ALAHI - Arizona Life Accident and Health Insurance Exam

Question 21: A sole practitioner dentist in Tempe buys coverage that pays office rent, staff salaries and utility bills if the dentist becomes disabled, but pays nothing toward the dentist's personal living expenses. Which of the following policies is described?

Individual disability income coverage

Business overhead expense coverage

Key employee disability income

Disability buy and sell coverage

Question 22: Two partners want funds available to purchase the ownership interest of whichever partner becomes permanently disabled, so that the disabled partner exits with fair value and the other keeps control. Which of the following coverages addresses this need?

Business overhead expense

Group long term disability

Social Security disability insurance

Disability buy and sell coverage

Question 23: A group long term disability plan reduces its monthly payment by amounts the insured receives from Social Security disability and workers compensation, so the combined total does not exceed a target percentage of income. Which of the following describes this design?

Coordination with social insurance benefits

A residual disability calculation

An impairment rider limitation

A recurrent disability offset

Question 24: A disability income policyowner adds a feature that increases the monthly benefit during a long claim so that payments keep pace with rising consumer prices over the years of disability. Which of the following riders provides this protection?

Waiver of premium rider

Cost of living rider

Future increase option rider

Rehabilitation benefit rider

Question 25: A young attorney with a modest income buys disability coverage now and wants the right to raise the monthly benefit as earnings grow, without submitting new medical evidence at that later time. Which of the following riders grants this right?

Return of premium rider

Cost of living rider

Presumptive disability rider

Future increase option rider

Question 26: A worker applies for federal disability benefits and learns the standard is stricter than most private policies, requiring inability to engage in any substantial gainful activity expected to last a long time or end in death. Which program applies this standard?

Business overhead expense coverage

Group short term disability

Social Security disability insurance

Workers compensation

Question 27: A managed care plan requires members to select a primary care physician who coordinates care and issues referrals, and generally pays nothing when a member goes outside the network for routine care. Which of the following plan types is described?

Indemnity major medical plan

Health maintenance organization

Preferred provider organization

Point of service plan

Question 28: A health plan contracts with a network of providers who accept discounted fees, allows members to use providers outside that network at a lower benefit level, and requires no referral to see a specialist. Which of the following plan types is described?

Health maintenance organization

Fee for service indemnity plan

Preferred provider organization

Exclusive provider organization

Question 29: A managed care plan lets a member decide at the time of each service whether to use the coordinated network through a primary care physician or to go outside it at a higher out of pocket cost. Which plan type is described?

Exclusive provider organization

Health maintenance organization

Indemnity hospital plan

Point of service plan

Question 30: A managed care plan requires the member or provider to obtain approval before a nonemergency hospital admission or an expensive imaging study, and reduces benefits if that approval is not obtained. Which of the following cost containment tools is described?

Preauthorization

Coordination of benefits

Concurrent review

A stop loss provision

Question 31: A policy pays a fixed dollar amount for each day the insured is confined to a hospital, without regard to what the hospital actually charges or what other coverage pays. Which of the following limited policies is described?

Critical illness policy

Dental expense policy

Hospital indemnity policy

Major medical policy

Question 32: A policy pays a single lump sum directly to the insured upon the diagnosis of a covered condition such as heart attack, stroke or cancer, and the insured may spend the money on anything. Which policy is described?

Disability income policy

Hospital indemnity policy

Long term care policy

Critical illness policy

Question 33: A federal law restricts how health plans and health care providers may use and disclose individually identifiable health information, and it gives individuals defined rights regarding that information. Which of the following statutes imposes these federal privacy requirements?

The Health Insurance Portability and Accountability Act

The Gramm Leach Bliley Act

The Fair Credit Reporting Act

The Genetic Information Nondiscrimination Act

Question 34: A federal requirement obligates health plans that offer dependent coverage to make it available to an enrollee's children up to a stated age, regardless of whether the child is a student, is married or is financially dependent. Which law imposes this?

The Consolidated Omnibus Budget Reconciliation Act

The Affordable Care Act

The Mental Health Parity Act

The Employee Retirement Income Security Act

Question 35: A federal requirement obligates certain health plans to cover a defined set of benefit categories including hospitalization, prescription drugs, maternity and newborn care, and mental health services. Which of the following terms describes that required set of categories?

Coordination of benefits

Creditable coverage

Essential health benefits

Metallic tier ratings

Question 36: Health plans sold on an exchange are sorted into categories named for metals, and the labels reflect the share of covered costs the plan is expected to pay rather than which services are included. Which term describes these categories?

Essential health benefits

Benefit triggers

Utilization tiers

Levels of coverage

Question 37: A taxpayer enrolled in a qualifying high deductible health plan contributes to an account that grows tax deferred and may be withdrawn tax free for qualified medical expenses, with unused balances carrying forward each year. Which arrangement is described?

