Disability Insurance
What percentage of a participant's income are group long-term disability benefit amounts typically
limited to?
30%
40%
50%
60%
What is the purpose of a Disability Income Benefit?
Provide money for living expenses
Completely replace the insured's total income
Reimburse for medical expenses related to a disability
Pay for business overhead expenses if the owner becomes disabled
Chris is an insured bricklayer who severed his left hand in an automobile accident. Although his primary
duty cannot be performed, Chris is also a substitute high school teacher. He collects a full disability
income check every month. How does his policy define total disability?
Recurrent
Any occupation
Own occupation
Presumptive
Typically, Long-Term Disability benefits are coordinated with which benefit plan?
Social Security
Individual Retirement Account
Life insurance
Accrued sick time
The monthly benefit for an individual disability income policy is usually limited to a percentage of the
insured's income in order to avoid
claims
the elimination period
over insurance
adverse selection
Which type of disability would be less than total impairment and equal to permanent impairment?
Partial total disability
Permanent partial disabilty
Residual partial disability
Temporary partial disability
A policyowner suffers an injury that renders him incapable of performing one or more important job
duties. Any decrease in income resulting from this injury would make him eligible for benefits under
which provision?
Partial disability
Nondisabling injury
Presumptive disability
Flat amount disability
The factor used most often when underwriting a disability income policy is
annual earnings
sex of the insured
marital status
occupation
Which clause defines total disability as being unable to perform the major duties of the insured's regular
occupation?
Own occupation clause
Any occupation clause
Residual clause
Presumptive clause
What is the elimination period of an individual disability policy?
Time period an insured must wait before coverage begins
Time period a disabled person must wait before benefits are paid
Time period after the policy issue date in which the provisions are still contestable
The point in time when benefits are no longer payable
Medical Expense Insurance
Amy has a group medical policy through her employer with a $500 deductible and a 90%
coinsurance provision. She incurs $1,500 in covered health care services. How much will her
group insurance carrier pay?
$500
$900
$1,000
$1,350
Kate has a Major Medical Plan with a 75/25 coinsurance and a deductible of $25. How much will
she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill
for $125?
$25.00
$50.00
$75.00
$100.00
All of the following are qualifications for establishing a health savings account (HSA) EXCEPT
Enrolled in a high deductible health plan
Be under the age of 65 (not enrolled in Medicare)
Enrolled in a health plan with a prescription drug benefit
Enrolled in a health plan that limits out of pocket expenses
A payment system for health care in which the provider is paid for each service given is called
a blanket plan
lump sum
fee-for-service
a prepaid arrangement
Which of the following types of deductibles would apply a single deductible to both medical and
dental insurance coverage?
Standard deductible
Combined deductible
Integrated deductible
Blended deductible
Major Medical expense plans provide coverage for each of the following EXCEPT
Medically necessary surgery
Diagnostic tests
Blood and urine lab screens
Work-related injuries
A pharmacy benefit covers prescription drugs derived from a list called a(n)
administrative drug list
drug formulary
controlled substance list
generic benefit manager
When an insured has a major medical plan with first dollar coverage, how does this impact the
benefits paid?
No deductible payment is required
Deductible specified in the contract is payable by the insured
Insured must pay a percentage of covered losses
An initial deductible plus a percentage of the remaining covered loss is owed by the insured
Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year.
Her health policy most likely contains a(n)
stop-loss provision
deductible
copayment
out of pocket provision
An insured under a Major Medical expense plan with a zero deductible and 80/20 coinsurance
provision files a $1,000 claim. How much of this claim is the insured responsible for?
$160
$200 80%of 1,000=800…1,000-800=200
$600
$800
Which type of coverage pays an amount per day for hospitalization directly to the insured
regardless of the insured's other health insurance?
MEWA
Mutual
Group
Hospital indemnity
What is the tax liability for employer contributions in Health Savings Accounts (HSA's)?
Taxable as regular income to the employee
Tax-deductible expense to the employee
No tax payment needed
Taxable to the employee when they exceed 7 1/2 % AGI
Which of the following is NOT included under a health benefit plan?
Major medical policy
Basic hospital policy
Hospital indemnity plan
Surgical expense policy
A fee for service health insurance plan will normally cover
vitamins and natural remedies
cosmetic procedures
gym membership
a disease
The focus of major medical insurance is providing coverage for
critical illnesses only
preventative care
medical and hospitalization expenses
doctor's visits
Private Insurance Plans for Seniors
Which of the following statements is TRUE about Medicaid?
It is health insurance for the elderly
It is administered by the Federal government
It is funded by federal, state, and local taxes
Coverage includes compulsory hospital and voluntary supplementary medical insurance
Which of the following does Medicare Part D cover?
Intensive care coverage
Doctor visits
Prescription drugs
Hospital coverage
Which of the following provides Medicare supplement policies?
Medicare
Medicaid
Private insurance companies
Associations and employers
In a Long-Term Care policy, activities of daily living (ADL's) can be each of the following EXCEPT
Talking
Dressing
Transferring
Feeding oneself
A Medicare Supplement Policy is
government insurance designed to provide healthcare to the elderly
designed to provide prescription drug coverage to the elderly
designed to fill in the gaps of Part A and Part B Medicare
a supplement to Medicare Advantage Part C
Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home
options would best serve him?
Nursing home
Assisted living
Congregate housing
Custodial residence
Respite care is able to provide
permanent relief to the patient's primary caregiver
health care to the patient's primary caregiver
weekly benefit payments to supplement the primary caregiver's income
temporary relief to the patient's primary caregiver
The purpose of Medicare Supplement Insurance is to address gaps in Medicare coverage, which can
include
Medicare in-hospital deductible
replacing HMO coverage
covering chiropractic treatment
treatment provided in a government hospital
The open enrollment period for Medicare Supplements begins at age
62
65
67
70
The IRS states that a taxpayer's medical expenses that exceed 7.5% of their adjusted gross income is tax
deductible. Which of the following may be considered a medical expense under this rule?
Long Term Care Insurance premiums
Dread Disease Insurance premiums
Travel Accidental Insurance premiums
Individual Disability Income Insurance premiums
Benefits provided by a Medicare Supplement policy must NOT
be payable to the insured
duplicate Medicare benefits
be sold to individuals under 70
charge additional premiums
A Medicare Supplement basic benefit is
the first 3 pints of blood per year
respite care
disability income
term life insurance
Generally speaking, which three levels of care are Long-Term Care policies provided with?
Disability, acute care, and hospitalization
Accident, medical care, and rehabilitation
Psychological, acute care, and assisted living
Skilled nursing, intermediate, and custodial care
Joe is a Medicare participant who receives his benefits through a Managed Health Care Plan. Which
Medicare plan does he have?
Part A
Part B
Part C
