Question 1

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)  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)  emphasis on cost containment

Question 2

The Affordable Care Act requires employers with 100 or more employees to provide health insurance on the employees or pay a penalty if at least one employee receives a tax credit and coverage through the Health Insurance Marketplace. This requirement-providing insurance or paying a fine-is known as the

Accepted Answer

A)  single-payer solution. 
B)  employer shared responsibility. 
C)  essential benefit requirement. 
D)  portability requirement. 
A)  single-payer solution. 
B)  employer shared responsibility. 
C)  essential benefit requirement. 
D)  portability requirement.

Question 3

All of the following statements about cost controls in dental insurance plans are true EXCEPT

Accepted Answer

A)  The coinsurance percentage used may vary by type of dental service. 
B)  Cosmetic dental work is usually excluded. 
C)  The limit on benefits may be expressed as an annual limit or as a lifetime limit for certain types of dental services. 
D)  To eliminate small claims, there is no coverage for routine oral examinations, X-rays, or cleaning teeth. 
A)  The coinsurance percentage used may vary by type of dental service. 
B)  Cosmetic dental work is usually excluded. 
C)  The limit on benefits may be expressed as an annual limit or as a lifetime limit for certain types of dental services. 
D)  To eliminate small claims, there is no coverage for routine oral examinations, X-rays, or cleaning teeth.

Question 4

Which of the following is a provision of the Affordable Care Act?

Accepted Answer

A)  strengthening the use of pre-existing conditions exclusions 
B)  prohibition of harmful practices by insurers. 
C)  introduction of annual and lifetime limits to control costs 
D)  elimination of flexible spending accounts 
A)  strengthening the use of pre-existing conditions exclusions 
B)  prohibition of harmful practices by insurers. 
C)  introduction of annual and lifetime limits to control costs 
D)  elimination of flexible spending accounts

Question 5

An HMO that contracts with two or more independent group practices to provide medical services to covered members is called a(n)

Accepted Answer

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

Question 6

Reasons for having a minimum participation requirement before a group is eligible for insurance include which of the following?
I.To lower the expense rate per unit of insurance
II.To minimize the possibility of insuring a group which consists largely of unhealthy individuals

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 7

Which of the following statements regarding recent developments in employer-sponsored health plans is (are) true?
I.Preferred provider organizations (PPOs) continue to dominate group health insurance markets.
II.The number of employers offering medical benefits to workers who retire early has increased.

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 8

Under older group medical expense plans, physicians were paid a fee for each covered service and were reimbursed on the basis of reasonable and customary charges, up to a maximum limit. These older group medical expense plans were called

Accepted Answer

A)  service medical plans. 
B)  managed care plans. 
C)  point-of-service plans. 
D)  indemnity plans. 
A)  service medical plans. 
B)  managed care plans. 
C)  point-of-service plans. 
D)  indemnity plans.

Question 9

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 10

Connors Company self-funds the medical expense benefits that it provides to its employees. Connors Company has a contract with a commercial health insurance company providing that the health insurance company will pay all claims in excess of $250,000. The arrangement with the health insurance company is called

Accepted Answer

A)  reinsurance. 
B)  managed care. 
C)  stop-loss insurance. 
D)  coinsurance. 
A)  reinsurance. 
B)  managed care. 
C)  stop-loss insurance. 
D)  coinsurance.

Question 11

Which of the following statements about cafeteria plans is (are) true?
I.Unspent flexible spending account balances are refunded to the employee, tax-free, at year-end.
II.Cafeteria plans enable employees to select benefits that meet their specific needs.

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 12

An employer-funded plan with favorable tax advantages, which repays employees for medical care not covered by the employer's standard medical plan is a(n)

Accepted Answer

A)  401(k) account. 
B)  individual retirement account (IR
A) . 
C)  health reimbursement arrangement (HR
A) . 
D)  flexible spending account (FS
A) . 
A)  401(k) account. 
B)  individual retirement account (IR
A) . 
C)  health reimbursement arrangement (HR
A) . 
D)  flexible spending account (FS
A) .

Question 13

Which of the following statements about the continuation of group health insurance under the COBRA law is true?

