XCEL Chapter 11

14 April 2023
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question
What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do? A. In the event of employment termination, group health insurance can be kept if the employee pays the premiums B. Receive a tax credit to help offset the cost of health insurance C. Remain on their current coverage for 30 months D. In the event of employment termination, group health insurance can be kept if the employer pays the premiums
answer
In the event of employment termination, group health insurance can be kept if the employee pays the premiums
question
Credit Accident and Health plans are designed to? A. permit creditors the ability to require that coverage be purchased through insurers of their choice B. provide permanent protection C. help pay off existing loans during periods of disability D. not permit free choice of coverage selection
answer
help pay off existing loans during periods of disability
question
Ron has a new employer and wishes to enroll in the company's group health plan. In determining whether his pre-existing health condition applies, Ron cannot have more than a ___ day gap without previous health insurance. A. 45 B. 63 C. 75 D. 90
answer
63
question
Health insurance involves two perils, accident and ____. A. death B. sickness C. disability D. liability
answer
sickness
question
Which of the following would evidence ownership in a participating health insurance contract? A. Stock ownership B. Irrevocable beneficiary status C. Policy ownership D. Collateral assignment
answer
Policy ownership
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Under the subrogation clause, legal action can be taken by the insurer against the? A. responsible third party B. beneficiary C. policyowner D. State
answer
responsible third party
question
Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of? A. costs that exceed 7 1/2 % of AGI B. costs that exceed 10% of AGI C. 100% of costs D. no deduction permitted
answer
100% of costs
question
The election of COBRA for continuation of health coverage will? A. increase the coverage and lower premium B. maintain the same coverage and increase premium C. increase out-of-pocket costs and lower premium D. decrease out-of-pocket costs and maintain same premium
answer
maintain the same coverage and increase premium
question
How many employees must an employer have for a terminated employee to be eligible for COBRA? A. 20 B. 30 C. 40 D. 50
answer
20
question
Coordination of Benefits regulation applies to all of the following plans EXCEPT? A. Group vision plan B. Preferred Provider Organization plan C. Self-funded group health plan D. Group health plan
answer
Preferred Provider Organization plan
question
According to the Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy renewal be denied? A. There have been too many claims in the previous year B. The size of the group has increased by more than 10% C. Participation or contribution rules have been violated D. Participation or contribution rules have been changed
answer
Participation or contribution rules have been violated
question
An insurer has the right to recover payment made to the insured from the negligent party. These rights are called? A. contributory B. indemnity C. estoppel D. subrogation
answer
subrogation
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A master contract and certificate of coverage can be found in which type of policy? A. Long-term B. Medicaid C. Group D. Medicare
answer
Group
question
Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA? A. It would be considered taxable income to the employee B. The employee would not be allowed to an HSA C. The employer would pay payroll tax and FICA on the contribution amount D. The employer would not be allowed to deduct the contribution from the employee's pay
answer
It would be considered taxable income to the employee
question
What is the contract called that is issued to an employer for a Group Medical Insurance plan? A. Master policy B. Certificate of coverage C. Provisional policy D. Document of coverage
answer
Master policy
question
Which of the following would be considered a possible applicant and contract policyholder for group health benefits? A. Human resource department B. Employer C. Insured employee D. Insurance company
answer
Employer
question
Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental? A. Presumptive disability provision B. Absolute accidental provision C. Accidental death benefit provision D. Accidental bodily injury provision
answer
Accidental bodily injury provision
question
According to HIPAA, when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual? A. is eligible for coverage upon hire B. must wait 360 days to be eligible for coverage C. must continue coverage with the previous employer D. is eligible for only health insurance, not life or dental insurance
answer
is eligible for coverage upon hire
question
Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled? A. Disability overhead policy B. Business continuation policy C. Disability buy-sell policy D. Business overhead expense policy
answer
Business overhead expense policy
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Which of the following is typically NOT eligible for coverage in a group health policy? A. Full-time employee B. Temporary employee C. Business owner D. Partner in a partnership
answer
Temporary employee
question
Susan is insured through her Group Health Insurance plan and changed her coverage to an individual plan with the same insurer after her employment was terminated. This change is called a(n) A. crossover B. conversion C. exchange D. extension of benefits
answer
conversion
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The purpose of the Coordination of Benefits provision in group accident and health plans is to? A. avoid overpayment of claims B. reduce out-of-pocket costs C. reduce adverse selection D. lower the cost of premiums
answer
avoid overpayment of claims
question
The policyholder for a group health benefit plan is considered to be the A. Employee B. Employer C. Liaison D. Insurer
answer
Employer
question
When are group disability benefits considered to be tax-free to the insured? A. When the recipient pays the premiums B. When the employer pays the premiums C. When both the employer and recipient pay the premiums D. When benefits paid are equal to or lower than the recipient's salary
answer
When the recipient pays the premiums
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A group Disability Income plan that pays tax-free benefits to covered employees is considered? A. non-contributory B. partially contributory C. group contributory D. fully contributory
answer
fully contributory
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Continued coverage under COBRA would be provided to a(n) A. former dependent of employee no longer of dependent status B. terminated employee C. divorced spouse of employee D. employee reaching full retirement
answer
terminated employee
question
Sonya applied for a health insurance policy on April 1. Her agent submitted the information to the insurance company on April 6. She paid the premium on May 15 with the policy indicating the effective date being May 30. On which date would Sonya have coverage? A. April 1 B. April 6 C. May 15 D. May 30
answer
May 30
question
Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the A. employee's benefits still owed can be claimed B. employee cannot be excluded from the new employer's health plan C. employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan D. new health insurance carrier will have a clear record of any chronic conditions that exist
answer
employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan
question
A common exclusion with Vision plans is A. eyeglass frames B. the examination C. contact lenses D. lasik surgery
answer
lasik surgery
question
Which of the following does Coordination of Benefits allow? A. Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid B. Allows both a group health plan and individual health plan to coordinate their benefit payments C. Allows the deductible to be spread out between all the health providers D. Allows each health provider to pay 100% of the claim
answer
Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid