Concepts, Provisions, and Clauses (ID A/H/S)

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Question 1 of 9

1. Question

Which of the following statements is true about dependent coverage that is mandated by the Affordable Care Act?

Dependent coverage must include children until the age of 26.

The requirement to offer dependent coverage applies only to unmarried children.

The requirement to offer dependent coverage applies only to married children.

Dependent coverage must include children until the age of 21.

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Question 2 of 9

2. Question

What does 80/20 coinsurance mean?

Before the deductible is reached, the insurer is responsible for 80% and the insured is responsible for 20%.

After the deductible is reached, the insured is responsible for 80% and the insurer is responsible for 20%.

Before the deductible is reached, the insured is responsible for 80% and the insurer is responsible for 20%.

After the deductible is reached, the insurer is responsible for 80% and the insured is responsible for 20%.

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Question 3 of 9

3. Question

What is a stop-loss provision in a health insurance policy?

It specifies the annual maximum out-of-pocket amount the insured will have to pay in deductibles and coinsurance.

It specifies the annual minimum out-of-pocket amount the insured will have to pay in deductibles and coinsurance.

It waives the insurer’s responsibility to pay all future claims that are related to a pre-existing medical condition.

It is the amount the insured is required to pay before the insurer will cover any medical costs.

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Question 4 of 9

4. Question

Which of the following statements is NOT true about an impairment rider?

This is an amendment to a health insurance policy that waives the insurer’s responsibility to pay all future claims that are related to a pre-existing medical condition.

Since the ACA went into effect, impairment riders are required on health insurance policies that are considered to provide qualifying health insurance coverage.

It is also known as an exclusionary rider.

It is also known as a medical exclusion rider.

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Question 5 of 9

5. Question

What are the two most common medical payment systems?

Partial and residual

Elimination and probationary

Fee-for-service (FFS) and prepaid

Presumptive and recurrent

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Question 6 of 9

6. Question

Which of the following statements is NOT true about fee-for-service (FFS) medical payment plans?

This type of plan is also known as managed care, capitated, or fixed per person.

The insurer will either pay the medical facility directly, or reimburse the insured after the insured pays the medical facility.

The amount the insurer will pay is based on typical costs for specific medical procedures and services in that demographic area.

Health care providers are paid a certain amount for each procedure performed or service provided.

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Question 7 of 9

7. Question

Which of the following statements is NOT true about prepaid medical payment systems?

The health care providers and facilities (hospitals and clinics) are paid a predetermined amount at regular intervals, regardless of how many procedures are performed or services are provided.

The insured members pay subscription fees in exchange for medical services.

Health care providers are paid a certain amount for each procedure performed or service provided.

This type of plan is also known as managed care, capitated, or fixed per person.

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Question 8 of 9

8. Question

A health insurance policy that provides very limited coverage (such as dental, cancer, drugs, or accident) is called what type of coverage?

Comprehensive coverage

Specified coverage

Dependent coverage

Presumptive coverage

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Question 9 of 9

9. Question

What words are used to describe a medical policy that covers a wide range of medical coverages including routine physicals, preventive care, doctor visits, hospital stays, and rehabilitative care?

Special coverage

Specified coverage

Comprehensive coverage

Deluxe coverage

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