Download Hawaii Health Insurance Exam: Chapter 1 With 100% Correct Answers 2024 and more Exams Nursing in PDF only on Docsity! Hawaii Health Insurance Exam: Chapter 1 With 100% Correct Answers 2024 3 Types of Medical Expense Insurance: - Correct Answer- Basic Hospital, Medical and Surgical (may be purchased together or separately and are sometimes called "first dollar" because they do not have deductibles) Relative Value - Correct Answer-The relative value approach - each procedure is assigned a number of "points" relative to the number of appoints assigned to the maximum benefit (where as the total amount payable per point is the Conversion Factor) Basic Medical Expense Coverage - Correct Answer-Offers wide range of limited benefits often resulting in high out-of- pocket expenses. Can cover maternity, mental and nervous disorder, hospice care and more (non-surgical) expenses Major Medical Policies - Correct Answer-Carry a deductible, but pickup where basic medical expense coverage leaves off pg. 1 professoraxe l Supplementary Major Medical Policies - Correct Answer- Used to support the coverage payable under a basic medical expense policy The corridor deductible - Correct Answer-The corridor refers to the gap between where the basic coverage leaves off and the major picks up (amount paid by insured) The Relative Value Approach - Correct Answer-Used in some Basic Surgical Expense Coverage policies, assigns points to all operations covered and uses a conversion factor to determine the total amount payable per point Comprehensive Major Medical Policies - Correct Answer-A combo of basic and major medical coverage generally including low premiums, high maximums and coinsurance HMOs (Health Maintenance Organizations) - Correct Answer-The main goal of HMOs is to offer preventative health care. HMOs are unique in that they provide BOTH the patient care and the financing for its members. HMOs are Primary Care Physician (gatekeeper) based and require referrals from a member's PCP in order to see a specialist. pg. 2 professoraxe l work) for conditions such as permanent blindness, loss of hearing, loss of speech, and either the loss of limb use or some require the limb to be severed. Benefit Limitations - Correct Answer-The limitations are based off of the insured's past earnings (say from the preceding two years) and are the maximum benefits the insurer is willing to accept as individual risk Social Insurance Supplement (SIS) - Correct Answer-Also known as Social Security Riders - generally provides payments if 1) insured is eligible for SS but is in the 5-month waiting period, 2) Insured is denied SS b/c of the rigid definition of total disability, 3) amount payable is greater than SS (only difference is paid in this case) Accidental Death and Dismemberment - Correct Answer- Coverage which can be written as a rider or as a separate policy, providing lump sum payment (usually for a policy's face amount) or a percentage of the principal sum for dismemberment, capital sum. Long-Term Care insurance - Correct Answer-Can be an individual policy, group or rider - has elimination period (say 30 days of confinement before it kicks in), limited pg. 5 professoraxe l benefit period generally of 2-5 years and most are guaranteed renewable but insurer CAN raise the premium LTC Prohibited Provisions - Correct Answer-Insurers are prohibited from cancelling a policy due to the insured's age and/or deterioration of the insured's physical or mental health, establishing a new waiting period unless more coverage opted for by the insured, Short-Term Medical - Correct Answer-Not regulated by the Affordable Care Act, not limited to enrollment periods, and do not meet requirements of federally mandated health insurance. Like traditional plans, they may have networks, impose premiums, deductibles, coinsurance and benefit maxes Group Disability Income Insurance - Correct Answer- Usually provides benefits based on the insured's income (monthly benefits usually limited to 60% of individual's income) Master Contract - Correct Answer-Issued only to the group sponsor in Group Health Insurance. Individuals covered by policy are issued Certificates of Insurance. pg. 6 professoraxe l Qualifying Event for COBRA - Correct Answer-In the event of voluntary termination, termination for reasons other than fireable offenses (like downsizing), change in employment status (like full to part time), requires employers (with 20 or more employees) to extend coverage up to 18 months. In the event of death of an employee or divorce, dependents have 36 months. Employer can collect up to 102% of terminated employee's premium (extra 2% for admin costs) Critical Illness Policy - Correct Answer- Accidental Death Benefit - Correct Answer-Most policies will pay the accidental death benefit if death is caused by the accident within the following 90 days Hospital Indemnity - Correct Answer-Pays a FIXED amount for each day the insured is hospitalized (even if cost is $100, it pays $120) Skilled Care - Correct Answer- pg. 7 professoraxe l
