Insurance MCQ

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Showing posts from January, 2021

Which of the following is normally NOT included on the monthly enrollment list?

Which of the following is normally NOT included on the monthly enrollment list? Answer: The name of the employer

Providers bill patients for services not covered by the cap rate under a(n):

Providers bill patients for services not covered by the cap rate under a(n): Answer: Capitated contract

Which of these is the best method for determining if a patient is eligible for services?

Which of these is the best method for determining if a patient is eligible for services? Answer: Verify the patient's insurance coverage

Careful attention must be paid to _____ when the practice has a capitated contract.

Careful attention must be paid to _____ when the practice has a capitated contract. Answer: Encounter reports and referral requirements | Patient eligibility and claim write offs | Referral requirements and billing procedures (All of these are correct)

Eligible members of a capitated plan are listed on the:

Eligible members of a capitated plan are listed on the: Answer: Monthly enrollment list

In submitting paper claims, the best practice is to:

In submitting paper claims, the best practice is to: Answer: Check with each payer for specific information required on the form as well as the NUCC notes

Which of the following is a method a practice can use to avoid major problems with payers?

Which of the following is a method a practice can use to avoid major problems with payers? Answer: Use good communication skills in working with payers

What is the electronic format used to verify benefits?

What is the electronic format used to verify benefits? Answer: HIPAA 270/271

Which of the following steps comes second in the standard medical billing cycle?

Which of the following steps comes second in the standard medical billing cycle? Answer: Establish financial responsibility for a visit

Which of the following steps comes after checking billing compliance in the standard medical billing cycle?

Which of the following steps comes after checking billing compliance in the standard medical billing cycle? Answer: Prepare and transmit claims

Which of the following describes a consultation?

Which of the following describes a consultation? Answer: A physician examines the patient at the request of another physician and provides report to requesting physician

A repricer is a company that:

A repricer is a company that: Answer: Works for a health plan and sets the discounts for out-of-network visits

Which of the following steps comes first in the standard medical billing cycle?

Which of the following steps comes first in the standard medical billing cycle? Answer: Preregister patients

Name the electronic format used to obtain approval for preauthorization's and referrals.

Name the electronic format used to obtain approval for preauthorization's and referrals. Answer: HIPAA 278

What billing information is summarized by the plan summary grid?

What billing information is summarized by the plan summary grid? Answer: Patient financial responsibility, billing information, and referral requirements

What entity generally hires a URO to evaluate the medical necessity of planned procedures?

What entity generally hires a URO to evaluate the medical necessity of planned procedures? Answer: Payer

Elective surgical procedures are done on a(n):

Elective surgical procedures are done on a(n): Answer: Both in-patient and out-patient basis

What should be prepared or updated for each participation contract?

What should be prepared or updated for each participation contract? Answer: Plan summary grid

What constitutes a silent PPO?

What constitutes a silent PPO? Answer: An MCO that does not have a contract, but purchases a list of participating providers with another plan and pays their enrollees' claims according to that contract's fee schedule

What is precertification?

What is precertification? Answer: Preauthorization for hospital admission or outpatient procedures

What might private payers use for a major course of treatment, such as surgery, chemotherapy, and radiation for a patient with cancer?

What might private payers use for a major course of treatment, such as surgery, chemotherapy, and radiation for a patient with cancer? Answer: URO

Identify the additional component that should be included in a contract when a payer's fee schedule is based on the MPFS.

Identify the additional component that should be included in a contract when a payer's fee schedule is based on the MPFS. Answer: Which year's MPFS is going to be used

A physician practice lists a service at $130, but in the participating contract it has with a payer, the service is listed at $95. Calculate the amount that the practice will need to write off if balance billing is not permitted.

A physician practice lists a service at $130, but in the participating contract it has with a payer, the service is listed at $95. Calculate the amount that the practice will need to write off if balance billing is not permitted. Answer: $35

A plan pays 50 percent of the provider's usual charge and requires the copayment of $5 to be applied toward the provider's payment. Calculate what the plan pays the provider when the usual charge is $200?

A plan pays 50 percent of the provider's usual charge and requires the copayment of $5 to be applied toward the provider's payment. Calculate what the plan pays the provider when the usual charge is $200? Answer: $95

A plan pays 75 percent of the provider's usual charge and requires the copayment of $15 to be applied toward the provider's payment. Calculate what the plan pays the provider when the usual charge is $380?

A plan pays 75 percent of the provider's usual charge and requires the copayment of $15 to be applied toward the provider's payment. Calculate what the plan pays the provider when the usual charge is $380? Answer: $270

What type of surgery is a procedure that can be scheduled ahead of time, but which may or may not be medically necessary?

What type of surgery is a procedure that can be scheduled ahead of time, but which may or may not be medically necessary? Answer: Elective surgery

Which section of a managed care participation contract includes information about a claim turnaround time?

Which section of a managed care participation contract includes information about a claim turnaround time? Answer: Managed care plan obligations section

Describe the features of managed care organizations that practices review when deciding about entering a participation contract.

Describe the features of managed care organizations that practices review when deciding about entering a participation contract. Answer: Its licensure status, accreditation standing, and business history

Some managed care contracts require referrals to be made solely to:

Some managed care contracts require referrals to be made solely to: Answer: Other participating providers

Which section of a managed care participation contract covers protection against loss?

Which section of a managed care participation contract covers protection against loss? Answer: Managed care plan obligations section

What term refers to the payer's process for determining medical necessity?

What term refers to the payer's process for determining medical necessity? Answer: Utilization review

It is common for physicians to participation in more than _____ health plans.

It is common for physicians to participation in more than _____ health plans. Answer: Twenty

Which of these is the primary factor that providers examine to decide whether to participate in managed care plans?

Which of these is the primary factor that providers examine to decide whether to participate in managed care plans? Answer: The financial arrangements

Stop-loss provisions protect providers against:

Stop-loss provisions protect providers against: Answer: Extreme financial loss

Which section of a managed care participation contract covers balance-billing rules?

Which section of a managed care participation contract covers balance-billing rules? Answer: Compensation and billing guidelines section

Which section of a managed care participation contract covers referrals and preauthorization rules?

Which section of a managed care participation contract covers referrals and preauthorization rules? Answer: Physician's responsibilities section

Name the term used to describe participating providers in BCBS plans.

Name the term used to describe participating providers in BCBS plans. Answer: Member physicians

What is the nation's largest health insurer in terms of enrollment?

What is the nation's largest health insurer in terms of enrollment? Answer: WellPoint, Inc.

What type of managed care program does BCBS offer?

What type of managed care program does BCBS offer? Answer: HMO, POS, and PPO

What is the purpose of the BlueCard program?

