NY Series 17-52
A man works for Company A and his wife works for Company B. The spouses are covered by
health plans through their respective companies that also cover the other spouse. If the
husband files a claim, - ANS-The insurance through his company is primary.
A medical insurance plan in which the health care provider is paid a regular fixed amount for
providing care to the insured and does not receive additional amounts of compensation
dependent upon the procedure performed is called - ANS-Prepaid plan.
A rating method in which the premium is the same for all covered persons, regardless of age,
sex, or health status is referred to as - ANS-Community rating
An individual applies for a life policy. Two years ago he suffered a head injury from an accident,
so he cannot remember parts of his past, but is otherwise competent. He has also been
hospitalized for drug abuse, but does not remember this when applying for insurance. The
insurer issues the policy and learns of his history one year later. What will probably happen? -
ANS-The policy will not be affected.
An insured is involved in a car accident. In addition to general, less serious injuries, he
permanently loses the use of his leg and is rendered completely blind. The blindness improves
a month later. To what extent will he receive Presumptive Disability benefits? - ANS-No benefits
At what point must an Outline of Coverage be delivered? - ANS-At the time of application or
upon delivery of the policy
For the purpose of insurance, risk is defined as - ANS-The uncertainty or chance of loss.
How many eligible employees must be included in a contributory health insurance plan? -
ANS-50%
If an employee terminates her employment, which of the following provisions would allow her to
continue health coverage under an individual policy, if requested within 60 days? -
ANS-Conversion
If seeking repayment of Medicaid funds per the Medicaid Estate Recovery Act would cause a
hardship to survivors, states may - ANS-Waive the estate recovery requirement.
In an HMO policy, one of the main responsibilities of the primary care physician (PCP) as a
gatekeeper is to do which of the following? - ANS-Help control costs
In which Medicare supplemental policies are the core benefits found? - ANS-All plans
Medicaid provides all of the following benefits EXCEPT - ANS-Income assistance for
work-related injury.
On a major medical insurance policy, the amount that an insured must pay on a claim before the
insurer will pay is known as - ANS-Deductible.
Pertaining to insurance, what is the definition of a fiduciary responsibility? - ANS-Promptly
forwarding premiums to the insurance company
Short term - ANS-less than 2 years
The insuring clause of a disability policy usually states all of the following EXCEPT - ANS-The
method of premium payment.
A man works for Company A and his wife works for Company B. The spouses are covered by
health plans through their respective companies that also cover the other spouse. If the
husband files a claim, - ANS-The insurance through his company is primary.
A medical insurance plan in which the health care provider is paid a regular fixed amount for
providing care to the insured and does not receive additional amounts of compensation
dependent upon the procedure performed is called - ANS-Prepaid plan.
A rating method in which the premium is the same for all covered persons, regardless of age,
sex, or health status is referred to as - ANS-Community rating
An individual applies for a life policy. Two years ago he suffered a head injury from an accident,
so he cannot remember parts of his past, but is otherwise competent. He has also been
hospitalized for drug abuse, but does not remember this when applying for insurance. The
insurer issues the policy and learns of his history one year later. What will probably happen? -
ANS-The policy will not be affected.
An insured is involved in a car accident. In addition to general, less serious injuries, he
permanently loses the use of his leg and is rendered completely blind. The blindness improves
a month later. To what extent will he receive Presumptive Disability benefits? - ANS-No benefits
At what point must an Outline of Coverage be delivered? - ANS-At the time of application or
upon delivery of the policy
For the purpose of insurance, risk is defined as - ANS-The uncertainty or chance of loss.
How many eligible employees must be included in a contributory health insurance plan? -
ANS-50%
If an employee terminates her employment, which of the following provisions would allow her to
continue health coverage under an individual policy, if requested within 60 days? -
ANS-Conversion
If seeking repayment of Medicaid funds per the Medicaid Estate Recovery Act would cause a
hardship to survivors, states may - ANS-Waive the estate recovery requirement.
In an HMO policy, one of the main responsibilities of the primary care physician (PCP) as a
gatekeeper is to do which of the following? - ANS-Help control costs
In which Medicare supplemental policies are the core benefits found? - ANS-All plans
Medicaid provides all of the following benefits EXCEPT - ANS-Income assistance for
work-related injury.
On a major medical insurance policy, the amount that an insured must pay on a claim before the
insurer will pay is known as - ANS-Deductible.
Pertaining to insurance, what is the definition of a fiduciary responsibility? - ANS-Promptly
forwarding premiums to the insurance company
Short term - ANS-less than 2 years
The insuring clause of a disability policy usually states all of the following EXCEPT - ANS-The
method of premium payment.
