-
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.
-
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.
-
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.
-
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.
-
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.
-
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).
-
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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