What is the purpose of the BlueCard program? Answer: To make it easier for patients to receive treatment when outside their local service area

Identify a method that BCBS uses to improve healthcare.

Identify a method that BCBS uses to improve healthcare. Answer: Pay-for-performance programs with financial incentives

A member in an indemnity BCBS plan has an individual deductible of $500 and a family deductible of $1,000, with a coinsurance rate of 90 percent after the deductible has been met, up to an annual maximum out-of-pocket amount of $2,000. Calculate the total amount the patient owes if their first charges of the year total $2,400.

A member in an indemnity BCBS plan has an individual deductible of $500 and a family deductible of $1,000, with a coinsurance rate of 90 percent after the deductible has been met, up to an annual maximum out-of-pocket amount of $2,000. Calculate the total amount the patient owes if their first charges of the year total $2,400. Answer: $1,590

A member in an indemnity BCBS plan has an individual deductible of $250 and a family deductible of $500, with a coinsurance rate of 70 percent after the deductible has been met, up to an annual maximum out-of-pocket amount of $1,000. Calculate the total amount the patient owes if their first charges of the year total $3,200.

A member in an indemnity BCBS plan has an individual deductible of $250 and a family deductible of $500, with a coinsurance rate of 70 percent after the deductible has been met, up to an annual maximum out-of-pocket amount of $1,000. Calculate the total amount the patient owes if their first charges of the year total $3,200. Answer: $1,000

Which term describes the periodic verification that a provider or facility meets professional standards?

Which term describes the periodic verification that a provider or facility meets professional standards? Answer: Credentialing

Identify an insurance service that private payers supply.

Identify an insurance service that private payers supply. Answer: Processing claims

BlueCross and BlueShield companies also offer a consumer-driven health plan called:

BlueCross and BlueShield companies also offer a consumer-driven health plan called: Answer: Flexible Blue

Identify the local BCBS plan in the provider's service area, where a claim is submitted after providing treatment.

Identify the local BCBS plan in the provider's service area, where a claim is submitted after providing treatment. Answer: Host plan

A patient's _____ processes the BCBS claim and sends it back to the host plan.

A patient's _____ processes the BCBS claim and sends it back to the host plan. Answer: Home plan

Identify why the best situation for medical practices is an integrated CDHP in which the same plan runs both the HDHP and the funding options.

Identify why the best situation for medical practices is an integrated CDHP in which the same plan runs both the HDHP and the funding options. Answer: Reduced paperwork

A member of a CDHP has an HSA fund of $820 and a deductible of $500 (which has not yet been met), and the HDHP has a 75-25 coinsurance. Calculate the total amount this patient would owe if the bill for their services is $2,100.

A member of a CDHP has an HSA fund of $820 and a deductible of $500 (which has not yet been met), and the HDHP has a 75-25 coinsurance. Calculate the total amount this patient would owe if the bill for their services is $2,100. Answer: $1,515

A member of a CDHP has an HSA fund of $500 and a deductible of $1,000 (which has not yet been met), and the HDHP has a 80-20 coinsurance. Calculate the total amount this patient would owe if the bill for their services is $1,800.

A member of a CDHP has an HSA fund of $500 and a deductible of $1,000 (which has not yet been met), and the HDHP has a 80-20 coinsurance. Calculate the total amount this patient would owe if the bill for their services is $1,800. Answer: $1,560

Determine which of the following criteria is important for payment under a CDHP.

Determine which of the following criteria is important for payment under a CDHP. Answer: Educating patients about their financial responsibility at the time of service

Which type of consumer-driven health plan funding option is set up and funded by employers?

Which type of consumer-driven health plan funding option is set up and funded by employers? Answer: A health reimbursement account (HRA)

Which type of consumer-driven health plan funding option can be funded by both employers and employees?

Which type of consumer-driven health plan funding option can be funded by both employers and employees? Answer: A flexible savings account (FSA)

A consumer-driven health plan combines a savings option and what kind of health plan?

A consumer-driven health plan combines a savings option and what kind of health plan? Answer: High deductible

Which type of consumer-driven health plan funding option is set up by individuals rather than employers?

Which type of consumer-driven health plan funding option is set up by individuals rather than employers? Answer: A health savings account (HSA)

Name the structure that emphasizes communication among the patient's physicians.

Name the structure that emphasizes communication among the patient's physicians. Answer: Medical home model

Identify the type of managed care structure that is usually the first component of a consumer-driven health plan.

Identify the type of managed care structure that is usually the first component of a consumer-driven health plan. Answer: Preferred provider organization (PPO)

What type of plan is a hybrid of two networks where members may choose from a primary or secondary network?

What type of plan is a hybrid of two networks where members may choose from a primary or secondary network? Answer: Point-of-service (POS) plans

Which is the most appropriate method in handling the termination of patients within an HMO?

Which is the most appropriate method in handling the termination of patients within an HMO? Answer: The PCP asks the payer for permission, then sends a certified letter to the patient, and receives the signed letter back from the patient

Which of the following could represent a member in a closed-panel HMO?

Which of the following could represent a member in a closed-panel HMO? Answer: A physician of a group with a contract with the HMO

Which of the following examples demonstrates sub capitation?

Which of the following examples demonstrates sub capitation? Answer: A capitated provider prepays an ancillary provider

What type of private payer offers lower costs, but also has the most stringent guidelines and the narrowest choice of providers?

What type of private payer offers lower costs, but also has the most stringent guidelines and the narrowest choice of providers? Answer: Health maintenance organizations (HMO's)

What type of plan requires premium, deductible, and coinsurance payments and typically covers 70 to 80 percent of costs for covered benefits after deductibles are met?

What type of plan requires premium, deductible, and coinsurance payments and typically covers 70 to 80 percent of costs for covered benefits after deductibles are met? Answer: Indemnity plans

Which of the following is the most popular type of group health plan?

Which of the following is the most popular type of group health plan? Answer: Preferred provider organizations (PPO's)

The type of payment structure that PPO's usually offer in their contracts with providers is called:

The type of payment structure that PPO's usually offer in their contracts with providers is called: Answer: Discounted fee-for-service

In conjunction with COBRA, determine what must be considered when an employee joins a new plan.

In conjunction with COBRA, determine what must be considered when an employee joins a new plan. Answer: Creditable coverage

What information is included in a formulary?

What information is included in a formulary? Answer: The list of a plan's selected drugs and proper dosages

Approximately what percent of all consumers with health insurance are enrolled in a PPO?

Approximately what percent of all consumers with health insurance are enrolled in a PPO? Answer: 50%

Define parity as it relates to medical insurance.

