1. 13 Qizz
  2. Which of the following statements is not correct regarding the FMLA?
    - Employee must provide two week advance notice for foreseeable events.
  3. Which of the following programs is designed to protect children of low income parents?
    - Healthy families program
  4. Concerning maternity leave under California law
    - Pregnancy disability leave requires that the employee's position be held during allowable time.
  5. Under the COBRA, a qualifying event ensures that an employee who is covered can:
    - Elect to continue coverage as is. bi 5
  6. Which of the following plans is an employer funded plan?
    - HRA
  7. Up to how many weeks of leave does FMLA allow eligible employees to take after the birth of a child?
    -12 weeks in a 12 month time frame.
  8. Which of the following is incorrect concerning group insurance?
    • -In group disability income location is not a factor.
    • All of the above are true
  9. Group insurance policies are issued to the following trusts except:
    -Associations that insure at least 5 members. B 8
  10. Group insurance in which the employees contribute 100% of the premium are called:
    -Contributory b 9
  11. COBRA qualifying events for spouses would be all of the following except
    -Death of covered child
  12. The differences between COBRA and Cal-COBRA apply to all of the following except
    -COBRA and Cal-COBRA both offer continuation of benefits to employees for 18 months and dependents for 36 months. 10
  13. Under HIPAA creditable coverage rules which of the following does not apply?
    -Regardless of creditable coverage the maximum preexisting waiting period is 6 months. 11
  14. California defines a small group as one that has:
    - 2-50 employees 12
  15. Medical benefits provided under the terms of the plan and available with COBRA include all except 13
    - Life and long-term care insurance.
  16. Which of the following is eligible for the health care tax credit for small employers?
    -Employers that have fewer than 25 full-time equivalent employees and pay wages averaging less than $50,000 per employee per year
  17. Group or individual policies providing dependent coverage must provide benefits for dependents
    -All of these are true statements.
  18. An employee benefit that allows an employee to deposit a certain amount of his/her paycheck into an account before paying taxes to cover eligible health care and dependent care expenses is
    -FSA (Flexible Spending Account)
  19. California defines a large group as a group with:
    -51 or more employees
  20. All of the following could be reasonable accommodations foran ADA qualified employee except:
    -Job restructuring, modifying work schedules, and increased compensation.
  21. All of the following statements about eligibility for the health care tax credit for small employers is correct,except
    -Only for-profit firms qualify for the tax credit.
  22. All of the following are elements to qualifying for COBRA benefits except:
    -Qualified time frame
  23. Qiz 14
  24. Modified Adjust Gross Income 19=64 The new health reform law extends Medicaid coverage to what population with Modified Adjust Gross Incomes (MAGI) below 133% of the federal poverty level?
    -All adults under age 65
  25. What employers are exempt from ACA's mandate to offer health insurance to their employees?
    -employers with fewer than 50 full-time employees
  26. What is the primary criterion that qualifies an individual for premium tax credits through an exchange?
  27. What term refers to health plans that are certified and available through an exchange?
    -qualified health plans (QHPs)
  28. Every qualified plan offered through an exchange is categorized according to a metal level: bronze, silver, gold, or platinum. This metal tier/level is a reflection of:
    -the percentage of essential health benefits costs the plan will pay
  29. The Patient Protection and Affordable Cost Act (PPACA) does not
    -Requires all health plans to cover preventive services without out-of-pocket expense
  30. ALL of the following qualify as providing minimum essential coverage EXCEPT-
    -critical illness plan
  31. When referring to individual exchange plans, the term cost-sharing includes all of the following except:
    -the plans premium
  32. The goal of reporting medical loss ratios is for more premium dollars to go to
    -clinical care
  33. Which of the following is designed to make health insurance more affordable and accessible to small businesses?
    -Small Business Health Options Program (SHOP)
  34. The functions of a health insurance exchange include all of the following EXCEPT.
    -license and regulate the activities of health insurance agents and producers
  35. Annual dollar limits on essential health benefits will not be permitted for plan years starting after January 1,
    - 2014
  36. Starting in 2014, those without acceptable health insurance must
    -pay a fee
  37. As of January 1, 2010 insurers must provide a rebate to enrollees if the insurer's medical loss ratio fails to meet.
    -The minimum requirements of 85% in large group and 80% in small group or individual market.
  38. The PPACA (Affordable Cost Act) allows young adults to stay on their parents employer plan only if:
    • 3 Financially dependent on their parents, In school, They are not married
    • - All of these answers are true
  39. Sally purchased a new individual health policy for herself and her 13 year old child who has a history of asthma on October 1, 2010. She is hospitalized for an asthma attack on December 1, 2010. The coverage can't be denied because
    -All of these are reasons coverage cannot be denied.
