Question 1

An HMO physician who determines if medical care from a specialist is necessary is called a(n)

Accepted Answer

A) capitator. 
B) internist. 
C) network facilitator. 
D) gatekeeper. 
A) capitator. 
B) internist. 
C) network facilitator. 
D) gatekeeper.

Question 2

Which of the following statements about group insurance underwriting principles is (are)true?
I.If a plan is contributory,100 percent of the eligible employees must be covered.
II.Employees should be allowed to determine their own level of benefits.

Accepted Answer

A) I only 
B) II only 
C) both I and II 
D) neither I nor II 
A) I only 
B) II only 
C) both I and II 
D) neither I nor II

Question 3

Marv is covered by a group health insurance plan at work.His employer funds the entire cost of the group health insurance.Because of this characteristic,the group health insurance plan can be described as

Accepted Answer

A) defined benefit. 
B) contributory. 
C) defined contribution. 
D) noncontributory. 
A) defined benefit. 
B) contributory. 
C) defined contribution. 
D) noncontributory.

Question 4

All of the following statements about HMOs are true EXCEPT

Accepted Answer

A) They organize and deliver health care services. 
B) HMOs place a heavy emphasis on controlling the cost of covered services. 
C) HMO members pay nothing for medical care until care is provided,then they must pay high deductibles and large coinsurance payments. 
D) The selection of physicians is usually limited to physicians affiliated with the HMO. 
A) They organize and deliver health care services. 
B) HMOs place a heavy emphasis on controlling the cost of covered services. 
C) HMO members pay nothing for medical care until care is provided,then they must pay high deductibles and large coinsurance payments. 
D) The selection of physicians is usually limited to physicians affiliated with the HMO.

Question 5

Under one type of HMO,the physicians are employees of the HMO and are paid a salary and sometimes an incentive bonus to hold down costs.This type of HMO is called a(n)

Accepted Answer

A) individual practice association (IP
A) . 
B) staff model. 
C) group model. 
D) network model. 
A) individual practice association (IP
A) . 
B) staff model. 
C) group model. 
D) network model.

Question 6

All of the following are reasons why employers self-insure medical expense plans EXCEPT

Accepted Answer

A) to reduce certain costs,such as premium taxes and commissions. 
B) to provide mandated state benefits. 
C) to retain funds until needed to pay claims. 
D) to eliminate the need to comply with separate state laws. 
A) to reduce certain costs,such as premium taxes and commissions. 
B) to provide mandated state benefits. 
C) to retain funds until needed to pay claims. 
D) to eliminate the need to comply with separate state laws.

Question 7

One type of managed care plan has a network of preferred providers.When care is needed,the member has the option to seek care in the network or to go outside the network.If care is received outside the network,the member must pay substantially higher deductibles and coinsurance.This type of managed care plan is a(n)

Accepted Answer

A) individual practice association plan. 
B) staff model plan. 
C) point-of-service plan. 
D) network model plan. 
A) individual practice association plan. 
B) staff model plan. 
C) point-of-service plan. 
D) network model plan.

Question 8

Some employers offer employees a choice of health care plans which are designed to make employees more sensitive to health care costs,to provide an incentive to avoid unneeded care,and to seek low-cost health care providers.Such plans are called

Accepted Answer

A) employee assistance plans. 
B) consumer-directed health plans. 
C) cafeteria plans. 
D) preferred provider organization (PPO)plans. 
A) employee assistance plans. 
B) consumer-directed health plans. 
C) cafeteria plans. 
D) preferred provider organization (PPO)plans.

Question 9

Which of the following statements about HMO managed care plans is (are)true?
I.There is an emphasis on controlling costs.
II.They usually have high deductibles.

Accepted Answer

A) I only 
B) II only 
C) both I and II 
D) neither I nor II 
A) I only 
B) II only 
C) both I and II 
D) neither I nor II

Question 10

Which of the following statements about the eligibility requirements for group insurance is true?