Define parity as it relates to medical insurance. Answer: Concept of equality with medical/surgical benefits

Explain the benefit that COBRA offers to employees who are leaving a job.

Explain the benefit that COBRA offers to employees who are leaving a job. Answer: The right to continue health coverage under the employer's plan for a limited time at his or her own expense

What name is given to the time between the date of an employee's hire and the earliest effective date of insurance coverage?

What name is given to the time between the date of an employee's hire and the earliest effective date of insurance coverage? Answer: A waiting period

A list of drugs that are covered under an insurance plan is called the:

A list of drugs that are covered under an insurance plan is called the: Answer: Formulary

Compare and contrast the following types of provider performance to determine which would be reimbursed at the highest level in a tiered network.

Compare and contrast the following types of provider performance to determine which would be reimbursed at the highest level in a tiered network. Answer: Practice provides quality healthcare at a low cost

What type of plan is structured to permit the funding of premiums with pretax payroll deductions?

What type of plan is structured to permit the funding of premiums with pretax payroll deductions? Answer: Section 125 cafeteria plan

Identify the type of deductible that can be met by combining payments.

Identify the type of deductible that can be met by combining payments. Answer: Family deductible

The term maximum benefit limit applies to:

The term maximum benefit limit applies to: Answer: A monetary amount

Identify the type of deductible which must be met for each separate enrollee.

Identify the type of deductible which must be met for each separate enrollee. Answer: Individual deductible

Which term refers to an individual who enrolls in a health plan after the original enrollment date?

Which term refers to an individual who enrolls in a health plan after the original enrollment date? Answer: Late enrollee

Self-funded health plans pay premiums to:

Self-funded health plans pay premiums to: Answer: No one because they assume the risk

Approximately what percent of the population are covered under IHPs?

Approximately what percent of the population are covered under IHPs? Answer: 10%

The amount of time that must pass before an employee can enroll in a health plan is called a(n):

The amount of time that must pass before an employee can enroll in a health plan is called a(n): Answer: Waiting period

What type of contract binds a third-party administrator to provide administrative services to an employer for a fixed fee per employee?

What type of contract binds a third-party administrator to provide administrative services to an employer for a fixed fee per employee? Answer: ASO

Determine what law a practice would follow if a state law is more restrictive than the related federal law.

Determine what law a practice would follow if a state law is more restrictive than the related federal law. Answer: The state law is followed

Generalize the advantages provided by employers by offering GHPs:

Generalize the advantages provided by employers by offering GHPs: Answer: They offer an important benefit to employees; thereby making the employer more attractive

What organization runs ERISA?

What organization runs ERISA? Answer: EBSA

How can employees customize their GHP policies?

How can employees customize their GHP policies? Answer: By choosing levels of premiums and deductibles

Identify the document self-funded plan members receive that states their benefits and legal rights.

Identify the document self-funded plan members receive that states their benefits and legal rights. Answer: SPD

How can TPAs help self-funded health plans?

How can TPAs help self-funded health plans? Answer: By handling collection of premiums, processing claims, and keeping list of members

Third-party claims administrators are classified as:

Third-party claims administrators are classified as: Answer: A separate company, often a managed care organization or insurance carrier

Which of the following is a way that an employer can reduce prices for their GHPs?

Which of the following is a way that an employer can reduce prices for their GHPs? Answer: Carve out benefits during negotiations to change the coverage

Which of the following type of plan do employers or employee organizations offer to their employees?

Which of the following type of plan do employers or employee organizations offer to their employees? Answer: Group health plan

Who may be covered under a GHP?

Who may be covered under a GHP? Answer: Employees, families, and former employees

Identify the type of contract under which an insurance carrier works as a third-party claim administrator for a self-funded health plan.

Identify the type of contract under which an insurance carrier works as a third-party claim administrator for a self-funded health plan. Answer: Administrate services only contract

Which of the following is a common reason why people elect to enroll in individual health plans?

Which of the following is a common reason why people elect to enroll in individual health plans? Answer: Because they are able to continue their health insurance coverage between jobs

Which of the following are not a common purchaser of IHPs?

Which of the following are not a common purchaser of IHPs? Answer: Employers

How often do open enrollment periods usually occur?

How often do open enrollment periods usually occur? Answer: Once per year

The federal law that regulates companies which set up employee health and pension plans is known as:

The federal law that regulates companies which set up employee health and pension plans is known as: Answer: ERISA

The health insurance program for federal government employees is:

The health insurance program for federal government employees is: Answer: FEHB

Identify what may be used to modify the terms of an insurance contract.

Identify what may be used to modify the terms of an insurance contract. Answer: Rider

Which of the following can refer to a treating physician /physician of record

Which of the following can refer to a treating physician /physician of record An injured workers PCP who has been approved by the workers compensation carrier

Which of the following is (are) not considered a work-related injury?

Which of the following is (are) not considered a work-related injury? Answer: An injury to a worker by another worker due to a personal conflict

Which of the following is considered a work-related injury?

Which of the following is considered a work-related injury? Answer: Repetitive motions such as typing, lung problem due to dust, loss of hearing to loud noises

Once an injured worker has been examined by a designated physician , which of the following is (are) the only persons involved in the case who is (are) allowed to have direct communications with the physician?

Once an injured worker has been examined by a designated physician , which of the following is (are) the only persons involved in the case who is (are) allowed to have direct communications with the physician? Answer: Representatives of the workers compensation carrier

Which of the following is considered workers compensation fraud?

Which of the following is considered workers compensation fraud? Answer: Worker pd under the table while receiving w.c., boiler plate medical reports, product switching

What for locators are left blank on a CMS-1500 claim form for a workers' compensation claim?

What for locators are left blank on a CMS-1500 claim form for a workers' compensation claim? Answer: Form locators 12 and 13

Workers' compensation fees are based on what fee schedule and a percentage?

Workers' compensation fees are based on what fee schedule and a percentage? Answer: Medicare

What information is required in form locator 1a when preparing a workers' compensation claim?

What information is required in form locator 1a when preparing a workers' compensation claim? Answer: Patient Social Security number

Supplement Security Income provides financial assistance to individuals who:

Supplement Security Income provides financial assistance to individuals who: Answer: Are qualified for welfare programs

Social Security Disability Insurance provides compensation for lost wages to individuals who:

Social Security Disability Insurance provides compensation for lost wages to individuals who: Answer: Have contributed to Social Security

When a provider initially examines a workers' compensation patient, what document must be filed with the state?