  40. What type of consumer are SHOP programs designed to serve?
    -small employers
  41. For plan years beginning in 2015, individual eligibility for premium tax credits with an exchange requires all of the following except:
    -The individual must be eligible for minimum essential coverage.
  42. When compared to other tiered qualified health plans (QHPs) the catastrophic plan available through an exchange has:
    -higher out-of-pocket expenses for the insured
  43. What term is used to refer to the comprehensive set of minimum core benefits that all qualified health plans must provide?
    -essential health benefits (EHBs)
  44. What is the 80% MLR, also referred to as the 80/20 rule imposed on insurers by the Affordable Care Act?
    -Insurers must spend at least 80 percent of the premiums they receive on medical expenses, health care, and quality improvement; only 20 percent can be directed to other costs. 37
  45. Which of the following is not one of the three major functions of the Federal law concerning Health Care Exchanges?
    -Serve as one of the places where federal tax credits may be used to purchase health coverage.
  46. 15 Qiz
  47. Eligible individuals who enroll in Medicare Part B can also purchase a Medicare supplement (Medigap) policy under what conditions?
    - A 6-month open enrollment sign-up period and generally no policy coverage exclusions or add-on policy pricing due to the individual's current health status
  48. What is one of the main goals of health care reform (PPACA) with regards to Medicare?
    -Reduce and control costs
  49. All of the following qualify for Medi-Cal except:
    -Those who are partially blind
  50. Which of the following would be a Part B Medicare exclusion?
    -Long-term care over 100 days per benefit period.
  51. Who can qualify for Medicare supplements?
    -Anyone who qualities for Medicare and is willing to pay the fee
  52. Which of the following would not be eligible for Medicare benefits?
    -A 69 year old whose spouse is 61, with a work record that is eligible.
  53. Medicare coverage is generally available to those individuals
    -Age 65 or over, certain disabled individuals, and those persons with ALS or ESRD
  54. A marketing method that fails to disclose that the purpose of the marketing method is to sell insurance and that contact will be made by an agent or insurer is illegal when selling in the senior market. This marketing method is known as
    -Cold lead method of advertising.
  55. Which of the following may be offered by an insurer offering Medicare supplements?
    -Core benefit plan without additional benefits.
  56. Which of the following health care plans are offered under Medicare Advantage?
    • Health maintenance organization (HMO) plan
    • Preferred provider organization (PPO) plan
    • & Private fee-for-service (PFFS) plan
    • All of the answers are correct
  57. Physicians who do not accept assignment under Medicare rules and regulations are
    -limited by law to charge no more than 115% of the Medicare-approved amount for a particular medical service
  58. Part C also known as Medicare Advantage provides Medicare beneficiaries the choice of services provided by which of the following?
    • PPOs & Provider-sponsored organizations (PSOs)HMOs
    • - All of the above
  59. All of the following are exclusions of Part A Medicare except:
    - The three pints of blood every 24 months.
  60. Which of the following is considered an optional service under Medi-Cal?
    -Nursing home care for adults over 65
  61. Services of physicians and surgeons provided in a hospital or elsewhere:
    -Are covered by Medicare Part B with a premium charge.
  62. Which Part or Parts of Medicare have a deductible that the Medicare beneficiary must pay before benefits are payable?
    -Part A, B, and D
  63. All of the following are incorrect regarding Part A of Medicare except
    -Monthly premium is free.
  64. An insured who wants to appeal a claim denial can do all the following except
    -Appear in person at a hearing for all claims under $100.
  65. All of the following statements about Medicaid are true except:
    • -Medicaid is financed solely by the federal government. 57
    • All of the following are required services under Medi-Cal except:
    • -TB tests 58
  66. Which Medicare components are considered mandatory and traditional?
    -Part A only
  67. Which Part of Medicare is not optional?
    -Part A
  68. Which Medicare supplemental policy costs the most?
    -Plan J
  69. Which of the following statements about Medicare Part D is NOT correct?
    -Coverage is available only from stand-alone plans.
  70. The requirement that the Medicare beneficiary be covered by both Part A and Part B applies to
    -Both are true statements.
  71. When a senior cannot afford a Medicare Supplement which program will pay for the expenses not covered by Medicare?
  72. Which of the following is not a Medicare enrollment period?
    -All of these are enrollment period for Medicare.
