1. What does underwriting a health insurance policy mean? o a.

o assessing risk based upon health and medical history That's correct! Underwriting means that the level of coverage, premium, and willingness of an insurer to issue the policy depends on the applicants health and medical history.

2. What component of pre-PPACA underwriting practices will be prohibited for health insurance obtained through a health insurance exchange? o a. o assessing risk based upon health and medical history That's correct! Per the provisions of the PPACA, health and medical history cannot be used for underwriting or rating for insurance obtained through a health insurance exchange.

3. Marvel Corporation has decided to self-insure its health benefits but wants to be sure it is not exposed to unexpectedly large claims. What type of policy should Marvel probably purchase? o c. o stop-loss policy That's correct! Stop-loss insurance from a commercial carrier protects against large, unpredictable losses above a specified threshold amount.

4. In most states what is the minimum number of persons required to be considered a group for insurance purposes? o

b.

two

1. Which of the following is applied to all expenses in a health insurance policy during a specified period? o b. all-cause deductible

2. Under the PPACA, all of the following will be required components of an essential benefits package, EXCEPT: o . d. stringent medical underwriting qualifications

3. Connie was in the hospital for four days undergoing surgery on her hip. Her insurance company paid her $75 a day for each day, totaling $300. What type of policy does Connie probably have? o b. a hospital indemnity policy

4. Which of the following is true of the Blues? o . c. They provide benefits on a service basis.

5. Under third-party indemnity insurance, insurers pay providers directly. o a. True

6. Mark has a major medical policy that requires him to pay 20 percent of the first $10,000 of medical expenses. This is known as o c. coinsurance.

1. What is RBRVS? o a. a managed care tool associated with Medicare Part B

2. With regard to a staff-based HMO, which of the following statements is true? o c. doctors are employees.

3. All of the following have been cited as causes of rising health-care costs EXCEPT: o a. a shortage of hospital beds

4. Which of the following statements is true with regard to a POS plan? o b. A POS plan permits the member to choose among different plan options at the time medical service is needed.

1. Felicia hurt herself in a car accident. After a brief stay in the hospital, she was no longer able to work as a forklift operator, but she got a job as a warehouse clerk. If she wanted to

collect disability benefits in the future, she should be covered under a policy that came with a(n) __________ definition of disability. o a. any occupation

2. Disability income insurance is typically provided through all of the following EXCEPT o a. a basic medical expense policy.

3. Short-term disability plans typically pay benefits for up to o c. 6 months.

4. How many ADLs must a person typically be unable to perform to qualify for LTC benefits? o b. two

5. As defined by the DRA, an insured participating in a state partnership program may be eligible for an exemption to Medicaids asset spend -down rule equal to o c. the total lifetime benefits paid through a LTC partnership policy.

1. Marla is covered by group health insurance maintained by her husbands employer. If her husband were to die, what is the maximum period of coverage Marla would receive under COBRA? o d. 36 months

2. Under PPACA, what is the minimum percentage of premiums collected for an individual health insurance plan that must be spent on actual medical expenses and health-care claims? o d. 80 percent

3. Eileen quits her job on September 30 and heads off to the Caribbean for five months. When she returns, she takes another job and submits a health insurance claim relating to a condition that she has had for several years. The administrator of the new plan o d. denies the claim and says the exclusion period is 12 months, because Eileen had a break in coverage that exceeded 63 days.

4. Which of the 12 mandatory provisions of the UPPL gives the insured 90 days to submit evidence of his or her loss? o d. proof of loss

5. The NAIC o o a d. provides model laws and regulations to be adopted and enforced by the individual states.

6. Which of the following optional provisions does NOT address the problem of overinsurance? o a. cancelation

1. Laura has disability income insurance through her employer and a personal policy. Which of the following is true about benefits she might receive from these policies? o a. Benefits from her employers policy will be taxable; those from her personal policy will not.

2. An HSA is a combination of o b. a tax-favored savings account and a high-deductible health insurance plan.

3. With which of the following is money that is not spent on medical expenses forfeited at the end of the year? o c. FSAs

4. The Patient Protection and Affordable Care Act mandates that all employers, regardless of size, offer comprehensive health-care coverage to their employees. o b. False