When a provider initially examines a workers' compensation patient, what document must be filed with the state? Answer: Work Status Report

After discharging a workers' compensation patient, the provider must file a(n)

After discharging a workers' compensation patient, the provider must file a(n) Answer: Final report

A wrongful retention of an insurance carriers overpayment is known as:

A wrongful retention of an insurance carriers overpayment is known as: Answer: Conversion

Which of the following is an acceptable signature on an appeal letter?

Which of the following is an acceptable signature on an appeal letter? Answer: Actual signature or stamped signature of the provider or authorized employee & signature of the provider represented by the signature and initials of an authorized employee

Who can file a complaint with the Insurance Commissioner?

Who can file a complaint with the Insurance Commissioner? Answer: The patient & The physician

Overpayment can occur for all of the following reasons except:

Overpayment can occur for all of the following reasons except: Answer: Both patient & payer pay at the same time

Which of the following is a reason that an insurance carrier may ask a medical provider to refill?

Which of the following is a reason that an insurance carrier may ask a medical provider to refill? Answer: Missing or incomplete claims forms & errors on a claim form

Medicare Part B states that the number-one reason an appeal is returned is because:

Medicare Part B states that the number-one reason an appeal is returned is because: Answer: It is invalid or there is no acceptable signature

Appealing denied insurance claims requires a:

Appealing denied insurance claims requires a: Answer: Perseverance

What percentage of denied claims are overturned on the second appeal?

What percentage of denied claims are overturned on the second appeal? Answer: 25%

The method of documentation most widely used by physician is the:

The method of documentation most widely used by physician is the: Answer: SOAP format

It is best to direct initial appeal letters to:

It is best to direct initial appeal letters to: Answer: The appeals department

If your first appeal is denied, it is appropriate to:

If your first appeal is denied, it is appropriate to: Answer: Write a second appeal

What percentages of denied claims are overturned on the first appeal?

What percentages of denied claims are overturned on the first appeal? Answer: 25%

The government dept. you should go to if multiple appeals to an MCO fail is:

The government dept. you should go to if multiple appeals to an MCO fail is: Answer: The state dept. of insurance/insurance commissioner

An employer who believes the work environment to be dangerous may file a complaint with the?

An employer who believes the work environment to be dangerous may file a complaint with the? Answer: (OSHA) Occupational Safety and Health Administration

For a widow worker age 55 years or older who is disabled to qualify for Social Security Disability Insurance (SSDI) his or her spouse must have paid into Social Security for at least ___ years.

For a widow worker age 55 years or older who is disabled to qualify for Social Security Disability Insurance (SSDI) his or her spouse must have paid into Social Security for at least ___ years. Answer: 10

Vocational rehabilitation programs provide ___________for individuals with job-related disabilities.

Vocational rehabilitation programs provide ___________for individuals with job-related disabilities. Answer: Training in a different job

A disability that limits a worker to jobs that are performed in an upright or standing position and that require no more than minimal effort is classified as?

A disability that limits a worker to jobs that are performed in an upright or standing position and that require no more than minimal effort is classified as? Answer: Limitation of light work

The classification of pain used in worker's compensation claims are?

The classification of pain used in worker's compensation claims are? Answer: Minimum, slight, moderate, severe

__________ Provides worker's compensation insurance coverage to employees of the federal government.

__________ Provides worker's compensation insurance coverage to employees of the federal government. Answer: Federal Employees Compensation Act

Before an injured employee can return to work, a physician must write?

Before an injured employee can return to work, a physician must write? Answer: A doctors final report

An individual with a disability described as precluding heavy work has lost _____ of the capacity to push, pull, bend, stoop and climb.

An individual with a disability described as precluding heavy work has lost _____ of the capacity to push, pull, bend, stoop and climb. Answer: 50%

A ____________ is a denial of employer liability issued by the worker's compensation insurance carrier.

A ____________ is a denial of employer liability issued by the worker's compensation insurance carrier. Answer: A notice of contest

Once an application for Social Security Disability Insurance (SSDI) is filed, there is a ___________ waiting period before benefits begin?

Once an application for Social Security Disability Insurance (SSDI) is filed, there is a ___________ waiting period before benefits begin? Answer: 5 month

Differentiate between Social security disability insurance (SDDI) and Supplementary Security income (SSI)

Differentiate between Social security disability insurance (SDDI) and Supplementary Security income (SSI) • SSDI provides compensation for lost wages for individuals who have contributed to Social Security through FICA payroll taxes. • SSI provides financial assistance to individuals in need, including individuals who are aged, blind and disabled

List 3 responsibilities of physician of record in a workers compensation case.

List 3 responsibilities of physician of record in a workers compensation case. • treat the injured worker • determine percentage of disability • Determine the return to work date and filing progress notes

Two types of state workers compensation benefits

Two types of state workers compensation benefits • one pays the workers medical expenses result from work related illness or injury • the other pays for lost wages while the worker is unable to return to work

What are the four federal workers compensation plans provide coverage to federal government employees?

What are the four federal workers compensation plans provide coverage to federal government employees? 1. The Federal Employees Compensation Program 2. Longshore and Harbor Worker Compensation program 3. The Federal Black Lung Program 4. The Energy Employees Occupational Illness Compensation program

What type of pain is merely annoying and does not limit an employee's ability to perform their job?

What type of pain is merely annoying and does not limit an employee's ability to perform their job? Answer: minimal pain

What classification of disability describes an individual who may work in an upright or walking position as long as no greater than minimal effort is required?

What classification of disability describes an individual who may work in an upright or walking position as long as no greater than minimal effort is required? Answer: limitation to light work

Injuries are generally covered under workers' compensation except for?

Injuries are generally covered under workers' compensation except for? Answer: if an injury was an intentional injury

Process of submitting charges and receiving payment through workers' compensation insurance?

Process of submitting charges and receiving payment through workers' compensation insurance? Answer: providers submit their charges to the workers' compensation insurance carrier and are paid directly by the carrier

Where is payment made when a federal worker injured on the job is treated by a physician authorized by the OWCP?

Where is payment made when a federal worker injured on the job is treated by a physician authorized by the OWCP? Answer: directly to the provider

What is the most common method states use to determine wage-loss benefits?

What is the most common method states use to determine wage-loss benefits? Answer: they compensate employees based on a percentage of their salary before the injury

What type of individual would generally NOT be covered by state workers' compensation insurance?

What type of individual would generally NOT be covered by state workers' compensation insurance? Answer: a self-employed individual

What does an insurance carrier not do after it receives the first report of injury?

What does an insurance carrier not do after it receives the first report of injury? Answer: contacts the employee for medical records

What is the purpose of an IME?

What is the purpose of an IME? Answer: to provide an additional, impartial medical opinion before a final determination is made

Who is allowed unrestricted access to workers' compensation files in most states?

