EXAMFX Health Insurance 4

Question 1

An insured is hospitalized for surgery. The plan pays 80% of covered expenses after the deductible and the insured pays 20%. This cost-sharing arrangement is called:

Accepted Answer

Coinsurance

Answer

Coinsurance is the percentage split of covered expenses between the insurer and insured after the deductible is satisfied.

Question 2

The 'birthday rule' is used to determine which parent's plan pays primary when a child is covered under both parents' group plans. Under this rule, primary coverage is provided by the parent:

Accepted Answer

Whose birthday falls earliest in the calendar year

Answer

The birthday rule designates the parent with the earlier birthday in the calendar year (month and day, not year) as the primary insurer.

Question 3

A provision that prevents an insured from collecting more than 100% of actual medical expenses from multiple health policies is called:

Accepted Answer

Coordination of Benefits (COB)

Answer

Coordination of Benefits rules determine which plan pays primary and which pays secondary to prevent over-insurance and duplicate recovery.

Question 4

Under the 'own occupation' definition of disability, a claimant qualifies for disability benefits if:

Accepted Answer

They cannot perform the duties of their specific regular occupation

Answer

The own-occupation definition is the broadest and most favorable to the insured, paying benefits if the insured cannot perform their specific job duties.

Question 5

A long-term care (LTC) insurance policy typically begins paying benefits when an insured requires assistance with how many Activities of Daily Living (ADLs)?

Accepted Answer

2

Answer

Most LTC policies trigger benefits when an insured is unable to perform at least 2 of 6 standard ADLs (bathing, dressing, eating, toileting, transferring, continence).

(EXAMFX) Exam FX Insurance Practice Test

(EXAMFX) Exam FX Insurance Practice Test

EXAMFX Health Insurance 4