What action can an insurer take to discourage malingering and false disability claims

Chapter 4

Which parties are directly involved in a group accident and health insurance contract?

Jill has a group health plan with an employer that covers employees in more than one state. Which of the following is NOT affected by the state regulatory jurisdiction established for this plan?

Continuation of coverage under COBRA

An accident and health insurance policy defines an injury as "bodily injury by accidental means". For an injury to be covered on this policy, what is required?

Both the cause and resultant injury must be accidental

Which of the following incidents would NOT be covered by an Accidental Death and Dismemberment policy?

Which of the following guidelines does NOT apply under the pregnancy provision of the Civil Rights Act?

Post-termination extensions of medical benefits must apply equally to pregnancy

ABC Corporation purchases and is beneficiary of an individual disability income insurance policy on a key employee. Which of the following statements is true?

Benefits are received tax-free by the company

Laura has an employer-based preventative health care plan that focuses on an enrollee's problems, such as drug abuse or stress. These plans are called

An employer pays the accident and health insurance premiums for its employees. The premiums paid by the employer are

deductible to the business

In a disability buy-sell agreement, the policies funding the agreement are owned by the

A group health insurance policy is a contract between an

employer and insurance company

Larry is about to file an accident and health insurance claim. Which of the following would make claim handling more convenient for him?

Bert's spouse passed away recently. Bert was covered under his spouse's group family health insurance plan but now is covered under COBRA. How much of the active-employee cost may be passed on to Bert for continued coverage?

Individuals covered with employer-paid group health plans will normally receive tax-free benefits under all of these plans EXCEPT

How many employees must an employer have for the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to apply?

Which of the following statements BEST describes the HIPAA portability rules for an individual who changes from one group medical plan to another?

Reduces or eliminates any pre-existing conditions excluded under the new plan

How are benefit payments from individually-owned medical expense policies treated for tax purposes?

Tina is insured under a business overhead expense insurance policy. Which of the following would be covered if she were to become disabled?

business property rental expense

Which of the following statements is NOT true concerning the relationship between group health insurance plans and Medicare? (assuming the business has more than 20 employees)

Group health coverage is NOT available for workers over the age of 65

According to HIPAA regulations, which of the following may reduce a medical plan's pre-existing conditions exclusion?

any period of prior coverage

ABC Partnership is a business with a limited number of partners. Which disability buy-sell agreement is best suited for this business?

entity purchase agreement

A certificate of coverage for a group health policy is best described as

proof of coverage for the employee

Which of the following is NOT a function of accident and health insurance?

Pays a death benefit as a result of natural causes

Darrell has a group long-term disability income policy paid by his employer. Which of these statements is true?

The specified benefit amount is a percentage of his wages

If group Health benefit levels are too high, what could be the end result?

overutilization of the plan

In regards to health insurance, employees age 65 or older are typically required to

be offered the same group health benefits offered to the younger employees

Trade association groups that are eligible for group medical benefits normally are

According to the Pregnancy Discrimination Act of 1978, employers must treat pregnancy in the same manner as

What type of employee welfare plans are not subject to ERISA regulations?

Which of the following statements BEST describes a double indemnity provision in travel accident insurance?

Benefits are doubled under certain circumstances stated in the policy

James owns a business and has a policy that covers the business expense of finding a permanent or temporary employee to replace a disabled one. This type of disability coverage is called

Steve has a group disability income policy where the premiums are paid by his employer. He elected to pay for additional residual disability coverage. Which of the following statements is true?

Steve will pay taxes on the disability benefit received from his employer, but will receive any residual disability benefits tax-free

What is the federal income tax liability of a death benefit paid from a health insurance policy to a named beneficiary?

The main role of accident and health and disability insurance is to

protect against medical care costs and the loss of earning power

Under HIPAA requirements, how would an individual NOT be eligible for the pre-existing conditions exclusion waiver?

There is a break in coverage of more than 63 days

The health insurance premiums paid for by each partner in a partnership is considered to be

Typically, states will permit the grouping of two or more small employers in the same industry for obtaining group health insurance at a favorable rate. This grouping of employers is known as a multiple employer

Kate received a group accident and health termination notice. How many days does she have to apply for a converted policy?

Under HIPAA, medical plan late enrollees may be excluded for pre-existing conditions for a maximum of

When group benefits under COBRA have expired, a fully insured group policy can be converted to a(n)

What action can an insurer take to discourage malingering and false disability claims?

When an insured has two disability policies with the same insurer, the insurer sets limits on the amount of benefits an insured can collect

A comprehensive group policy also covers expenses related to vision care. Which of the following is not typically covered under a vision plan?

What type of group plan is excluded from HIPAA statutes?

In which of the following situations can an insurance company offer group Health insurance?

The sponsoring group provides an employer-employee relationship

Which of the following does NOT help determine group health insurance premiums?

income level of group members

Laura is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period?

How do birthing centers reduce medical costs?

using certified nurse midwives

For employees covered in multiple states under a group health plan, jurisdiction rules cannot alter

Which of the following statements BEST describes employer contributions for employer provided health insurance?

Employer contributions are deductible

Nonqualified distributions from a health savings account (HSA) have a tax penalty of

Which of these is NOT a factor that influences group health insurance underwriting?

Physical exams of group members

When disability buy-sell insurance benefits exceed a partner's cost basis, which of the following is correct?

The full amount is non-taxable to the partner

Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy?

A disabled business owner who has payroll and business expenses paid for has what kind of insurance policy?

Business overhead expense

Pete is covered by a group health insurance plan which covers employees in multiple states. This plan is governed by the laws of which state?

where the master contract was issued

Group accident and health insurance may be offered by an insurer when the sponsoring group

provides an employer-employee relationship

Mary is an employee who is covered with a disability income policy through her employer. She pays for the portion of the premium attributable to the cost of residual disability benefits, while her employer pays for the remainder. What are the tax implicat

Residual benefits will be received income tax-free

Mike recently lost sight in both eyes. He has a policy that pays a lump sum benefit for this injury. What type of insurance does Mike have?

accidental death and dismemberment

Under a key person disability income policy, benefits will be received as

tax-free income to the business

Which of the following statements BEST describes disability buy-sell insurance policies?

Policy proceeds are typically received tax-free

Kim is covered under two medical expense plans. Plan A pays up to $5,000. Plan B pays up to $4,000. If she incurs $7,000 in expenses, the coordination of benefits provision dictates that

Plan A pays up to $5,000 and Plan B pays up to $2,000

What is the name of the period of time during which a new employee is ineligible for group Health insurance coverage?

Typically, working individuals age 65 or over must be

offered the same Health benefits as the younger employees

For employees covered in multiple states under a group health plan, jurisdiction rules cannot alter

Notice of information practices must be given to a policyholder at least