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Health insurance policies automatically cover all family members.

A) True
B) False

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Internal limits are constraints placed on insurance agents stipulating the level of risk for which they can write a policy.

A) True
B) False

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A characteristic of dental insurance is


A) high cost.
B) dentist financing.
C) high deductible limits.
D) lack of orthodontic coverage.
E) low maximum limits.

F) B) and D)
G) B) and C)

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Hospital insurance policies will pay for all hospital expenditures most of the time.

A) True
B) False

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Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. -If you are laid off,your health insurance [can be continued at the employer's option | may be continued if you pay the premiums].

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Hospital indemnity policies would make payment for


A) surgery.
B) doctor's office visits.
C) private duty nursing care.
D) prescriptions when not in the hospital.
E) per-day hospital charges.

F) A) and B)
G) C) and D)

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Choose the word or phrase in [ ] which will correctly complete the statement. Select A for the first item, B for the second item, and C if neither item will correctly complete the statement. -Your health insurance stipulates that you will pay the first $500 of your health care expenses for the year.This is an example of a [deductible | co-payment].

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When you are hospitalized for surgical care,surgical expense coverage will pay the hospital bill.

A) True
B) False

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Medicare provides health care coverage to persons age ____ and those who are ____.


A) 55 and over; collecting disability under Social Security
B) 60 and over; collecting disability under Social Security
C) 65 and over; collecting disability under Social Security
D) 60 and over; low income
E) 65 and over; low income

F) B) and D)
G) B) and E)

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Medicare Advantage supplemental benefits include all of the following except


A) Vision
B) Dental
C) General checkups
D) Hospitalization
E) Wellness programs

F) A) and E)
G) All of the above

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Nick and Sheila Preston are married and have purchased a comprehensive major medical policy which covers them and their two sons,Wally and Brent.The policy has a $500 calendar-year family deductible,a $2,500 stop-loss provision,and an 80% coinsurance clause.The following losses occur: On January 1,Sheila was treated for an infection at a cost of $200; on July 1,Wally was treated for an injury suffered while waterskiing at a cost of $10,000; on December 5,Nick underwent eye surgery at a cost of $1,500; and on January 5 of the following year,Brent was treated for a broken leg at a cost of $2,000. ​ How much will the insurer pay for each of these losses?

Correct Answer

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January 1 loss: ($200 āˆ’ $200 of deductib...

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Disability occurs only when someone is completely incapable of doing any type of work.

A) True
B) False

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Major medical plans are characterized by deductibles,internal limits,and


A) benefit levels.
B) participation or coinsurance.
C) illness or injury frequency limits.
D) maximum surgical medical benefits.
E) sliding or decreasing premiums.

F) A) and D)
G) All of the above

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In insurance terminology,"participation" and "co-insurance" mean the same thing.

A) True
B) False

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Disability benefits are almost always taxable,so you typically need to purchase coverage that will replace gross pay.

A) True
B) False

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Your health insurance has an 80% co-insurance clause.Once the deductible is satisfied,your insurance company will pay 80% of your covered losses up to the stated limits.

A) True
B) False

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Most surgical expense plans fully reimburse the cost of second opinions.

A) True
B) False

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Suppose a person has a health insurance policy with a $500 calendar-year deductible,a $2,000 out-of-pocket cap,and an 80% coinsurance provision.If this person suffers a $600 covered loss,how much will the insurance company pay? (Assume no previous losses have occurred.)


A) $80
B) $100
C) $480
D) $600
E) Some other amount

F) B) and C)
G) A) and C)

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The Affordable Care Act requires insurance companies to set premiums based on all of the following except


A) family size.
B) where you live.
C) tobacco use.
D) gender.
E) age.

F) A) and D)
G) All of the above

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Under the ACA,all Americans are required to have or buy health insurance or pay a penalty.

A) True
B) False

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