Life and Health California Exam Health Insurance Policies 3

Question 1

What is a 'deductible carryover' provision in a major medical policy?

Accepted Answer

It allows expenses incurred in the last 3 months of the year to apply to the next year's deductible

Answer

It allows unused deductible amounts to carry forward to the next year

Answer

It waives the deductible if hospitalized more than 30 days

Answer

It transfers the deductible obligation to a third party

Question 2

Under an exclusive provider organization (EPO), what happens if the insured uses an out-of-network provider for non-emergency care?

Accepted Answer

No benefits are paid

Answer

Benefits are paid at 50% of the usual rate

Answer

The insured must pay a higher copay

Answer

A referral will still be covered

Question 3

A 'family deductible' in a health insurance policy means:

Accepted Answer

Once total family expenses meet the family deductible, further covered expenses are paid at 100%

Answer

Each family member has the same individual deductible

Answer

The deductible applies only to the primary policyholder

Answer

Family members share a deductible equally regardless of usage

Question 4

Under the California Insurance Code, individual health insurance policies must provide coverage for which of the following mental health services?

Accepted Answer

Mental health and substance use disorder services at parity with medical/surgical benefits

Answer

Unlimited inpatient psychiatric hospitalization only

Answer

Only outpatient mental health visits up to 20 per year

Answer

Mental health benefits only if included as a rider

Question 5

Which type of health policy provision gives the insured the right to renew the policy each year, but the insurer may change the premium at renewal?

Accepted Answer

Guaranteed renewable

Answer

Non-cancelable

Answer

Conditionally renewable

Answer

Optionally renewable

Question 6

What is the purpose of a 'coordination of benefits' (COB) provision in group health insurance?

Accepted Answer

To prevent the insured from collecting more than 100% of covered expenses when covered by more than one plan

Answer

To ensure the insured never pays more than the deductible

Answer

To coordinate premium payments between employer and employee

Answer

To transfer benefits from one insured to another within the same family