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Joe Johnson needs surgery for appendicitis.Which part of his basic insurance coverage should help pay for this surgery?


A) hospital expense
B) surgical expense
C) physician expense
D) major medical
E) Medicare Part B

F) All of the above
G) A) and D)

Correct Answer

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A good health insurance plan should offer basic coverage for hospital and doctor bills.

A) True
B) False

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Medicare does not cover the expenses of private-duty nursing care.

A) True
B) False

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The number of Americans without basic health insurance has been decreasing since the 1980s.

A) True
B) False

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Which one of the following provisions requires that the policyholder pay a basic amount before the policy benefits begin?


A) coinsurance
B) stop loss
C) deductible
D) self insurance
E) incontestable

F) All of the above
G) A) and E)

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Nathanial Drummond has three different insurance policies.He has been injured in an accident and has incurred $30,000 in medical bills.There is a clause in all of his insurance contracts that ensures he receives no more than a total of $30,000 in payments from his insurance companies.What is this clause called?


A) coordination of benefits
B) deductible
C) coinsurance
D) stop-loss provision
E) waiver of premium

F) C) and D)
G) A) and E)

Correct Answer

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Medicaid is financed by both state and federal funds.

A) True
B) False

Correct Answer

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Each year,Sophie Bennett must pay $500 for doctor's visits before her insurance company will make any payments for doctor's visits.What is this requirement called?


A) coordination of benefits
B) deductible
C) coinsurance
D) stop-loss provision
E) waiver of premium

F) All of the above
G) C) and D)

Correct Answer

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What should you do when an HMO denies treatment or coverage?


A) Ask for a letter detailing the clinical reasons for the denial.
B) Refer to the plan document or contact your HMO's member services department to gather information on the appeals process.
C) Make copies of any correspondence,including payments,and any reimbursements.
D) Enlist the help of your doctor,employer,and state insurance department to lobby your case before the HMO.
E) You should do everything included in the other answers.

F) B) and E)
G) All of the above

Correct Answer

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In 2009,the largest percentage of U.S.health care dollars was spent on:


A) hospital care.
B) dental care.
C) physician/clinical services.
D) prescription drugs.
E) nursing carE.

F) A) and B)
G) C) and D)

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Generally,disability income policies with shorter waiting periods have lower premiums.

A) True
B) False

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Which of the following is not a key provision of the Patient Protection and Affordable Care Act of 2010?


A) Offers tax credits for small businesses to make employee coverage more affordable
B) Eliminates co-payments for preventive services
C) Encourages insurance companies to drop people from coverage when they get sick
D) Restricts the annual limits to ensure access to needed care in all plans
E) Increases funds for Community Health Centers

F) A) and D)
G) B) and E)

Correct Answer

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Title XIX of the Social Security Act provides for a program of medical assistance to certain low-income individuals and families.

A) True
B) False

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Very few group health policy contracts have a coordination of benefits provision.

A) True
B) False

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Which type of health insurance pays part or all of an insured's hospital bills for room,board,and other charges?


A) surgical expense
B) hospital expense
C) physician's expense
D) Medicare Part B
E) major medical

F) B) and C)
G) C) and D)

Correct Answer

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Marcia Fuller has an insurance policy that lists that she and her three daughters,ages 6,10,and 12,are covered under this policy.Which provision in her insurance policy is defined by this list?


A) eligibility
B) assigned benefits
C) benefit limits
D) guaranteed renewable
E) exclusions and limitations

F) B) and E)
G) A) and B)

Correct Answer

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____________ is a type of major medical insurance that has a very low deductible amount and is offered without any separate basic plan.


A) Comprehensive major medical insurance
B) Major Medical expense insurance
C) Physician's expense insurance
D) Hospital expense insurance
E) Surgical expense insurance

F) D) and E)
G) C) and D)

Correct Answer

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Health insurance includes both medical expense insurance and disability income insurance.

A) True
B) False

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People often buy surgical expense insurance in combination with hospital expense insurance.

A) True
B) False

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Julie Cumbie is playing softball and gets hurt sliding into second base.She gets an x-ray at her doctor's office to make sure her ankle isn't broken.Which part of her basic insurance coverage should help pay for this x-ray?


A) hospital expense
B) surgical expense
C) physician expense
D) major medical
E) Medicare Part B

F) B) and C)
G) A) and B)

Correct Answer

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