health Insurance 3

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Author:
skarlet90
ID:
77636
Filename:
health Insurance 3
Updated:
2011-04-05 19:02:13
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Health Insurance
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Health Ins
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  1. 19. Which one of the following is an eligibility requirement
    for Social Security disability income benefits?

    A Experiencing
    at least one year of disability

    B Being
    at least 50 years of age

    C Currently
    employed status

    D. FULLY
    insured status
    • Social Security Disability benefits are
    • available only if the worker is "fully insured". Benefits are
    • provided only after a five-month waiting period.
  2. 20. Which type of
    Medicare policy requires insureds to use specific healthcare providers and
    hospitals, except in emergency situations?

    A Preferred


    B SELECT


    C Limited


    D HMO
    • 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. 21. Sarah becomes
    disabled at age 22 and can no longer work. She meets the definition of total
    disability under Social Security. What other requirement must Sarah have met to
    receive Social Security disability benefits?

    A Sarah
    must have accumulated 40 work credits

    B Sarah
    need not have accumulated any work credits because she is under 24 years old


    C SARAH
    MUST HAVE ACCUMULATED 6 WORK CREDITS IN THE PAST 3 YEARS

    D Sarah
    must have accumulated 20 work credits in the past 10 years
    • To qualify for disability
    • benefits under Social Security, the disabled person must have earned a certain
    • amount of work credits. A maximum of 4 work credits can be earned each year.
    • The amount of credits required varies by age. Persons disabled before the age
    • of 24 can qualify for Social Security Benefits with only 6 work credits earned
    • in the 3 years prior to the start of the disability.
  4. 22. In order for an insured under Medicare Part A to receive
    benefits for care in a skilled nursing facility, which of the following
    conditions must be met?

    A THE
    INSURED MUST HAVE FIRST BEEN HOSPITALIZED FOR 3 CONSECUTIVE DAYS.


    B The
    insured must have a Medicare supplement insurance policy.

    C There
    is no benefit provided under Medicare Part A for skilled nursing care.

    D The
    insured must cover daily copayments.
    • Part A covers the cost of care
    • in a skilled nursing facility as long as the patient was first hospitalized for
    • 3 consecutive days, and the services are medically necessary and only up to
    • amounts deemed.
  5. 23. All of the
    following statements about Medicare supplement insurance policies are correct
    EXCEPT

    A Medigap
    policies pay most, if not all, Medicare deductibles and copayments.

    B Medigap
    policies supplement Medicare benefits.

    C Medigap
    policies pay for some health care services not covered by Medicare.

    D MEDIGAP
    POLICIES COVER THE COST OF EXTENDED NURSING HOME CARE.
    • Medigap
    • policies do not cover the cost of extended nursing home care.
  6. 24. An insured has a
    primary group health plan and an excess plan, each covering losses up to
    $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or
    deductibles how much will the excess plan pay?

    A $15,000


    B $10,000


    C $7,500


    D $5,000
    • Once the primary plan has paid its full promised
    • benefit, the insured submits the claim to the secondary, or excess, provider
    • for any additional benefits payable.
  7. 25. A family medical expense policy
    must generally do all the following EXCEPT

    A Continue
    to cover any children after age 19 who are still dependent upon their parents
    because of a mental or physical handicap.

    B CONTINUE
    TO COVER ANY CHILDREN WHO ARE REMAIN LIVING AT HOME AFTER THEY REACH THE
    MAXIMUM AGE STIPULATED BY THE POLICY.

    C Cover
    any adopted children on the same basis as a newborn.

    D Cover
    any newborn children as long as proper notification has been given.
    • Once children turn 19 (23 for full-time
    • students), those children cannot remain on the family plan, but they do have
    • the right to convert to their own individual plan.
  8. 26. Disability income
    coverage specifies that the policy covers the insured if he is unable to
    perform any job for which he is qualified. In this case, total disability is
    defined as

    A Any
    occupation - less restrictive than other definitions.

    B Own
    occupation - more restrictive than other definitions.

    C Own
    occupation - less restrictive than other definitions.

    D ANY
    OCCUPATION - MORE RESTRICTIVE THAN OTHER DEFINITIONS.
    • If total disability is defined
    • as any occupation, it means the coverage will apply only if the insured cannot
    • find any means of income whatsoever. This is more strict than own occupation,
    • where a person merely has to prove that they cannot perform the job for which
    • they were previously trained.
  9. 27. Disability income
    policies can provide coverage for a loss of income when returning to work only
    part-time after recovering from total disability. What is the benefit that is
    based on the insured's loss of earnings after recovery from a disability?

    A Recurrent
    disability

    B Partial
    disability

    C Income
    replacement

    D RESIDUAL
    DISABILITY
    • A residual disability will pay
    • an amount to make up the difference between what the insured would have earned
    • before the loss.

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