Who is allowed unrestricted access to workers' compensation files in most states? Answer: employers and claim adjusters

Who do most states require public and private companies to provide workers' compensation coverage for?

Who do most states require public and private companies to provide workers' compensation coverage for? Answer: full time, part time and minors

What may a claimant be eligible for if a workers' compensation claim is not paid within the specified time?

What may a claimant be eligible for if a workers' compensation claim is not paid within the specified time? Answer: interest on the payment or a late fee

What program helps to pay living expenses for people who are blind or have disabilities and those of low-income older people?

What program helps to pay living expenses for people who are blind or have disabilities and those of low-income older people? Answer: SSI

What type of codes must be included in ICD-10-CM coding to report the cause of an accident?

What type of codes must be included in ICD-10-CM coding to report the cause of an accident? Answer: external causes

Life and Health Insurance 👆

Life and Health Insurance | List of Questions: Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days? All of the following qualify for Medicare Part A EXCEPT Which type of care is NOT covered by Medicare? All of the following are covered by Part A of Medicare EXCEPT The part of Medicare that helps par for important hospital care, inpatient care in a skilled nursing facility, home health care and hospicare care, is known as Which of the following is NOT an enrollment period for Medicare Part A applicants? 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? All of the following individuals may qualify for Medicare health insurance benefits EXCEPT Medicare Part A services do NOT include which of the following? Hospice care is intended for For how many days of skilled nursing faci

Long-term care policies may not define a preexisting condition more restrictively than a condition for which medical advice or treatment was sought

Long-term care policies may not define a preexisting condition more restrictively than a condition for which medical advice or treatment was sought A) Beyond the six month waiting period. B) Before the six month waiting period. C) Within six months following the effective date of coverage of an insured person. D) Within six months preceding the effective date of coverage of an insured person. Answer: Within six months preceding the effective date of coverage of an insured person.

The free-look (right to return) period for a Medicare supplement policy is

The free-look (right to return) period for a Medicare supplement policy is A) 30 days B) 45 days C) 10 days D) 25 days Answer: 30 days

How old must applicants for a producer's license be?

How old must applicants for a producer's license be? A) 21 years old. B) 16 years old. C) 17 years old. D) 18 years old. Answer: 18 years old.

Which of the following terms describes an insurance company that is doing business in Nebraska but was incorporated in another state?

Which of the following terms describes an insurance company that is doing business in Nebraska but was incorporated in another state? A) Foreign company. B) Domestic company. C) Alien company. D) Chartered company. Answer: Foreign company.

An admitted company is one that is:

An admitted company is one that is: A) on probation for admitting the commission of an insurance violation. B) organized in another country, but approved for doing business in the United States. C) qualified and licensed to do business in Nebraska. D) found guilty of breaking the law. Answer: qualified and licensed to do business in Nebraska.

Which of the following is not considered unlawful and prohibited when marketing long-term care insurance?

Which of the following is not considered unlawful and prohibited when marketing long-term care insurance? A) Consultative selling tactics B) Cold lead advertising C) Twisting D) High pressure tactics Answer: Consultative selling tactics

All of the following are excluded from coverage under a long-term care insurance policy EXCEPT

All of the following are excluded from coverage under a long-term care insurance policy EXCEPT A) Intentionally self-inflicted injuries B) Mental or nervous disorders C) Alcoholism D) Alzheimer's disease Answer: Alzheimer's disease

Which of the following people could qualify for coverage under the Nebraska Comprehensive Health Insurance Pool?

Which of the following people could qualify for coverage under the Nebraska Comprehensive Health Insurance Pool? A) Tatiana, a 9-year-old dependent of a Nebraska resident with a family history of heart disease. B) Mike, who is no longer employed but has continued group coverage under COBRA. C) Wendy, a Nebraska resident who last month applied for coverage from a private carrier but was offered a premium rate higher than that charged by NECHIP for the same coverage. D) Jake, who lived in Nebraska all his life before moving to Kansas for work last year. Answer: Wendy, a Nebraska resident who last month applied for coverage from a private carrier but was offered a premium rate higher than that charged by NECHIP for the same coverage.

Disclosure requirements in the life insurance solicitation regulation mandate that prospective purchasers be given a:

Disclosure requirements in the life insurance solicitation regulation mandate that prospective purchasers be given a: A) Notice to Purchasers. B) buyer's guide and policy summary. C) written policy guarantee. D) conditional receipt. Answer: buyer's guide and policy summary.

An HMO may not use a schedule of charges for health care services until it is approved by the:

An HMO may not use a schedule of charges for health care services until it is approved by the: A) Department of Consumer Affairs. B) Nebraska Life and Health Insurance Guaranty Association. C) Nebraska Property and Liability Insurance Guaranty Association. D) Director of Insurance. Answer: Director of Insurance.

Under a group health insurance policy, dependents include

Under a group health insurance policy, dependents include A) nannies, caretakers and housekeepers. B) children enrolled part-time in any college, university, or trade school. C) students up to age 18. D) children up to age 30. Answer: children up to age 30.

Medicare supplement policies may be returned within how many days for a full refund if the purchaser is not satisfied for any reason?

Medicare supplement policies may be returned within how many days for a full refund if the purchaser is not satisfied for any reason? A) 10 days. B) 30 days. C) 14 days. D) 21 days. Answer: 30 days.

Conversion privileges under an individual HMO contract

Conversion privileges under an individual HMO contract A) must include a Benefit Schedule B) must cover all services rendered during the conversion C) must provide a 30-day free look period D) must provide a 10-day free look period Answer: must provide a 10-day free look period

All of the following words or phrases are prohibited from being used in advertisements or in sales presentations for Medicare supplement policies because their use can be misleading EXCEPT:

All of the following words or phrases are prohibited from being used in advertisements or in sales presentations for Medicare supplement policies because their use can be misleading EXCEPT: A) comprehensive. B) as high as. C) this is a limited policy. D) unlimited. Answer: this is a limited policy.

Persons licensed to sell life and accident and health insurance must complete continuing education hours within how many years after receiving their license?

Persons licensed to sell life and accident and health insurance must complete continuing education hours within how many years after receiving their license? A) Two years. B) Five years. C) Three years. D) One year. Answer: Two years.

Producers licensed in life, accident, or health insurance must take how many hours of continuing education courses in these lines every 2-year compliance period?

Producers licensed in life, accident, or health insurance must take how many hours of continuing education courses in these lines every 2-year compliance period? A) 21 hours B) 24 hours C) 18 hours D) 26 hours Answer: 21 hours

If the Director of Insurance denies an application for an insurance producer's license and the applicant requests a hearing in writing, the hearing must begin within how many days from the time the Director receives the request?

