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PENNSYLVANIA HEALTH AND ACCIDENT INSURANCE EXAM
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PENNSYLVANIA HEALTH AND ACCIDENT INSURANCE EXAM
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PENNSYLVANIA HEALTH AND ACCIDENT INSURANCEEXAM 2024 NEWEST EXAM 350 QUESTIONS WITH
DETAILED VERIFIED ANSWERS (100% CORRECT)
/ALREADY GRADED A+
During the underwriting process for a group health policy, it was discovered that 15
out of 50 members of the group have major health issues. How would the insurer
handle this? - ANSWER: Accept or reject the whole group
When a claim has coverage under more than one health plan, which group medical
plan provision applies? - ANSWER: Coordination of benefits
What percentage of eligible employees must participate in a noncontributory group
health plan before it can be put in effect? - ANSWER: 100%
Who is financially liable for the payment of covered claims in a fully insured group
health plan? - ANSWER: Insurer
Buy-Sell Plans are typically funded by which two types of insurance? - ANSWER: Life
insurance and Disability insurance
In regards to a group health insurance plan, which statement is CORRECT? -
ANSWER: A non-contributory group health plan must cover all eligible members
Which of the following is NOT typically covered under vision care insurance? -
ANSWER: Eye Surgery
An eligible individual who would like to obtain group health insurance without
providing evidence of insurability must? - ANSWER: Enroll within a specified
eligibility period
Coverage is limited for vision and dental insurance in all of the following ways,
EXCEPT? - ANSWER: Specific dollar amount for examinations
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers
who employ at least? - ANSWER: 20 employees
The problem of overinsurance is addressed in which health insurance provision? -
ANSWER: Coordination of benefits
Minimum participation standards exist for group health insurance plans in order to -
ANSWER: prevent adverse selection
In an employer-sponsored group accident and health plan, a master contract is
issued to the? - ANSWER: Employer
, Which of the following does Coordination of Benefits allow? - ANSWER: Allows the
secondary payor to reduce their benefit payments so no more than 100% of the
claim is paid.
Under the Health Insurance Portability and Accountability Act (HIPAA), the
employee's new Group Health Plan will verify Creditable Coverage so that the -
ANSWER: Employee's waiting period for coverage of a preexisting condition can be
reduced under the new employer's health plan
Credit Accident and Health plans are designed to? - ANSWER: Help pay off existing
loans during periods of disability
Health insurance involves two perils, accident and _________. - ANSWER: sickness.
When can a group health policy renewal be denied according to the Health Insurance
Portability and Accountability Act (HIPAA)? - ANSWER: When contribution or
participation rules have been violated.
Mark continues working after the age of 65 and is covered through his employer's
group health plan. Which of the following statements is TRUE? - ANSWER: Medicare
is the secondary payer.
The election of COBRA for continuation of health coverage will... - ANSWER:
Maintain the same coverage and increase premium.
How many employees must an employer have for a terminated employee to be
eligible for COBRA? - ANSWER: 20
What is issued to each employee of an employer health plan? - ANSWER: Certificate
Under the subrogation clause, legal action can be taken by the insurer against the? -
ANSWER: responsible third party
Without a Section 125 Plan in place, what would happen to an employee's payroll
contribution to an HSA? - ANSWER: It would be considered taxable income to the
employee
Business Overhead Expense Insurance pays for? - ANSWER: business expenses when
a business owner becomes disabled
Key Person Disability Insurance pays benefits to the... - ANSWER: Employer
Ron has a new employer and wishes to enroll in the company's group health plan. In
determining whether his pre-existing health condition applies, Ron cannot have
more than a _____ day gap without previous health insurance. - ANSWER: 63
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