8/7/25, 4:58 PM Ohio Health Insurance Exam: 2025 EXAM QUESTIONS AND VERIFIED SOLUTIONS |ELABORATED &DETAILED ANSWERS!! Fla…
Ohio Health Insurance Exam: 2025 EXAM
QUESTIONS AND VERIFIED SOLUTIONS
|ELABORATED &DETAILED ANSWERS!!
Save
Terms in this set (238)
ACCIDENTAL AND ...
HEALTH INSURANCE
BASICS STARTS: 15%
Two major perils under a Policies may cover both accident and sickness or
health insurance policy: accident only.
An unforeseen and unintended injury that resulted
Accidental bodily injury:
from an accident rather than a sickness.
Normally defined as an illness, which first manifests
Sickness: itself while the policy is in force. This is where a
majority of health insurance claims result from.
Loss of income caused by accident or sickness
Loss of income from
causing an insured the inability to work and earn in
disability:
come.
Limited health insurance policies only cover specific
Limited Vs accidents or diseases.
Comprehensive: Comprehensive plan would cover all sickness or
accidents that are not specifically excluded.
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,8/7/25, 4:58 PM Ohio Health Insurance Exam: 2025 EXAM QUESTIONS AND VERIFIED SOLUTIONS |ELABORATED &DETAILED ANSWERS!! Fla…
-A group large enough to reasonably predict future
loss experience.
-Sound statistical data to support the self-funding
A successful self funded
concept.
plan will have the
-A stop-loss contract to assume losses beyond the
following characteristics:
insured's retention.
(5)
-A third party administrator who services claims.
-Flexibility in plan design and administrative
procedures.
Employee Retirement A federal law that was enacted to ensure that
Income Security Act of employees receive the pension and other benefits
1974 (ERISA): promised by their employers.
Can buy group insurance for its members. The group
must have at least 100 members, be organized for a
Association (alumni or
reason other than buying insurance, have been active
professional) group:
for two years, have a constitution, by-laws, and must
hold at least annual meetings.
Made up of two or more employers in similar or
Multiple-Employer Trust
related businesses who do not qualify for group
(MET):
insurance on their own.
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
Multiple Employer Welfare sickness or death benefits to the employees of at
Associations (MEWAs): least 2 employers, including self-employed individuals
and their dependents.
They pool their risks in order to self-insure
Limited policies that provide coverage for death,
dismemberment, disability or hospital and medical
Accident only policies:
care resulting from an accident. Only pays for losses
from accidents not sickness.
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, 8/7/25, 4:58 PM Ohio Health Insurance Exam: 2025 EXAM QUESTIONS AND VERIFIED SOLUTIONS |ELABORATED &DETAILED ANSWERS!! Fla…
This amount is usually equal to the amount of
Principal Sum: coverage under the insurance contract, or the face
amount.
In case of loss of sight or accidental dismemberment,
Capital Sum: a percentage of that principal sum will be paid by the
policy.
Provides a variety of benefits for a specific disease
Dread Disease (limited
such as cancer policy or heart disease policy. Benefits
risk) policy:
usually paid as scheduled, fixed dollar amount.
Provides a specific amount on a daily, weekly or
Hospital indemnity: monthly basis while the insured is confined to a
hospital.
Pays a lump sum to the insured upon the diagnoses
(and survival) of a critical illness. The insured must
Critical illness policy:
survive the illness for a certain period of time (30
days)
Covers members of a particular group when they are
Blanket Policy:
participating in a particular activity.
Routine and Preventive Covered up to an annual maximum without a
Maintenance: deductible or copayment.
Includes treatment of cavities, oral surgeries, bridges,
Routine and Major and dentures. These are covered up to a specific
restorative care: maximum, subject to an annual deductible per insured
family member and a coinsurance.
Must be delivered at the time of application or upon
Outline of coverage:
delivery of the policy.
Must create a disclosure document describing their
Ohio Life and Health
general purposes and current limitations. All policies
Insurance Guaranty
must include a copy of this document at or prior to
Association:
the time of delivery.
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Ohio Health Insurance Exam: 2025 EXAM
QUESTIONS AND VERIFIED SOLUTIONS
|ELABORATED &DETAILED ANSWERS!!