If the Director of Insurance denies an application for an insurance producer's license and the applicant requests a hearing in writing, the hearing must begin within how many days from the time the Director receives the request? A) 14 days. B) 30 days. C) 10 days. D) 21 days. Answer: 30 days.

Which of the following would NOT be included in the definition of an insurance advertisement?

Which of the following would NOT be included in the definition of an insurance advertisement? A) Audiovisual material. B) Radio and television scripts. C) Sales presentations. D) Medicare buyer's guide. Answer: Medicare buyer's guide.

The life insurance solicitation regulation applies to which of the following?

The life insurance solicitation regulation applies to which of the following? A) Endowment life insurance. B) Credit life insurance. C) Variable life insurance. D) Group life insurance. Answer: Endowment life insurance.

The maximum fine for each flagrant violation of the Unfair Trade Practices Act is

The maximum fine for each flagrant violation of the Unfair Trade Practices Act is A) 20000 B) 15000 C) 10000 D) 25000 Answer: 15000

What must be given to prospects during a direct response solicitation for long-term care insurance?

What must be given to prospects during a direct response solicitation for long-term care insurance? A) A shopper's guide B) A policy illustration C) An outline of coverage D) A thank you gift Answer: A shopper's guide

The free-look period for individual accident and health policies is

The free-look period for individual accident and health policies is A) 10 days B) 30 days C) 15 days D) 25 days Answer: 10 days

Benefits payable on behalf of an insured high school student under a blanket policy may be payable to any of the following EXCEPT:

Benefits payable on behalf of an insured high school student under a blanket policy may be payable to any of the following EXCEPT: A) the designated beneficiary. B) a parent. C) the school. D) the student's estate. Answer: the school.

Which of the following is considered to be a prepaid dental service plan?

Which of the following is considered to be a prepaid dental service plan? A) Plan that offers referral services, consultation, and advice in addition to dental treatment. B) Plan whereby a group of employees pays a predetermined amount to cover only dental expenses. C) Group health plan that includes coverage for dental expenses. D) Retainer contract made by a dentist with an individual patient. Answer: Plan whereby a group of employees pays a predetermined amount to cover only dental expenses.

Long-term care insurance policies may not be cancelled for any of the following reasons EXCEPT

Long-term care insurance policies may not be cancelled for any of the following reasons EXCEPT A) decline in physical health. B) the insured's age. C) deteriorating mental health D) fraudulent claims. Answer: fraudulent claims.

At the time of application, insurers must provide prospects for Medicare supplement policies with a copy of the:

At the time of application, insurers must provide prospects for Medicare supplement policies with a copy of the: A) insurer's warranty. B) Medicare supplement buyer's guide. C) Medicare rules. D) Notice for Renewal. Answer: Medicare supplement buyer's guide.

Prepaid dental service plans must be approved by the:

Prepaid dental service plans must be approved by the: A) Secretary of State. B) State Medical Director. C) Director of Insurance. D) Nebraska Dental Association. Answer: Director of Insurance.

In long-term care insurance the definition of adult day care is

In long-term care insurance the definition of adult day care is A) Medical and nonmedical services provided to disabled and ill persons in their residences. B) Assisting an adult with activities of daily living. C) Personal care services in a hospital after surgery. D) a community group setting that provides social and medical services for six or more individuals. Answer: a community group setting that provides social and medical services for six or more individuals.

In Nebraska, insurers must retain records of insurance transactions for:

In Nebraska, insurers must retain records of insurance transactions for: A) five years. B) three years. C) six years. D) one year. Answer: five years.

Which of the following statements regarding Safe Harbor 401(k) Plans is CORRECT?

Which of the following statements regarding Safe Harbor 401(k) Plans is CORRECT? A) The penalty for early withdrawal is 25%. B) Employees must be 25 years old to be eligible participants. C) Employers may deduct up to 25% of their contributions to the Plan. D) Contributions are included in employee taxable income. Answer: Employers may deduct up to 25% of their contributions to the Plan.

When must individual and group health insurance policies that provide coverage for family members make payments of children's benefits effective with respect to a newborn child of the insured?

When must individual and group health insurance policies that provide coverage for family members make payments of children's benefits effective with respect to a newborn child of the insured? A) When the child is 1 month old. B) 14 days after birth. C) 8 days after birth. D) From birth. Answer: From birth.

Basic coverage for the treatment of alcoholism includes how many days of hospital inpatient coverage during any 365-day benefit period?

Basic coverage for the treatment of alcoholism includes how many days of hospital inpatient coverage during any 365-day benefit period? A) 30 days. B) 14 days. C) 60 days. D) 21 days. Answer: 30 days.

The following may be excluded from Medicare supplement coverages EXCEPT:

The following may be excluded from Medicare supplement coverages EXCEPT: A) mental or emotional disorders, alcoholism, or drug addiction. B) eyeglasses, hearing aids, and examinations for the prescription or fitting of the same. C) daily coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any benefit period. D) treatment provided in a governmental hospital. Answer: daily coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any benefit period.

None of the following needs to be licensed as an insurance consultant EXCEPT:

None of the following needs to be licensed as an insurance consultant EXCEPT: A) actuaries during the normal course of their business. B) licensed agents who give advice incidental to the normal course of their business and do not charge a fee, but who receive commissions for the insurance they write. C) bank trust officers performing their usual duties. D) persons who, for a fee, offer advice and service with respect to insurable risks. Answer: persons who, for a fee, offer advice and service with respect to insurable risks.

A viatical settlement broker must provide a notice stating that the viator has the right to rescind the viatical settlement contract within

A viatical settlement broker must provide a notice stating that the viator has the right to rescind the viatical settlement contract within A) 45 days of receiving the proceeds B) 60 days of receiving the proceeds C) 60 days of executing the contract D) 90 days of executing the contract Answer: 60 days of executing the contract

Which one of the following must be licensed as an insurance producer?

Which one of the following must be licensed as an insurance producer? A) Anyone involved solely with the enrollment of individuals under group insurance policies. B) An employee involved in underwriting who does not receive commissions. C) Applicant for a temporary license. D) Those who solicit only sickness and accident and health insurance. Answer: Those who solicit only sickness and accident and health insurance.

A utilization review conducted during a patient's hospital stay or course of treatment is a

A utilization review conducted during a patient's hospital stay or course of treatment is a A) medical review B) concurrent review C) prospective review D) clinical review Answer: concurrent review

The head of the Department of Insurance in Nebraska is the:

The head of the Department of Insurance in Nebraska is the: A) Commissioner of Insurance. B) Director of Insurance. C) Superintendent of Insurance. D) Chief of Insurance. Answer: Director of Insurance.

