Exam (elaborations)
Health and Accident Insurance Exam/62 Questions and Answers
Health and Accident Insurance Exam/62 Questions and Answers
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Health and Accident InsuranceExam/62 Questions and Answers
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? - -Accept or reject the whole group
-When a claim has coverage under more than one health plan, which group
medical plan provision applies? - -Coordination of benefits
-What percentage of eligible employees must participate in a
noncontributory group health plan before it can be put in effect? - -100%
-Who is financially liable for the payment of covered claims in a fully insured
group health plan? - -Insurer
-Buy-Sell Plans are typically funded by which two types of insurance? - -Life
insurance and Disability insurance
-In regards to a group health insurance plan, which statement is CORRECT? -
-A non-contributory group health plan must cover all eligible members
-Which of the following is NOT typically covered under vision care insurance?
- -Eye Surgery
-An eligible individual who would like to obtain group health insurance
without providing evidence of insurability must? - -Enroll within a specified
eligibility period
-Coverage is limited for vision and dental insurance in all of the following
ways, EXCEPT? - -Specific dollar amount for examinations
-The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to
employers who employ at least? - -20 employees
-The problem of overinsurance is addressed in which health insurance
provision? - -Coordination of benefits
-Minimum participation standards exist for group health insurance plans in
order to - -prevent adverse selection
-In an employer-sponsored group accident and health plan, a master
contract is issued to the? - -Employer
, -Which of the following does Coordination of Benefits allow? - -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 - -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? - -Help pay off existing
loans during periods of disability
-Health insurance involves two perils, accident and _________. - -sickness.
-When can a group health policy renewal be denied according to the Health
Insurance Portability and Accountability Act (HIPAA)? - -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? - -
Medicare is the secondary payer.
-The election of COBRA for continuation of health coverage will... - -Maintain
the same coverage and increase premium.
-How many employees must an employer have for a terminated employee
to be eligible for COBRA? - -20
-What is issued to each employee of an employer health plan? - -Certificate
-Under the subrogation clause, legal action can be taken by the insurer
against the? - -responsible third party
-Without a Section 125 Plan in place, what would happen to an employee's
payroll contribution to an HSA? - -It would be considered taxable income to
the employee
-Business Overhead Expense Insurance pays for? - -business expenses
when a business owner becomes disabled
-Key Person Disability Insurance pays benefits to the... - -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. - -63
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