Insurance MCQ

Group accident and health insurance may be offered by an insurer when the sponsoring group A. was formed to purchase insurance B. provides individual evidence of insurability of its group members C. provides an employer-employee relationship D. consists of unrelated members Answer: C. provides an employer-employee relationship

Notice of information practices must be given to a policyholder at least A. every year B. every two years C. every three years D. every four years Answer: C. every three years

Under a key person disability income policy, benefits will be received as A. taxable income to the key employee B. tax-free to the key employee C. tax-free income to the business D. taxable income to the business Answer: C. tax-free income to the business

What type of employee welfare plans are not subject to ERISA regulations? A. Church plans B. Major medical plans C. Corporate D. Qualified plans Answer: A. Church plans

Which of the following statements BEST describes a double indemnity provision in travel accident insurance? A. Benefits are doubled under conditions stated in the policy B. If the claim is disputed in court and the insurer loses, the face amount will be doubled C. Benefits cover two people when traveling D. Accidents and illnesses are covered while the insured is travelling Answer: A. Benefits are doubled under conditions stated in the policy

Bert's spouse passed away recently. Bert was covered under his spouse's group family health insurance plan but now is covered under COBRA. How much of the active-employee cost may be passed on to Bert for continued coverage? A. No maximum B. Maximum of 50% C. Maximum of 100% D. Maximum of 102% Answer: D. Maximum of 102%

Trade association groups that are eligible for group medical benefits normally are A. in the same industry B. in different industries C. formed for the sole reason of obtaining insurance D. large businesses Answer: A. in the same industry

Which of the following incidents would NOT be covered by an Accidental Death and Dismemberment policy? A. Deafness in one ear as a result of an accident B. Loss of vision as a result of a hunting incident C. Suicide D. Killed from an accident while being a passenger in a taxicab Answer: C. Suicide

A health insuring corporation (HIC) provider is A. One who offers administrative services to the HIC B. A health care professional or facility contracted by the HIC to furnish services or supplies to the HIC members C. Any physician other than a surgeon D. Anyone who has a contract with the HIC Answer: B. A health care professional or facility contracted by the HIC to furnish services or supplies to the HIC members

Which of the following is a key characteristic of an HIC compared to other health and accident plans? A. HIC does offer group insurance B. HIC provides medical and disability insurance C. HIC combines health care delivery and financing D. Private commercial insurers will not accept nonprofit groups Answer: C. HIC combines health care delivery and financing

With whom may the subscriber of an HIC file an appeal regarding the resolution of a complaint concerning services provided? A. Superintendent of Insurance B. Peer Review Committee C. HIC Policy Administrator D. Ohio Chief of Medicine Answer: B. Peer Review Committee

In Ohio, what must an HIC establish and maintain to provide reasonable procedures for the resolution of written complaints initiated by subscribers concerning services provided? A. complaint system B. provider credentialing C. customer satisfaction surveys D. physician evaluations Answer: A. complaint system

Which of these is usually true of an HIC prescription drug plan? A. An annual deductible must be satisfied B. Coverage is restricted to generic drugs C. Drugs are dispensed through participating pharmacies D. In-network benefits are paid on a reimbursement basis Answer: C. Drugs are dispensed through participating pharmacies

Which of the following must a health insuring corporation (HIC) provide to prospective plan subscribers at or before the point of sale? A. A list of all participating physicians B. The HIC's certificate of authority C. A proof of insurability form D. A solicitation document Answer: D. A solicitation document

All of the following statements about HICs are true EXCEPT: A. Routine physical examinations usually are covered B. These plans may be established by health care providers C. Benefits include both physician and hospital care D. Benefits are usually provided on a reimbursement basis Answer: D. Benefits are usually provided on a reimbursement basis

The main purpose of an Ohio health insuring corporation (HIC) solicitation document is to A. request data for a certificate of authority B. persuade individuals to enroll in an HIC C. provide a detailed medical plan description D. verify acceptance of the plan when signed Answer: C. provide a detailed medical plan description

In Ohio, health insuring corporation (HIC) complaint responses must include a notice of the right to appeal the HIC's decision to A. The Ohio Director of Health B. The HIC's complaint system administrator C. An independent external review organization D. The Ohio State Medical Board Answer: B. The HIC's complaint system administrator

To resolve written grievances received, each HIC specialty plan must establish A. a complaint system B. a provider credentialing system C. a point of service system D. an annual examination system Answer: A. a complaint system

A significant difference between HIC's and private commercial accident and health insurers is that A. Private commercial insurers do NOT offer group coverage B. HICs are limited to providing coverage for nonprofit organizations C. HICs combine medical care delivery and funding in one organization D. Private commercial insurers will NOT offer coverage to nonprofit organizations Answer: C. HICs combine medical care delivery and funding in one organization

Which statement is true if a member suffers a broken leg while outside the insuring corporation (HIC) service area? A. The injury will be covered as an emergency health service B. The member is responsible for emergency treatment expenses C. The member must seek care from a participating provider D. The member must obtain prior HIC authorization for emergency treatment Answer: A. The injury will be covered as an emergency health service