An insurer may pay its producer for the sale of a Medicare supplement policy only if

An insurer may pay its producer for the sale of a Medicare supplement policy only if A) it is not a replacement. B) the payment in the second year is no more than 200% of what was paid for selling or servicing the policy in the first year. C) payment in the third and subsequent years is the same as what was paid in the first year. D) the first-year payment is no more than 200% of what was paid for selling or servicing the policy in the second year. Answer: the first-year payment is no more than 200% of what was paid for selling or servicing the policy in the second year.

All of the following statements regarding Medicare supplement policies are true EXCEPT

All of the following statements regarding Medicare supplement policies are true EXCEPT A) eligible individuals must apply no later than 63 days after the date of termination of enrollment in a group health or Medicare Advantage plan. B) preexisting conditions may not be excluded for more than nine months after the effective date of coverage. C) All Medicare supplements must include Plan A as a separate policy. D) As long as an applicant is enrolled in Medicare Part B and 65 years old, a policy may not be cancelled based on the individual's medical condition. Answer: preexisting conditions may not be excluded for more than nine months after the effective date of coverage.

What is the minimum age that minors may contract for life, health, or accident insurance or annuities for the benefit of themselves or their estates or for the benefit of their father, mother, husband, wife, brother, or sister?

What is the minimum age that minors may contract for life, health, or accident insurance or annuities for the benefit of themselves or their estates or for the benefit of their father, mother, husband, wife, brother, or sister? A) Age 10. B) Age 18. C) Age 16. D) Age 14. Answer: Age 10.

Which of the following activities would NOT subject a licensed producer to a penalty under Nebraska law?

Which of the following activities would NOT subject a licensed producer to a penalty under Nebraska law? A) Forging a person's name to an insurance application or any other document. B) Obtaining a license for the purpose of writing controlled business. C) Misrepresenting the terms of any policy to the detriment of the applicant or the insured. D) Selling a life insurance policy to an individual who already owns a current life policy. Answer: Selling a life insurance policy to an individual who already owns a current life policy.

Which of the following is a trigger for benefit payments under a long-term care insurance policy?

Which of the following is a trigger for benefit payments under a long-term care insurance policy? A) The inability to perform not more than three activities of daily living. B) The inability to go grocery shopping. C) The inability to perform not more than four activities of daily living. D) The inability to operate a motor vehicle safely. Answer: The inability to perform not more than three activities of daily living.

The replacement regulation does NOT apply to which of the following?

The replacement regulation does NOT apply to which of the following? A) Individual annuity contracts. B) Group life insurance. C) Limited-pay life policies. D) Endowment insurance. Answer: Group life insurance.

An insurance company desiring to do business in Nebraska must apply for and be granted a(n):

An insurance company desiring to do business in Nebraska must apply for and be granted a(n): A) certificate of merit. B) company permit. C) operating license. D) certificate of authority. Answer: certificate of authority.

What is the minimum number of labor union or professional association members required for franchise insurance?

What is the minimum number of labor union or professional association members required for franchise insurance? A) Seven members. B) Nine members. C) Ten members. D) Five members. Answer: Ten members.

All of the following are exempted from the replacement rule EXCEPT:

All of the following are exempted from the replacement rule EXCEPT: A) application to exercise contractual changes or privileges in existing policies. B) individual life insurance policies. C) group annuities. D) credit life insurance. Answer: individual life insurance policies.

Medicare supplement policies may not exclude preexisting conditions for more than how many months after the effective date of coverage?

Medicare supplement policies may not exclude preexisting conditions for more than how many months after the effective date of coverage? A) Six months. B) Ten months. C) Three months. D) Four months. Answer: Six months.

Generally, anything of value that directly or indirectly reduces the premium below the amount specified in an insurance policy is a:

Generally, anything of value that directly or indirectly reduces the premium below the amount specified in an insurance policy is a: A) dividend. B) discount. C) rebate. D) bonus. Answer: rebate.

How long is the free-look period for long-term care policies?

How long is the free-look period for long-term care policies? A) 25 days B) 10 days C) 30 days D) 45 days Answer: 30 days

To establish an HMO in Nebraska, the proper application must be submitted to:

To establish an HMO in Nebraska, the proper application must be submitted to: A) the Director of Health. B) the Director of Insurance. C) the Secretary of State. D) the Nebraska Medical Association. Answer: the Director of Insurance.

All life insurance policies (except industrial insurance) issued in Nebraska must contain all of the following EXCEPT:

All life insurance policies (except industrial insurance) issued in Nebraska must contain all of the following EXCEPT: A) an entire contract provision. B) a misstatement of age provision. C) a 30-day grace period. D) a 30-day free look period. Answer: a 30-day free look period.

What association protects owners of life insurance policies issued by insurers who become insolvent?

What association protects owners of life insurance policies issued by insurers who become insolvent? A) Nebraska Comprehensive Insurance Pool Act. B) Nebraska Life and Health Insurance Guaranty Association. C) Nebraska Life Insurance Pool. D) Nebraska Property and Liability Association. Answer: Nebraska Life and Health Insurance Guaranty Association.

Controlled business refers to insurance written upon the following EXCEPT:

Controlled business refers to insurance written upon the following EXCEPT: A) a producer's employer. B) employees of the producer. C) friends of the producer. D) relatives of the producer by blood or marriage. Answer: friends of the producer.

Convicted violators of the Unfair Trade Practices Act are subject to all of the following penalties EXCEPT:

Convicted violators of the Unfair Trade Practices Act are subject to all of the following penalties EXCEPT: A) suspension or revocation of the violator's license, if he knew or reasonably should have known about the violation. B) minimum fines of $2,000 for each violation. C) fines of up to $1,000 for each violation to a maximum total of $30,000. D) for violators who knew or should have known that they were breaking the law, fines of up to $15,000 for each violation or an aggregate penalty of $150,000. Answer: minimum fines of $2,000 for each violation.

A temporary license is good for up to:

A temporary license is good for up to: A) 120 days. B) 180 days. C) 60 days. D) 90 days. Answer: 180 days.

An employer group health plan must insure at least how many employees?

An employer group health plan must insure at least how many employees? A) 10 B) 2 C) 15 D) 25 Answer: 2

The following statements regarding the free look provision in individual health and accident policies are true EXCEPT:

The following statements regarding the free look provision in individual health and accident policies are true EXCEPT: A) the provision must be printed on single premium, nonrenewable policies, as well as other kinds of health insurance policies. B) the free look provision must be printed on the face of the policy or be included as a notice with the policy. C) when a policy is returned in accordance with the free look provision, it is void as though it were never issued. D) the policyowner may return the policy within 10 days for a full refund of any premium paid. Answer: the provision must be printed on single premium, nonrenewable policies, as well as other kinds of health insurance policies.