Save
Terms in this set (238)
ACCIDENTAL AND ...
HEALTH INSURANCE
BASICS STARTS: 15%
Two major perils under a Policies may cover both accident and sickness or
health insurance policy: accident only.
An unforeseen and unintended injury that resulted
Accidental bodily injury:
from an accident rather than a sickness.
Normally defined as an illness, which first manifests
Sickness: itself while the policy is in force. This is where a
majority of health insurance claims result from.
Loss of income caused by accident or sickness
Loss of income from
causing an insured the inability to work and earn in
disability:
come.
Limited health insurance policies only cover specific
Limited Vs accidents or diseases.
Comprehensive: Comprehensive plan would cover all sickness or
accidents that are not specifically excluded.
https://quizlet.com/1064439329/ohio-health-insurance-exam-2025-exam-questions-and-verified-solutions-elaborated-detailed-answers-flash-cards/?n… 1/30
,8/7/25, 4:58 PM Ohio Health Insurance Exam: 2025 EXAM QUESTIONS AND VERIFIED SOLUTIONS |ELABORATED &DETAILED ANSWERS!! Fla…
-A group large enough to reasonably predict future
loss experience.
-Sound statistical data to support the self-funding
A successful self funded
concept.
plan will have the
-A stop-loss contract to assume losses beyond the
following characteristics:
insured's retention.
(5)
-A third party administrator who services claims.
-Flexibility in plan design and administrative
procedures.
Employee Retirement A federal law that was enacted to ensure that
Income Security Act of employees receive the pension and other benefits
1974 (ERISA): promised by their employers.
Can buy group insurance for its members. The group
must have at least 100 members, be organized for a
Association (alumni or
reason other than buying insurance, have been active
professional) group:
for two years, have a constitution, by-laws, and must
hold at least annual meetings.
Made up of two or more employers in similar or
Multiple-Employer Trust
related businesses who do not qualify for group
(MET):
insurance on their own.
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
Multiple Employer Welfare sickness or death benefits to the employees of at
Associations (MEWAs): least 2 employers, including self-employed individuals
and their dependents.
They pool their risks in order to self-insure
Limited policies that provide coverage for death,
dismemberment, disability or hospital and medical
Accident only policies:
care resulting from an accident. Only pays for losses
from accidents not sickness.
https://quizlet.com/1064439329/ohio-health-insurance-exam-2025-exam-questions-and-verified-solutions-elaborated-detailed-answers-flash-cards/?n… 2/30
, 8/7/25, 4:58 PM Ohio Health Insurance Exam: 2025 EXAM QUESTIONS AND VERIFIED SOLUTIONS |ELABORATED &DETAILED ANSWERS!! Fla…
This amount is usually equal to the amount of
Principal Sum: coverage under the insurance contract, or the face
amount.
In case of loss of sight or accidental dismemberment,
Capital Sum: a percentage of that principal sum will be paid by the
policy.
Provides a variety of benefits for a specific disease
Dread Disease (limited
such as cancer policy or heart disease policy. Benefits
risk) policy:
usually paid as scheduled, fixed dollar amount.
Provides a specific amount on a daily, weekly or
Hospital indemnity: monthly basis while the insured is confined to a
hospital.
Pays a lump sum to the insured upon the diagnoses
(and survival) of a critical illness. The insured must
Critical illness policy:
survive the illness for a certain period of time (30
days)
Covers members of a particular group when they are
Blanket Policy:
participating in a particular activity.
Routine and Preventive Covered up to an annual maximum without a
Maintenance: deductible or copayment.
Includes treatment of cavities, oral surgeries, bridges,
Routine and Major and dentures. These are covered up to a specific
restorative care: maximum, subject to an annual deductible per insured
family member and a coinsurance.
Must be delivered at the time of application or upon
Outline of coverage:
delivery of the policy.
Must create a disclosure document describing their
Ohio Life and Health
general purposes and current limitations. All policies
Insurance Guaranty
must include a copy of this document at or prior to
Association:
the time of delivery.
https://quizlet.com/1064439329/ohio-health-insurance-exam-2025-exam-questions-and-verified-solutions-elaborated-detailed-answers-flash-cards/?n… 3/30