  73. Medicare supplement policies include a core package of benefits that include all of the following except
    -The Part B co-payment amount is $252
  74. A producer must comply with certain standards of ethical conduct when soliciting potential clients for Medicare supplement policies. These standards of conduct include
    - Non-duplication of existing policyholder Medigap coverage and care in not selling policies to existing Medicare Advantage policyholders
  75. Which of the following is not a covered service of Part B of Medicare?
    -Physician and surgeon services
  76. All of the following are required services under Medi-Cal except:
  77. - TB tests
  78. Which Medicare components are considered mandatory and traditional?
    -Part A only
  79. Medicare supplement policies include a core package of benefits that include all of the following except:
    The Part B co-payment amount is $252
  80. A general description of Medicare supplement policy premiums would state that
    -actual premiums for the same benefits from company to company can vary widely; it's always a good idea for a prospective consumer to compare a reasonable number of available plans in his locale before finally deciding on one
  81. Which of the following is not provided by hospice care?
  82. Select the statement that most accurately describes Medicare eligibility
    -Someone who is 65 and will pay a premium, but is not eligible for Social Security.
  83. Under health care reform, the Medicare Part D coverage gap (donut hole) will be phased out completely by
  84. Under Medicare Part B, the Medicare beneficiary must:
    -Pay 20% of covered charges above the deductible and there is no stop loss.
  85. Which of the following is not a difference between Medi-Cal and Medicare?
    -Administered by using CMS vs. administered by using federal government
  86. Concerning Medicare supplement policies which of the following statement is not true?
    -Medicare supplement policies require Medicare beneficiaries to use a network of pre-selected providers 76
  87. Which component of Medicare would pay for a hospital stay?
    -Part A
  88. Original Medicare consisted of:
    -Part A and B
  89. 16- Qiz
  90. The Notice of Claim provision in a disability policy says all of the following except:
    -The insured must submit proof of disability every year for disabilities that last over 6 months.
  91. All of the following statements about partial disability are true except:
    -The benefit amount for a partial disability is usually the same as that for total disability
  92. Morbidity tables are used by insurance companies to calculate:
    -The likelihood of sickness.
  93. Each of the following are levels of severity for temporary disability except
    -Modified Total
  94. What is the purpose of the recurrent disability provision?
    -To do away with the elimination period in case of a relapse
  95. Which of the following statements about federal income tax is not true?
    -Premiums are tax deductible if the insured pays the premium.
  96. Which of the following statements is false regarding disability income policies?
    -Three methods are used to determine the amount of benefits payable to the insured.
  97. What disability rider provides increases in coverage for specific periods of time?
    -Automatic Increase Rider
  98. A disability resulting from war or any military duty is covered by:
    -None of the above
  99. All of the following are disability rating factors except
    - Family health history
  100. What is a Capital Sum Benefit on disability policies?
    -Pays a lump sum benefit for certain specified loss.
  101. Disability income policies differ in premium, underwriting standards and the policy itself by:
    • The elimination period required
    • The definition of total disability
    • Whether or not coverage is provided in addition to workers compensation
    • - All of these
  102. The following are guidelines that help avoid unfair underwriting for the risk of HIV/AIDS except:
    -The insurer cannot deny coverage based solely on results from two different medical samples.
  103. Disability insurance is similar to life insurance because they both
    -protect future income.
  104. All of the following are true about the Cost of Living Rider (COLA)except:
    -COLA rider is the best rider, because it doesn t have a maximum cap and always increases.
  105. Under the residual disability provision, an insured receives:
    -a percentage of his or her disability benefit based on the percentage of income loss.
  106. What is the definition of own occupation?
    - Inability to work at your regular occupation.
  107. When a client completely loses his speech, hearing and sight and the use of both hands, both feet or one hand and one foot, it is known as.
    -Presumptive disability
  108. Which of the following statements is TRUE?
    - Disability underwriters are given a lot of leeway when dealing with preexisting conditions.
  109. What type of individual disability insurance would offer a guaranteed future premium?
    -Non-cancelable policy
  110. What provision in disability allows an insurer to pay no benefits for 30 days?
    -Both Elimination and Waiting Period are correct
  111. Which of the following statements about the MIB it’s not true?
    - Insurance companies may use MIB reports to decline a policy.
  112. Disability income insurance provides income to an insured who is:
    -unable to work because of sickness or injury.
  113. What are four key risk factors underwriters consider before issuing a policy?
    -Occupation, health, income, and age
  114. Workers Compensation policies provide:
    -Compensation for work-related injuries without regard to fault or negligence
  115. What is the purpose of the residual benefit provision?
    -To make up income that cannot be earned due to a permanent partial disability
  116. Partially disabled means that as a result of the injury or sickness you are:
    -able to perform all duties of your own occupation only on a part time basis.
