Brain Teasers

  1. The                                     provision provides that a policy covering a person as an employee will pay claims up to its limits and a policy covering the same person as a dependent will pay for expenses beyond those limits.
    coordination of benefits
  2. If a person is covered by policy A for up to $5,000 and by policy B for up to $3,000, and has a $6,500 claim for covered expenses, the primary policy will pay           and the secondary policy will pay               if each has a coordination of benefits provision.
    • $5000
    • $1,500
  3. Teaser #2 1. If the employees pay a portion of the premium, the plan is a                  plan and at least             must participate.
    • contributory 
    • 75%
  4. If the employer pays all of the premium, the plan is a                       plan and at least         % of the employees must participate.
    • noncontributory 
    • 100%
  5. The period of time before a new employee may be eligible for coverage is the                      period.
  6. 4. The initial period during which an employee may enroll in a contributory plan is the                  period.
  7. COBRA allows a person to continue group benefits for        months after his employment is terminated.
  8. COBRA provides that a widow of an insured employee may continue her group coverage for up to      months.
  9. A                  policy covers all group members without identifying them or providing certificates of insurance for them.
  10.          specialize in preventive health care.
  11. Under an HMO            model, doctors are employees of the HMO. 
  12. When Z visits a doctor at his HMO, he must pay a $15 fee, called a                    , per visit.
  13. A       provides a reduced level of benefits if care is obtained from a nonparticipating provider.
  14.                               policies cover the cost of hospital, surgery, and physician care.
    Medical expense
  15.                  policies cover accidental loss of life or limb.
  16.                        policies cover loss of income due to illness and/or injury. 
    Disability income
  17. Monthly or weekly income paid to a disabled person is called an                            .
  18. Generally, disability income policies cover only                   disabilities. 
  19. If a worker suffering a back injury is able to continue working but unable to perform all of his regular functions, he would receive benefits if his policy provided coverage for a                       disability.
  20. The maximum benefit offered for a partial disability is generally            of the total disability benefit.
  21.                                    benefit will pay for lost income if the loss is above a certain percentage of the income earned by working before the disability.
    A residual disability income
  22. The benefit period for short-term disability policies is generally no more than       year.
  23. If an insured has an auto accident, is disabled for six months, returns to work for three weeks, and then is unable to continue working due to his injuries from the auto accident, he would not have a waiting period for the second disability due to the                   disability provision in his policy.
  24. Insurers generally offer to provide disability income equal to no more than            of the insured’s lost income.
  25. Disability income policies offer to replace a percentage of                         income.
  26. If an insured earns $800 a month in salary and $300 a month from a rental property, his disability income indemnity would be a percentage of              .
  27. If a person is injured and takes two hours off from work to go to a hospital or physician, he could receive benefits if his policy contained a                      injury benefit.
  28. A                                    rider waives premiums while the person paying the premiums for a juvenile policy is disabled.
    payor waiver of premium
  29. There is generally a                month waiting period for the waiver of premium and disability income riders.
    3- to 6-
  30. The                          sum is the amount paid in the event of accidental death.
  31. The                  sum is the maximum amount paid in the event of accidental dismemberment. 
  32. If a life policy has a face amount of $20,000 and an accidental death benefit rider, the insured’s beneficiaries will collect                       if he is killed in an automobile accident.
  33. If the principal sum of an AD & D policy is $20,000, generally                   would be paid for a multiple dismemberment.
  34. If the principal sum is $20,000, $10,000 would generally be paid for a single dismemberment                      .
  35. If a policy will pay up to $175 per day on an expense-incurred basis and the insured is hospitalized for 10 days, he will receive            if he is charged $125 per day or                if he is charged $200 per day.
    • $1,250 
    • $1,750
  36. If a policy offers to pay usual, customary or reasonable charges for a semi-private room and such charges would total $150 per day, the insured will receive           if he chooses a private room for 10 days at a cost of $250 per day.
  37. Room and board and general nursing are covered by the                       benefit. 
    daily hospital
  38. The                  period is the number of days of hospital confinement covered by a policy.
  39. Covered hospital costs not included in the daily room charge are called                     or                       hospital expense benefits.
    • “ancillary”
    •  “miscellaneous”
  40. A policy has a $150 daily hospital expense benefit with a 90-day benefit period, and a miscellaneous hospital expense benefit of 10 times the daily hospital expense benefit; if the insured were hospitalized for 60 days and had miscellaneous expenses of $4,000, he would receive           for daily hospital expense and            for ancillary benefits
    • $9,000
    • $1,500
  41. The cost of surgery is covered by a              expense benefit.
  42. A surgical schedule which assigns a unit value, rather than a dollar amount, to each surgical procedure is called a                          schedule.
    relative value
  43. In a relative value schedule, the              factor is expressed as a dollar amount and based on geographic area.
  44. If an operation has a unit value of 60 and a conversion factor of $40, the policy would pay                  for that operation.
  45. The                      provision provides that expenses incurred in the last three months of the year may be applied to the deductible the following year.
Card Set
Brain Teasers
Nevada Health Insurance Basics and Beyond-Health-Group Insurance and sources of Healthcare/Disability Income Insurance/AD&D and Medical Expense Policies