Accepted Answer

A)  A continuation of coverage must be made available even if an employee voluntarily terminates employment. 
B)  The length of the continuation of coverage is 90 days. 
C)  The option to continue coverage applies to minor children only, not to adults. 
D)  The employer must pay the entire cost of coverage during the continuation period. 
A)  A continuation of coverage must be made available even if an employee voluntarily terminates employment. 
B)  The length of the continuation of coverage is 90 days. 
C)  The option to continue coverage applies to minor children only, not to adults. 
D)  The employer must pay the entire cost of coverage during the continuation period.

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

All of the following statements about cost controls in dental insurance plans are true EXCEPT

Which of the following is a provision of the Affordable Care Act?

An HMO that contracts with two or more independent group practices to provide medical services to covered members is called a(n)

Reasons for having a minimum participation requirement before a group is eligible for insurance include which of the following? I.To lower the expense rate per unit of insurance II.To minimize the possibility of insuring a group which consists largely of unhealthy individuals

Under older group medical expense plans, physicians were paid a fee for each covered service and were reimbursed on the basis of reasonable and customary charges, up to a maximum limit. These older group medical expense plans were called

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

Which of the following statements about cafeteria plans is (are) true? I.Unspent flexible spending account balances are refunded to the employee, tax-free, at year-end. II.Cafeteria plans enable employees to select benefits that meet their specific needs.

An employer-funded plan with favorable tax advantages, which repays employees for medical care not covered by the employer's standard medical plan is a(n)

Which of the following statements about the continuation of group health insurance under the COBRA law is true?

Risk and Its Treatment

Insurance and Risk

Introduction to Risk Management

Enterprise Risk Management and Related Topics

Types of Insurers and Marketing Systems

Insurance Company Operations

Financial Operations of Insurers

Government Regulation of Insurance

Fundamental Legal Principles

Analysis of Insurance Contracts

Life Insurance

Life Insurance Contractual Provisions

Buying Life Insurance

Annuities and Individual Retirement Accounts

Health-Care Reform; Individual Health Insurance Coverages

Employee Benefits: Retirement Plans

Social Insurance

The Liability Risk

Auto Insurance

Auto Insurance (continued)

Homeowners Insurance, Section I

Homeowners Insurance, Section II

Other Property and Liability Insurance Coverages

Commercial Property Insurance

Commercial Liability Insurance

Crime Insurance and Surety Bonds

Filters

Exam 16: Employee Benefits: Group Life and Health Insurance

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

All of the following statements about cost controls in dental insurance plans are true EXCEPT

Which of the following is a provision of the Affordable Care Act?

An HMO that contracts with two or more independent group practices to provide medical services to covered members is called a(n)

Reasons for having a minimum participation requirement before a group is eligible for insurance include which of the following? I.To lower the expense rate per unit of insurance II.To minimize the possibility of insuring a group which consists largely of unhealthy individuals

Under older group medical expense plans, physicians were paid a fee for each covered service and were reimbursed on the basis of reasonable and customary charges, up to a maximum limit. These older group medical expense plans were called

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

Which of the following statements about cafeteria plans is (are) true? I.Unspent flexible spending account balances are refunded to the employee, tax-free, at year-end. II.Cafeteria plans enable employees to select benefits that meet their specific needs.

An employer-funded plan with favorable tax advantages, which repays employees for medical care not covered by the employer's standard medical plan is a(n)

Which of the following statements about the continuation of group health insurance under the COBRA law is true?

Risk and Its Treatment

Insurance and Risk

Introduction to Risk Management

Enterprise Risk Management and Related Topics

Types of Insurers and Marketing Systems

Insurance Company Operations

Financial Operations of Insurers

Government Regulation of Insurance

Fundamental Legal Principles

Analysis of Insurance Contracts

Life Insurance

Life Insurance Contractual Provisions

Buying Life Insurance

Annuities and Individual Retirement Accounts

Health-Care Reform; Individual Health Insurance Coverages

Employee Benefits: Retirement Plans

Social Insurance

The Liability Risk

Auto Insurance

Auto Insurance (continued)

Homeowners Insurance, Section I

Homeowners Insurance, Section II

Other Property and Liability Insurance Coverages

Commercial Property Insurance

Commercial Liability Insurance

Crime Insurance and Surety Bonds

Filters