250-302
Medicare and Health Insurance Claims Quiz
Test your knowledge on Medicare, long-term care insurance, and health care terminology with our comprehensive quiz! Dive deep into the regulations, coverage details, and important facts about insurance systems.
- 53 challenging questions
- Designed for healthcare enthusiasts and professionals
- Learn about Medicare, COBRA, and more!
What is the first step in submitting Medicare claims?
Review by the Medicare Appeals
The medical provider submits expenses to Medicare.
Wait for the decision by the office of Medicare Hearings
Unless certified by another governmental agency, which entity has jurisdiction over providers of coverage designed to pay for health care services?
The Department of Insurance
Worker’s Compensation program
California Insurance Code
Long-term care insurance may be purchased in all of the following forms EXCEPT
Insurance companies
Federal government-sponsored policies
Under the Consolidated Omnibus Budget Reconciliation Act(COBRA),a qualifying event ensures that an employee who loses coverage can
Elect to continue coverage
Elect to cancel coverage
Pay lump sum premium
Which statement is TRUE regarding Worker’s Compensation?
The employer helps pays employee when employer is disabled
The beneficiary pays part of the premium
The employer pays the entire premium for Workers’ Compensation coverage
Which program is designed to provide medical assistance to people with low incomes?
Medicare A
Medicare B
Medicare
Medi-cal
The Social Security normal retirement age depends upon the
Income
Worker’s year of birth
Health
Who submits Medicare Part A claims?
Hospital
Insurer
Insurance Company
How long do Worker’s Compensation medical expenses continue for disabled workers?
5 years
At least a year
There is no limit
Which of the following statements concerning the usual coordination of benefits provision are CORRECT?
When two plans both have the provision, coverage as an employer is primary to coverage as a independent
When two plans both have the provision, coverage as an employee is primary to coverage as a dependent
It important for employer to provide group insurance
The Americans with Disabilities Act(ADA) defines a disabled person as one who is unable to perform any of the following life activities EXCEPT
Epilepsy
Cystic Fibrosis
Driving
After the deductible, what portion does a patient pay for covered expenses under Medicare Part B?
20%
45%
50%
Probationary periods reduce costs to employers in all of the following ways EXCEPT
Employees must pay the entire premium during this time
Allows an employer to terminate an employee who is not doing well at their job
Employee can terminate employee if not suitable for position
Members of the Medical Information Bureau are REQUIRED to report
Income of insured
Medical impairments found during the underwriting process
The health of beneficiary(ies)
.A worker dies who is credited with 6 quarters of coverage during the last 13-quarter period. What status does the worker have under Social Security?
Currently insured
Partially insured
Uninsured
What is the cost of service from the Health Insurance Counseling Advocacy Program (HICAP)?
No charge
15% of all premiums paid
25% of insured's premium payments
Which program pays the cost of nursing home care for people who cannot afford it themselves?
Medi-Cal
Medicare
HICAPP
The frequency and severity of certain illnesses and accidents is known as
Chronic illness
Morbidity
Chronic disability
A Long-Term Care Insurance rider can include coverage for all of the following EXCEPT
Hospital acute care
Nursing home
Assisted living
A terminating employee who wants to exercise the conversion privilege must meet all of the following requirements EXCEPT
Same premium price
Supply evidence of insurability
An insured has a disability income policy with a $1500 monthly benefits and a 30-day elimination period. The insured is unable to work for 120 days following an accident. What amount will the policy pay?
$450
$200
$500
Social Security survivor benefits are available for all of the following EXCEPT
Spouse of deceased
Parents of any age who were dependent upon the deceased worker
Children of deceased
Under group disability insurance an employee is eligible for a partial disability benefit when they can
Drive
Perform some of their job activities on a part time basis after injury
Feed by themselves
Which of the following is NOT an example of cost sharing in a health insurance policy?
