EXAMFX Health Insurance 5

Question 1

Which type of health insurance plan requires members to receive care from a designated primary care physician and generally does NOT cover out-of-network providers except in emergencies?

Accepted Answer

HMO

Answer

HMOs require members to use network providers and obtain PCP referrals, with out-of-network coverage only for emergencies.

Question 2

A health insurance policy's 'out-of-pocket maximum' is best described as:

Accepted Answer

The cap on the insured's cost-sharing after which the insurer pays 100% of covered expenses

Answer

Once the insured reaches the out-of-pocket maximum, the insurer covers 100% of additional in-network covered costs for the remainder of the year.

Question 3

The COBRA qualifying event of a covered employee's death entitles surviving dependents to how many months of continuation coverage?

Accepted Answer

36 months

Answer

Death of the covered employee is a qualifying event that entitles surviving dependents to 36 months of COBRA continuation coverage.

Question 4

Under the 'time of payment of claims' provision, health insurers must pay claims immediately after receiving:

Accepted Answer

Written proof of loss

Answer

The time of payment of claims provision requires the insurer to pay claims promptly upon receipt of written proof of loss.

Question 5

A guaranteed renewable health insurance policy means:

Accepted Answer

The insurer must renew the policy but may increase premiums for an entire class of insureds

Answer

Guaranteed renewable policies cannot be cancelled by the insurer as long as premiums are paid, but the insurer may raise rates on a class-wide basis.

(EXAMFX) Exam FX Insurance Practice Test

(EXAMFX) Exam FX Insurance Practice Test

EXAMFX Health Insurance 5