Health Policies Part 2

  1. 12.
    Which of the following riders would NOT increase the premium for a

    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


    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.

    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

    A 60

    B 90


    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

    A 6 credits

    B 40 credits

    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.

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

    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.
Card Set
Health Policies Part 2