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All of the following statements concerning Social Security disability benefits are true except - ANSWER Benefits are retroactive to the time of disability (benefits are retroactive but do not include the waiting period) Which statement concerning commercial companies is not true? - ANSWER They are not debit companies (Commercial insurance can be sold by debit or industrial or home service companies. They are synonyms) Which of the following service providers allows for a primary care physician as well as out-of-network care? - ANSWER Point of Service Plan (POS) (Point of Service is a combination of an HMO and a PPO.) Which of the following are NOT eligible for Medicare coverage? - ANSWER People with any life threatening condition (ife threatening conditions do not qualify a person for benefits.) All of the following are types of deductible provisions associated with major medical policies except: - ANSWER Stop loss (A stop loss is not a deductible. It "stops" an insured's loss at a certain dollar amount.) All of the following may administer self-insured plans except: - ANSWER Actuaries (A self insured plan may contract with ASOs & TPAs to process the paper work. They may also use an insurance company to pay for large unpredictable losses.) How does a basic medical plan avoid small claims and keep the cost of premiums down? - ANSWER By imposing benefit limits (These are known as first dollar policies. They pay first, no deductibles or co-insurance. Known for low maximum benefits.) Which of the following statements about deductible provisions in medical insurance policies is NOT correct? - ANSWER They are most common in basic medical expense policies (Basic medical expense policies are called "first dollar" policies because they have no deductibles. Deductibles are found in major medical policies.) The type of health care provider that provides both the health care services and the health care financing is a: - ANSWER Health Maintenance Organization Stagmite purchases a major medical policy with a $100 annual deductible, 80/20 co-insurance and a maximum out-of-pocket of $5000. If Stagmite were to incur covered expenses of $10,100, how much would Stag be out of pocket?