Accepted Answer

A) Most plans cover both full-time and part-time employees. 
B) An employee must be actively at work on the day the employee's group insurance becomes effective. 
C) An employee who signs-up for insurance during an eligibility period must furnish evidence of insurability. 
D) One purpose of a probationary period is to determine whether the employee is healthy enough to be covered under the group health insurance plan. 
A) Most plans cover both full-time and part-time employees. 
B) An employee must be actively at work on the day the employee's group insurance becomes effective. 
C) An employee who signs-up for insurance during an eligibility period must furnish evidence of insurability. 
D) One purpose of a probationary period is to determine whether the employee is healthy enough to be covered under the group health insurance plan.

Question 11

Which of the following is a characteristic of a health maintenance organization (HMO)?

Accepted Answer

A) unlimited choice of health-care providers 
B) no premiums until care is provided 
C) narrow,limited,medical services provided 
D) great emphasis on cost containment 
A) unlimited choice of health-care providers 
B) no premiums until care is provided 
C) narrow,limited,medical services provided 
D) great emphasis on cost containment

Question 12

Which of the following statements about group accidental death and dismemberment (AD&D)insurance is (are)true?
I.The principal sum is paid if the employee dies in an accident.
II.A percentage of the principal sum is paid for certain types of dismemberments.

Accepted Answer

A) I only 
B) II only 
C) both I and II 
D) neither I nor II 
A) I only 
B) II only 
C) both I and II 
D) neither I nor II

Question 13

One provision of the Affordable Care Act is the creation in each state of a new and transparent marketplace where individuals and small employers can purchase affordable,qualified,health insurance plans.This marketplace is called a(n)

Accepted Answer

A) residual pool. 
B) catastrophic health insurance pool. 
C) FAIR plan. 
D) insurance exchange. 
A) residual pool. 
B) catastrophic health insurance pool. 
C) FAIR plan. 
D) insurance exchange.

Question 14

Which of the following statements about group term life insurance is true?

Accepted Answer

A) It usually is written in the form of 5-year level term insurance. 
B) An employee who leaves the group can usually convert the coverage to an individual term life insurance policy. 
C) Many employers provide a reduced amount of coverage on retired employees. 
D) It represents only about 5 percent of the group life insurance in force. 
A) It usually is written in the form of 5-year level term insurance. 
B) An employee who leaves the group can usually convert the coverage to an individual term life insurance policy. 
C) Many employers provide a reduced amount of coverage on retired employees. 
D) It represents only about 5 percent of the group life insurance in force.

Question 15

HMOs typically pay network physicians or medical groups a fixed annual or monthly payment for each member,regardless of the frequency or type of service provided.This payment is called a

Accepted Answer

A) pro-rata charge. 
B) persistency bonus. 
C) capitation fee. 
D) corridor payment. 
A) pro-rata charge. 
B) persistency bonus. 
C) capitation fee. 
D) corridor payment.

Question 16

Med Profs is a group of 18 doctors.These doctors work out of their own offices and treat patients on a fee-for-service basis.In addition,Med Profs doctors also agree to treat HMO members at reduced fees.The type of HMO that uses organizations like Med Profs is called a(n)

Accepted Answer

A) group model plan. 
B) closed panel plan. 
C) individual practice association plan. 
D) network model plan. 
A) group model plan. 
B) closed panel plan. 
C) individual practice association plan. 
D) network model plan.

Question 17

Which of the following statements about group short-term disability income plans is true?

Accepted Answer

A) Most plans have a short elimination period for accidents but cover sickness from the first day of disability. 
B) Disability is usually defined in terms of any substantial,gainful,employment. 
C) The amount of disability income benefits typically is equal to some percentage of a worker's normal earnings. 
D) Most short-term plans cover occupational disability only. 
A) Most plans have a short elimination period for accidents but cover sickness from the first day of disability. 
B) Disability is usually defined in terms of any substantial,gainful,employment. 
C) The amount of disability income benefits typically is equal to some percentage of a worker's normal earnings. 
D) Most short-term plans cover occupational disability only.