A cafeteria plan election

A health savings account

A health reimbursement arrangement

A flexible spending arrangement

Question 38: An employer holds the master health insurance contract with the insurer, while each covered employee receives a separate document summarizing the benefits and describing that person's rights under the plan. Which of the following names the document the employee receives?

A certificate of coverage

A summary annual report

A policy of insurance

A conditional receipt

Question 39: A group health plan requires employees to pay part of the premium through payroll deduction, and the insurer responds by requiring that a stated percentage of eligible employees enroll. Which of the following describes this plan and the insurer's condition?

Franchise, requiring individual underwriting

Blanket, requiring no enrollment at all

Contributory, requiring a participation percentage

Noncontributory, requiring full participation

Question 40: An insurer will write group health coverage only for a group that was formed for some purpose other than obtaining insurance, such as an employer or a trade association. Which of the following underwriting concerns explains this requirement?

Satisfying coordination of benefits

Preventing adverse selection

Meeting preauthorization standards

Establishing creditable coverage

ALAHI Arizona Life Accident and Health Insurance Exam - Set 5 - Part 2

Question 21: A sole practitioner dentist in Tempe buys coverage that pays office rent, staff salaries and utility bills if the dentist becomes disabled, but pays nothing toward the dentist's personal living expenses. Which of the following policies is described?

Question 22: Two partners want funds available to purchase the ownership interest of whichever partner becomes permanently disabled, so that the disabled partner exits with fair value and the other keeps control. Which of the following coverages addresses this need?

Question 23: A group long term disability plan reduces its monthly payment by amounts the insured receives from Social Security disability and workers compensation, so the combined total does not exceed a target percentage of income. Which of the following describes this design?

Question 24: A disability income policyowner adds a feature that increases the monthly benefit during a long claim so that payments keep pace with rising consumer prices over the years of disability. Which of the following riders provides this protection?

Question 25: A young attorney with a modest income buys disability coverage now and wants the right to raise the monthly benefit as earnings grow, without submitting new medical evidence at that later time. Which of the following riders grants this right?

Question 26: A worker applies for federal disability benefits and learns the standard is stricter than most private policies, requiring inability to engage in any substantial gainful activity expected to last a long time or end in death. Which program applies this standard?

Question 27: A managed care plan requires members to select a primary care physician who coordinates care and issues referrals, and generally pays nothing when a member goes outside the network for routine care. Which of the following plan types is described?

Question 28: A health plan contracts with a network of providers who accept discounted fees, allows members to use providers outside that network at a lower benefit level, and requires no referral to see a specialist. Which of the following plan types is described?

Question 29: A managed care plan lets a member decide at the time of each service whether to use the coordinated network through a primary care physician or to go outside it at a higher out of pocket cost. Which plan type is described?

Question 30: A managed care plan requires the member or provider to obtain approval before a nonemergency hospital admission or an expensive imaging study, and reduces benefits if that approval is not obtained. Which of the following cost containment tools is described?

Question 31: A policy pays a fixed dollar amount for each day the insured is confined to a hospital, without regard to what the hospital actually charges or what other coverage pays. Which of the following limited policies is described?

Question 32: A policy pays a single lump sum directly to the insured upon the diagnosis of a covered condition such as heart attack, stroke or cancer, and the insured may spend the money on anything. Which policy is described?

Question 33: A federal law restricts how health plans and health care providers may use and disclose individually identifiable health information, and it gives individuals defined rights regarding that information. Which of the following statutes imposes these federal privacy requirements?

Question 34: A federal requirement obligates health plans that offer dependent coverage to make it available to an enrollee's children up to a stated age, regardless of whether the child is a student, is married or is financially dependent. Which law imposes this?

Question 35: A federal requirement obligates certain health plans to cover a defined set of benefit categories including hospitalization, prescription drugs, maternity and newborn care, and mental health services. Which of the following terms describes that required set of categories?

Question 36: Health plans sold on an exchange are sorted into categories named for metals, and the labels reflect the share of covered costs the plan is expected to pay rather than which services are included. Which term describes these categories?

Question 37: A taxpayer enrolled in a qualifying high deductible health plan contributes to an account that grows tax deferred and may be withdrawn tax free for qualified medical expenses, with unused balances carrying forward each year. Which arrangement is described?

Question 38: An employer holds the master health insurance contract with the insurer, while each covered employee receives a separate document summarizing the benefits and describing that person's rights under the plan. Which of the following names the document the employee receives?

Question 39: A group health plan requires employees to pay part of the premium through payroll deduction, and the insurer responds by requiring that a stated percentage of eligible employees enroll. Which of the following describes this plan and the insurer's condition?

Question 40: An insurer will write group health coverage only for a group that was formed for some purpose other than obtaining insurance, such as an employer or a trade association. Which of the following underwriting concerns explains this requirement?

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