  117. Disability income benefits are a percentage of which of the following?
    -Earned income
  118. Qiz 17
  119. Qualified long-term insurance policies are entitled to special tax advantages under
    -both federal law and California law
  120. Insurers must offer inflation protection for all of the following types of LTC policies except:
    -Life insurance policies with LTC riders
  121. Which one of the following would not be a trigger of benefit under a LTC policy?
  122. Long term care is especially needed when an elderly person requires assistance with activities of daily living due to:
    -Physical or cognitive impairments
  123. Which of the following would not be a common LTC exclusion?
    -Alzheimer illness
  124. Long-term care services are typically divided into four categories except:
    -Adult hospital care
  125. Once the elimination period in a long term care policy has been met which of the following periods would begin?
    -Benefit period
  126. An agent replaces a long-term care insurance policy for one of her clients. The new policy materially improves the insured's benefits, but the annual premium increases from $2,500 to $3,500. The replacing insurer may pay the agent the full first-year commission rate on what amount?
  127. Most LTC policies are known as all the following except:
    -Medical Triggers
  128. Each of the following benefits are available with a LTC policy except:
    - In-Patient Hospital Care
  129. Attempting to void a long-term care policy after a claim has been made rather than eliminating applicants in the underwriting process Is the illegal practice of
    • known as:
    • -Post-selection underwriting
  130. Which of the following would not be considered an ADL or a trigger for LTC benefits?
    -person cannot walk and can only get around in a wheel chair.
  131. Which of the following is NOT a requirement of a tax-qualified, long-term care policy?
    -The insured's physical impairment must be expected to last at least 30 days for benefits to be paid.
  132. Long term care policies must contain which of the following provisions?
    -Guaranteed renewability
  133. Which of the following statements ts correct?
    -Annuities do not pass tax-exempt however life insurance does.
  134. LTC Non-forfeiture provisions can apply based on all of the following except:
    -Reduced Paid Up
  135. Which of the following statements best describes a nursing home?
    -It provides professional health-care services around the clock in the most cost-efficient manner.
  136. Asset protection under Medi-Cal is a feature of which of the following types of long-term care policies?
    -Partnership policies only
  137. Which of the following is not a non-forfeiture provision for LTC?
    -Annual Renewable Term
  138. Under what law or laws would qualified long term care policies receive special tax treatment?
    -Both California and Federal law
  139. Which of the following statements about qualified long-term care insurance policies is FALSE?
    -The benefit triggers under qualified long-term care policies are the same as under nonqualified policies.
  140. Policy premiums vary according to each of the following except
    -Past health conditions
  141. Which category of LTC services provides the highest level of service?
    -Nursing Home Care
  142. Formal care delivered in the home that is designed to provide custodial care and assistance with activities of daily living would be considered which type of care?
    -Home care
  143. Who would be the most likely candidate for purchasing a LTC policy?
    -Those who have the resources to pay the premiums
  144. HICAP stands for:
    -Health Insurance Counseling Advocacy Program
  145. In California, which program provides free counseling to individuals and families about long term care, Medicare, and other health care issues and programs available for seniors?
  146. HICAP provides all the following except:
    -Medicare financial assistance
  147. The purpose of the Long-Term Care Insurance Personal Worksheet is primarily to determine
    -whether an applicant's purchase of LTC insurance meets the insurer's suitability standards
  148. All of the following are ways to issue LTC contracts except:
    -Endorsement/Rider to the Medicare supplement.
  149. Which of the following is not a non-forfeiture provision for LTC?
    -Annual Renewable Term
  150. Under what law or laws would qualified long term care policies receive special tax treatment?
    -Both California and Federal law
  151. Which of the following statements about qualified long-term care insurance policies is FALSE?
    -The benefit triggers under qualified long-term care policies are the same as under nonqualified policies.
  152. The most important benefit of the California Partnership Program is:
    -the insured can apply for Medicaid benefits.
  153. Aperson who is NOT self-employed may deduct the premiums for qualified long-term care insurance as a medical expense
    - only if the person itemizes deductions, and the person's deductible medical expenses exceed 10% of adjusted gross income, seniors 7.5% until 2016
  154. Which\s not a reason for someone to buy a long-term care policy?
    -40 percent of people will be in a nursing home before they're eligible for Medicare.
  155. California Partnership for Long-term Care policies does all the following except:
    -The insurer may deduct paid out benefits from their state income tax.
  156. Which of the following is not one of the three general classes of long-term care policies that may be sold in California?
    -adult day care only
  157. What is the definition of inflation protection with a LTC policy?
    -Insurers offer policyholders the option to increase benefits without evidence of insurability.
  158. All of the following are true about HICAP except:
    -HICAP providers information and counseling solely about the Medicare program.
  159. Most long term care expenses are paid by:
    -Medicaid (Medi-Cal)
  160. When an agent solicits a sale of long-term care insurance, the outline of coverage must be delivered to the applicant
    -before the presentation of an application or enrollment form
Card Set
Test 13-17