Ohio Health Insurance Exam Latest Updated 2024 Q&A

Ohio Health Insurance Exam Latest Updated 2024 Q&A ACCIDENTAL AND HEALTH INSURANCE BASICS STARTS: 15% - CORRECT ANSWER-... Two major perils under a health insurance policy: - CORRECT ANSWER-Policies may cover both accident and sickness or accident only. Accidental bodily injury: - CORRECT ANSWER-An unforeseen and unintended injury that resulted from an accident rather than a sickness. Sickness: - CORRECT ANSWER-Normally defined as an illness, which first manifests itself while the policy is in force. This is where a majority of health insurance claims result from. Loss of income from disability: - CORRECT ANSWER-Loss of income caused by accident or sickness causing an insured the inability to work and earn in come. Limited Vs Comprehensive: - CORRECT ANSWER-Limited health insurance policies only cover specific accidents or diseases. Comprehensive plan would cover all sickness or accidents that are not specifically excluded. A successful self funded plan will have the following characteristics: (5) - CORRECT ANSWER--A group large enough to reasonably predict future loss experience. -Sound statistical data to support the self-funding concept. -A stop-loss contract to assume losses beyond the insured's retention. -A third party administrator who services claims. -Flexibility in plan design and administrative procedures. Employee Retirement Income Security Act of 1974 (ERISA): - CORRECT ANSWER-A federal law that was enacted to ensure that employees receive the pension and other benefits promised by their employers. Association (alumni or professional) group: - CORRECT ANSWER-Can buy group insurance for its members. The group must have at least 100 members, be organized for a reason other than buying insurance, have been active for two years, have a constitution, by-laws, and must hold at least annual meetings. Multiple-Employer Trust (MET): - CORRECT ANSWER-Made up of two or more employers in similar or related businesses who do not qualify for group insurance on their own. Multiple Employer Welfare Associations (MEWAs): - CORRECT ANSWER-Can be any entity, other than a duly admitted insurer, that establishes an employee benefit plan for the purpose of offering or providing accident and sickness or death benefits to the employees of at least 2 employers, including self-employed individuals and their dependents. They pool their risks in order to self-insure Accident only policies: - CORRECT ANSWER-Limited policies that provide coverage for death, dismemberment, disability or hospital and medical care resulting from an accident. Only pays for losses from accidents not sickness. Principal Sum: - CORRECT ANSWER-This amount is usually equal to the amount of coverage under the insurance contract, or the face amount. Capital Sum: - CORRECT ANSWER-In case of loss of sight or accidental dismemberment, a percentage of that principal sum will be paid by the policy. Dread Disease (limited risk) policy: - CORRECT ANSWER-Provides a variety of benefits for a specific disease such as cancer policy or heart disease policy. Benefits usually paid as scheduled, fixed dollar amount. Hospital indemnity: - CORRECT ANSWER-Provides a specific amount on a daily, weekly or monthly basis while the insured is confined to a hospital. Critical illness policy: - CORRECT ANSWER-Pays a lump sum to the insured upon the diagnoses (and survival) of a critical illness. The insured must survive the illness for a certain period of time (30 days