
✔✔Medicare Advantage Plans are often issued by - ✔✔HMO's
✔✔Medicaid - ✔✔federally funded, state administered program for anyone who is
medically in need and without income or financial resources; referred to as public aid
✔✔Long-Term Care (LTC) Insurance is to avoid - ✔✔significantly depleting assets in
the case of a long-term nursing home stay
✔✔LTC pays - ✔✔benefit amount for each day of service for a set benefit period
✔✔LTC pays if insured is unable to perform 2 or more - ✔✔Activities of Daily Living
such as Bathing, Dressing, Toileting, Transferring, Continence, and Eating
✔✔LTC with a pre-existing condition provision can - ✔✔go back no more than 6 months
and forward no more than 6 months
✔✔LTC must be - ✔✔Guaranteed Renewable; the insurance company cannot refuse to
renew but can rase rates only by broad classification
✔✔LTCs and cancellation provisions - ✔✔usually does not have and is referred to as
noncancelable
✔✔Inflation Protection riders - ✔✔must be offered for an extra premium charge;
guarantees the insured the option to purchase additional amounts of insurance at the
premium rate for the insured's attained age without evidence of insurability
✔✔LTC policies are usually - ✔✔non-coordinating and have waiting period provisions
✔✔HIPAA (Health Insurance Portability and Accountability Act) - ✔✔is a federal law that
established federal health insurance standards and assures portability