Question 18

Advantages of cafeteria plans include all of the following EXCEPT

Accepted Answer

A) simplicity of benefit administration. 
B) employees can select benefits that best match their needs. 
C) reduced taxes for employees. 
D) greater employer control over increasing benefit costs. 
A) simplicity of benefit administration. 
B) employees can select benefits that best match their needs. 
C) reduced taxes for employees. 
D) greater employer control over increasing benefit costs.

Question 19

Which of the following statements about group long-term disability income plans is true?

Accepted Answer

A) The definition of disability becomes less restrictive after a worker has been disabled for 2 years. 
B) Coverage is provided for both occupational and nonoccupational disabilities. 
C) Benefits are increased if a worker is eligible for Social Security or workers compensation benefits. 
D) Maximum monthly benefits under long-term disability income plans are lower than the benefits paid under short-term disability income plans. 
A) The definition of disability becomes less restrictive after a worker has been disabled for 2 years. 
B) Coverage is provided for both occupational and nonoccupational disabilities. 
C) Benefits are increased if a worker is eligible for Social Security or workers compensation benefits. 
D) Maximum monthly benefits under long-term disability income plans are lower than the benefits paid under short-term disability income plans.

Question 20

A deductible under which expenses are accumulated on an annual basis,and once a specified total is reached,the deductible is satisfied for the year is called a

Accepted Answer

A) calendar-year deductible. 
B) prospective deductible. 
C) straight deductible. 
D) waiting period. 
A) calendar-year deductible. 
B) prospective deductible. 
C) straight deductible. 
D) waiting period.

Exam 16: Employee Benefits: Group Life and Health Insurance

An HMO physician who determines if medical care from a specialist is necessary is called a(n)

Which of the following statements about group insurance underwriting principles is (are)true? I.If a plan is contributory,100 percent of the eligible employees must be covered. II.Employees should be allowed to determine their own level of benefits.

Marv is covered by a group health insurance plan at work.His employer funds the entire cost of the group health insurance.Because of this characteristic,the group health insurance plan can be described as

All of the following statements about HMOs are true EXCEPT

Under one type of HMO,the physicians are employees of the HMO and are paid a salary and sometimes an incentive bonus to hold down costs.This type of HMO is called a(n)

All of the following are reasons why employers self-insure medical expense plans EXCEPT

Some employers offer employees a choice of health care plans which are designed to make employees more sensitive to health care costs,to provide an incentive to avoid unneeded care,and to seek low-cost health care providers.Such plans are called

Which of the following statements about HMO managed care plans is (are)true? I.There is an emphasis on controlling costs. II.They usually have high deductibles.

Which of the following statements about the eligibility requirements for group insurance is true?

Which of the following is a characteristic of a health maintenance organization (HMO)?

Which of the following statements about group accidental death and dismemberment (AD&D)insurance is (are)true? I.The principal sum is paid if the employee dies in an accident. II.A percentage of the principal sum is paid for certain types of dismemberments.

One provision of the Affordable Care Act is the creation in each state of a new and transparent marketplace where individuals and small employers can purchase affordable,qualified,health insurance plans.This marketplace is called a(n)

Which of the following statements about group term life insurance is true?

HMOs typically pay network physicians or medical groups a fixed annual or monthly payment for each member,regardless of the frequency or type of service provided.This payment is called a

Med Profs is a group of 18 doctors.These doctors work out of their own offices and treat patients on a fee-for-service basis.In addition,Med Profs doctors also agree to treat HMO members at reduced fees.The type of HMO that uses organizations like Med Profs is called a(n)

Which of the following statements about group short-term disability income plans is true?

Advantages of cafeteria plans include all of the following EXCEPT

Which of the following statements about group long-term disability income plans is true?

A deductible under which expenses are accumulated on an annual basis,and once a specified total is reached,the deductible is satisfied for the year is called a

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