Insurance MCQ

Individuals covered under a Blue Cross/Blue Shield HMO plan are typically referred to as: A. Insureds B. Participants C. Members D. Subscribers Answer: D.

A Basic Hospital Expense Policy provides coverage for the insured while ________. A. In a nursing home B. Confined to the hospital C. At home D. In rehabilitation Answer: B.

How do PPOs save consumers money? A. They charge minors less than adults B. They charge patients utilizing providers contracted with the PPO less than those who are not contracted with the PPO C. They waive their charges in cases of emergency care D. They offer senior discounts Answer: B.

PPO plans pay providers based on a: A. Discounted fee for service negotiated in advance B. Prepaid basis determined by a primary care physician C. Flat benefit determined by geographical region D. Reimbursement basis Answer: A.

A Hospital Indemnity Plan pays for: A. Prescription drugs administered in the hospital B. A daily hospital benefit on a daily limit as stated in the policy C. Usual, reasonable, and customary charges based on the geographic location of where the services were performed D. Costs associated with emergency room treatment after a deductible and coinsurance amount have been met Answer: B.

A Medical Expense Policy's list of the amounts the insurer will pay for each medical service is known as a(n) __________. A. Payment of Claims provision B. Schedule of Benefits C. Service Program D. Insuring Clause Answer: B.

A type of provider that consists of employers who pay claims out of their own funds instead of funding claims as an insurer is known as what type of provider? A. Practicing medical B. Service C. Indemnity D. Self-insured Answer: D.

A commercial insurer who reimburses insureds for medical expenses they incur is known as what type of a provider? A. Self-insured B. Service C. Indemnity D. Practicing medical Answer: C.

The HMO provider is paid a set fee per enrollee, known as a: A. Service fee B. Provider fee C. Enrollee fee D. Capitation fee Answer: D.

If a policy requires the payment of an additional premium for the continuation of coverage for a newborn, the insurer must be notified within 31 days of the ______. A. Hospitalization date B. Policy date C. Date of birth D. First day of the month birth Answer: C.

A policy that only covers cancer is considered a: A. Blanket Insurance plan B. AD&D plan C. Limited sickness plan D. Hospital Income plan Answer: C.

What type of contract do commercial insurers traditionally market? A. Practical medical B. Reimbursement C. Service D. Self-Insured Answer: B.

Which policy covers inpatient doctor visits and may be expanded to include payment for office visits, diagnostic x-rays, laboratory charges, ambulance and nurse's expenses when not hospitalized, and maternity benefits for an additional premium? A. Basic Medical Expense B. Catastrophic Medical Expense C. Hospital Expense D. Surgical Expense Answer: A.

Which of the following types of limited policies would a common carrier purchase to provide medical and surgical benefits in excess of any primary coverage? A. Short Term Medical Expense B. Accidental Death and Dismemberment C. Blanket Plan D. Hospital Indemnity Answer: C.

The Smith family has a $1,000 annual family deductible with a coinsurance provision of 80/20. The family's claims for the year are $200, $300, $400, $500, $300, and $300, totaling $2,000. The insurer is responsible for paying: A. $1,600 B. $1,200 C. $2,000 D. $800 Answer: D.

All of the following are common exclusions found in dental insurance plans EXCEPT: A. Cosmetic procedures that is not necessary for sound dental health B. Coverage for teeth that are missing at the time coverage takes effect C. Expenses for oral hygiene instructions and plaque control programs D. Emergency dental treatment Answer: D.

What does it mean if dental benefits are scheduled? A. Benefits are limited to specified maximums per procedure B. A dentist must get insurance company pre-approval of any and all procedures ahead of time C. A dentist must get insurance company pre-approval of all visits D. Two scheduled visits to the dentist are allowed per year Answer: A.

Which of the following would likely be treated as a common exclusion found in most health insurance policies? A. An honorably discharged Navy veteran who visits his primary care physician B. A retired commercial airline pilot receiving preventive care C. A homemaker who is seriously injured in an unintentional accident and needs physical therapy D. A U.S. citizen, who owns and resides in a home in Costa Rica, needs an operation Answer: D.

What is the benefit of a credit disability insurance plan? A. It waives the repayment of credit card debt during the entire time a person remains totally disabled B. It makes the minimum monthly payment on a person's debt for a stated period of time C. It prevents foreclosure on a person's home in the event of any disability lasting more than one year D. It automatically pays 100% of the balance of a person's debt if permanently disabled Answer: B.

A typical hospital indemnity insurance plan provides payment of benefits in which of the following ways? A. According to a written schedule of benefits for common procedures and treatments B. As reimbursement for necessary medical expenses paid by the insured C. In an amount equal to the insured's copay or coinsurance amounts D. According to a daily or monthly benefit amount without regard to actual medical expenses Answer: D.