Health Policies Part 2

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Author:
skarlet90
ID:
77620
Filename:
Health Policies Part 2
Updated:
2011-04-05 18:05:07
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Health Policies
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HP
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  1. 12.
    Which of the following riders would NOT increase the premium for a
    policyowner?



    A Waiver of premium rider

    B Multiple indemnity rider

    C Impairment rider

    D Payor benefit rider
    • The
    • impairment rider excludes a specified pre-existing condition for the policyowner,
    • therefore, reducing benefits. An insurance company will not charge extra for a
    • rider that reduces benefits.
  2. 13.
    Which type of Medicare policy requires insureds to use specific
    healthcare providers and hospitals, except in emergency situations?



    A HMO

    B Preferred

    C
    Select

    D Limited
    • Medicare Select policies require
    • insureds to use specific healthcare providers and hospitals, except in
    • emergency situations. In return, the insured pays lower premium amounts.
  3. 14. A person is enrolled in Part A
    of Medicare and not Part B. Three months into coverage, he applies for a
    Medicare supplement policy. Which of the following is true?



    A The insurer cannot deny coverage
    but can raise premium amounts.

    B
    The insurer can deny coverage.

    C The application must be approved
    by the state department of insurance.

    D The insurer cannot exclude
    pre-existing conditions from coverage for six months.
    • Under the Omnibus Budget
    • Reconciliation Act (OBRA) of 1990, Medicare Supplement insurance may not be
    • denied on the basis of an applicant's health status, claims experience, or
    • medical condition during the first six months after a Medicare beneficiary age
    • 65 or older first enrolls in Part B of Medicare. This is referred to as the
    • "open enrollment period." In this case, the insured was enrolled in
    • Part A coverage, so this law would not apply.
  4. 15.
    Which of the following is NOT covered under a "core" policy,
    Plan A in Medigap insurance?
    • A The 20% Part B coinsurance amounts
    • for Medicare approved services.

    • B The first three pints of blood
    • each year.

    • C
    • The Medicare Part A deductible.

    • D Approved hospital costs for 365
    • additional days after Medicare benefits end.



    • Medicare Supplement Plan A provides
    • the core, or basic, benefits established by law. All of the above are part of
    • the basic benefits, except for the Medicare Part A deductible, which is a
    • benefit offered through nine other plans.
  5. 16.
    For how many days of skilled nursing facility care will Medicare pay
    benefits?

    A 60

    B 90

    C
    100

    D 30
    • Treatment
    • in a skilled nursing facility is covered in full for the first 20 days. From
    • the 21st to the 100th day, the patient must pay the daily copayment. There are
    • no Medicare benefits provided for treatment in a skilled nursing facility
    • beyond 100 days.
  6. 17.
    If a person is disabled at age 27 and meets Social Security's definition
    of total disability, how many work credits must he/she have earned to receive
    benefits?

    A 6 credits

    B 40 credits

    C
    12 credits

    D 20 credits
    • Persons disabled between ages 24 and
    • 31 can qualify for benefits if they have credit for having worked half of the
    • time between age 21 and the start of the disability. For example, if Joe
    • becomes disabled at age 27, he would need 12 credits (or 3 years worth) out of
    • the prior 6 years (between ages 21 and 27).
  7. 18.
    A Medicare SELECT policy does all of the following EXCEPT



    A Provide payment for full coverage
    under the policy for covered services not available through network providers.

    B Provide for continuation of
    coverage in the event that Medicare SELECT policies are discontinued due to the
    failure of the Medicare SELECT program.

    C
    Prohibit payment for regularly covered services if provided by non-network
    providers.

    D Make full and fair disclosure in
    writing of the provisions, restrictions, and limitations of the Medicare select
    policy to each applicant.
    • A
    • Medicare SELECT policy issued in this state must not restrict payment for
    • covered services provided by non-network providers if the services are for
    • symptoms requiring emergency care and it is not reasonable to obtain such
    • services through a network provider.

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