Deductibles
Coordination
Coinsurance
The insurer can do which of the following under a noncancelable health insurance policy?
Cancel the policy for nonpayment of premium.
Renew policy
Extend grace period for premium payments
In the absence of a coordination of benefits clause, all of the following circumstances might result in recovery of more than 100% of actual health care expenses EXCEPT:
None of the above
A worker’s medical plan includes a carryover deductible provision
What rights do individuals have if they disagree with a decision on the amount Medicare will pay?
They can ask a Medicare carrier to review the decision
The can opt to pay less over time
They can pay the lump sum at once
An individual is allowed to enroll in individual health insurance under the following circumstances EXCEPT
In addition to work place insurance
To help with medical expenses in case of illness
Within 30 days of being diagnosed with an illness
Medicare Part A provides coverage for all of the following EXCEPT
Inpatient hospital care
Physicians’ services
Skilled nursing facility
Home health care
After the deductible, what portion does a patient pay for covered expenses under Medicare Part B?
80%
25%
50%
40%
The premium of proposed disability income policy could be lowered by increasing the
Elimination period
Grace period
Leveled premium
Providers of coverage for all of the following types of care are subject to the jurisdiction of the California Department of Insurance(CDI)EXCEPT
All types of health insurance
Lasik
Plans that offer traditional health insurance products
Indemnity plans
Which plan covers the medical expenses that are NOT covered by Medicare?
Medicare supplement
Medi-cal supplement
Health insurance plans
The type of health care provider that provides both the health care services and health care coverage is called
Medicare supplement
Health insurance plans
A Health Maintenance Organization
In medical expense insurance, what serves the same purpose as the elimination period in disability income insurance?
PPO
Deductible
Medicare supplement
An example of a third-party administrator is an
Outside organization that processes claims for an employer’s self-funded group plan
Employer insurance company
Group life inusrance
The Family and Medical Leave Act(FMLA) covers all of the following EXCEPT
Traveling with a spouse who has been transferred overseas.
Employers to take unpaid leave
The employee must cover immediate family with serious medical condition
What is the purpose of social insurance?
To elavate social programs for the poor
To protect certain vulnerable segments of the population
Improve social conditions in society
Which program pays the cost of nursing home care for people who cannot afford it themselves?
Medicare supplement
Medicare
Medi-Cal
What is covered by Part A of Medicare?
Hospitalization
Disability
Paid leave
Which of the following conditions would NOT be included among the chronic illness triggers of a long-term care policy?
Deafness
Asthma
Cancer
Diabetes
Benefits under Social Security are available only for workers who are
Partially insured
Half insured
Fully insured
Group health plans obligated by the Consolidated Omnibus Budget Reconciliation Act(COBRA) cover groups of at least
35 employees
15 employees
20 employees
45
With Medicare coverage
Part A provides benefits for diagnostic tests and X-rays performed on an outpatient basis
Part B provides benefits for diagnostic tests and X-rays performed on an outpatient basis
A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ratio (MLR) is less than what percentage?
80%
40%
25%
According to the California Insurance Code, all of the following Long- Term Care (LTC) insurance sales are considered unnecessary EXCEPT
None of the above
A replacement LTC policy with equal benefits for a lower premium.
All of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT
Medical expense
Vision insurance
Dental insurance
The most common type of specified disease insurance policy is
Diabetes
Stroke
Cancer
After the deductible is satisfied, what percentage of a reasonable charge does Medicare Part B pay?
80%
25%
35%
40%
Which of the following statements concerning the usual coordination of benefits provision is correct?
When two plans both have the provision, coverage as an employee is primary to coverage as a dependent
When two plans both have the provision, coverage as an employer is primary to coverage as a independent.
Which health insurance provision protects an insured from the expense of a catastrophic illness?
Risk
Stop-loss
Elimination period
Which health insurance contract provision addresses the problem of overinsurance?
Coordination of benefits
Elimination period
Vision insurance
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