With group health insurance, a covered dependent child who is mentally or physically handicapped may be eligible for continued coverage if proof of his incapacity and dependency is furnished to the insurer within how many days of the child's attainment of the limiting age?

With group health insurance, a covered dependent child who is mentally or physically handicapped may be eligible for continued coverage if proof of his incapacity and dependency is furnished to the insurer within how many days of the child's attainment of the limiting age? A) 21 days. B) 15 days. C) 31 days. D) 60 days. Answer: 31 days.

Assisted living facilities must provide care

Assisted living facilities must provide care A) on a 24-hours basis for acute and chronic individuals. B) for individuals who have had a minimum hospital stay of 14 days prior to arriving at the facility. C) for at least four individuals requiring assistance due to age, illness or physical handicap. D) for a minimum of five individuals requiring medical services due to age, illness or physical handicap. Answer: for at least four individuals requiring assistance due to age, illness or physical handicap.

Long-term care insurers must keep all advertisements for at least

Long-term care insurers must keep all advertisements for at least A) Five years B) Three years C) Two years D) Four years Answer: Three years

Insurance producers may be licensed to write one or more of the following lines of insurance EXCEPT:

Insurance producers may be licensed to write one or more of the following lines of insurance EXCEPT: A) celebrity insurance. B) credit life and credit accident and health insurance. C) miscellaneous insurance. D) variable contracts. Answer: celebrity insurance.

An agent's commissions for controlled business must not exceed what percentage of annual commissions to avoid the conclusive presumption that the license was obtained for the purpose of writing controlled business?

An agent's commissions for controlled business must not exceed what percentage of annual commissions to avoid the conclusive presumption that the license was obtained for the purpose of writing controlled business? A) 30%. B) 50%. C) 25%. D) 10%. Answer: 30%.

Each domestic insurance company in Nebraska is subject to an examination by the Department of Insurance at least every:

Each domestic insurance company in Nebraska is subject to an examination by the Department of Insurance at least every: A) 3 years. B) 5 years. C) 4 years. D) 2 years. Answer: 5 years.

All of the following are duties of the Director of Insurance EXCEPT:

All of the following are duties of the Director of Insurance EXCEPT: A) appointing a staff of actuaries and examiners. B) issuing insurance licenses. C) drafting and enacting insurance laws. D) enforcing insurance laws. Answer: drafting and enacting insurance laws.

One of the prohibited provisions precludes a life insurance policy from taking effect more than how many months before the original application was made?

One of the prohibited provisions precludes a life insurance policy from taking effect more than how many months before the original application was made? A) Six months. B) Five months. C) Two months. D) Three months. Answer: Six months.

Sajji has an accidental death and dismemberment policy through her company. What is the tax treatment on the expenses if her employer pays 100% of the premiums?

Sajji has an accidental death and dismemberment policy through her company. What is the tax treatment on the expenses if her employer pays 100% of the premiums? A) Her employer may deduct the premiums and receive corporate benefits tax-free. B) She receives benefits tax-free and is taxed on the premium. C) The premiums are deductible for her employer and her benefits are tax-free. D) The premiums are not deductible for her employer and her benefits are taxed. Answer: The premiums are deductible for her employer and her benefits are tax-free.

If a company buys disability buy-sell insurance,

If a company buys disability buy-sell insurance, A) the business must pay tax on the benefits received B) the businessowners must pay tax on the benefits received C) the premiums are deductible by the businessowners D) the premiums are not deductible by the business Answer: the premiums are not deductible by the business

Megan is the sole proprietor of a bookstore and paid $5,000 last year in premiums for medical expense coverage. She incurred $6,000 in medical expenses and was reimbursed for these costs under her health plan. Which of the following statements is CORRECT?

Megan is the sole proprietor of a bookstore and paid $5,000 last year in premiums for medical expense coverage. She incurred $6,000 in medical expenses and was reimbursed for these costs under her health plan. Which of the following statements is CORRECT? A) Megan can take a partial deduction for the amount of premiums paid. B) Megan must include the benefits received from her health plan in income. C) Megan must include part of the benefits received from her health plan in income. D) Megan can take a deduction for the entire amount of premiums paid. Answer: Megan can take a deduction for the entire amount of premiums paid.

When the premiums for qualified long-term care insurance are paid by an employer,

When the premiums for qualified long-term care insurance are paid by an employer, A) the employer may not deduct the premiums B) the benefits are tax-free up to a specified inflation-indexed limit for employees C) the employee pays taxes on the benefits D) the employee pays taxes on the premiums Answer: the benefits are tax-free up to a specified inflation-indexed limit for employees

Health reimbursement accounts are established by employers who provide covered employees with high-deductible health plans. The employer makes tax-deductible contributions, which employees can use for all of the following purposes EXCEPT

Health reimbursement accounts are established by employers who provide covered employees with high-deductible health plans. The employer makes tax-deductible contributions, which employees can use for all of the following purposes EXCEPT A) to apply co-payments B) to pay deductibles C) to pay coinsurance D) to create tax-deferred savings accounts Answer: to create tax-deferred savings accounts

Which of the following statements about flexible spending accounts is NOT correct?

Which of the following statements about flexible spending accounts is NOT correct? A) They may reimburse participants for all medical expenses. B) They allow participants to pay for health care expenses with pretax dollars. C) They provide reimbursement for medical expenses incurred. D) They may be provided as a stand-alone plan or as part of a traditional cafeteria plan. Answer: They may reimburse participants for all medical expenses.

The premiums and benefits in a business overhead expense plan are

The premiums and benefits in a business overhead expense plan are A) deductible and taxable B) deductible and tax-free C) not deductible and taxable D) not deductible and not tax-free Answer: deductible and taxable

Which of the following descriptions characterizes a health reimbursement account (HRA)?

Which of the following descriptions characterizes a health reimbursement account (HRA)? A) A tax-exempt trust or account in a financial institution in which the account holder saves money for qualified medical expenses B) A cafeteria plan with several components C) A tax-exempt trust or account designed to pay for qualified medical expenses of the account holder D) An employer-funded account that pays employees for qualified medical expenses they incur Answer: An employer-funded account that pays employees for qualified medical expenses they incur

The purpose of a health savings account is to

The purpose of a health savings account is to A) save for retirement B) shield assets for the purpose of qualifying for Medicaid C) serve as a tax-favored way to accumulate funds to cover medical expenses D) provide funds to pay for the health care of dependents Answer: serve as a tax-favored way to accumulate funds to cover medical expenses