NMLAHIP - New Mexico Life Accident and Health Insurance Producer

Question 21: Under a group health plan, employees must pay part of the monthly premium themselves through payroll deduction, so the insurer requires that a minimum percentage of eligible employees actually enroll before the plan can take effect. What type of plan is being described?

A noncontributory plan

A conversion plan

A contributory plan

A blanket plan

Question 22: To open and contribute to a certain tax-advantaged medical savings account, an individual generally must be covered under a qualifying high-deductible health plan, must carry no other disqualifying health coverage, and must not be enrolled in a federal health program for older adults. Which account is this?

A flexible spending account

A health reimbursement arrangement

A major medical policy

A health savings account

Question 23: An employee who had continuous prior group health coverage enrolls in a new employer's group plan and asks whether her time covered under the old plan can reduce or eliminate any preexisting condition exclusion period the new plan would otherwise apply. Which federal law addresses this credit?

The Health Insurance Portability and Accountability Act

The Employee Retirement Income Security Act

The Consolidated Omnibus Budget Reconciliation Act

The Affordable Care Act

Question 24: A federal health reform law establishes an online exchange where individuals who lack access to affordable employer coverage may compare and purchase individual health plans, apply for available premium subsidies, and enroll during a designated annual window each year. What is this exchange commonly called?

An employer cafeteria plan

The health insurance marketplace

A group conversion exchange

A managed care service area

Question 25: A federal employment law generally prohibits an employer from reducing group health or other benefits for employees once they reach a certain age, or from otherwise treating older workers less favorably in employment decisions solely because of their age, subject to narrow, defined exceptions. Which federal law is this?

The Genetic Information Nondiscrimination Act

The Employee Retirement Income Security Act

The Age Discrimination in Employment Act

The Fair Credit Reporting Act

Question 26: A federal health reform law requires certain individual and small group health plans to cover a defined set of broad service categories, including hospitalization, prescription drugs, maternity and newborn care, and mental health services, as part of every plan's minimum benefit package. What is this defined set of categories called?

A basic hospital expense schedule

A coordination of benefits list

A capitation benefit package

Essential health benefits

Question 27: An insurance company's compliance officer notices a pattern of unusually large cash-equivalent premium payments structured to avoid otherwise applicable reporting thresholds, and company policy under a federal anti-money-laundering law requires that this pattern be reported to the appropriate federal authority. What has the compliance officer identified?

Suspicious activity requiring a report

A routine coordination of benefits issue

A guaranteed renewability dispute

A standard claims examination finding

Question 28: An employee declined to enroll in her employer's group health plan because she was covered under her spouse's plan, but after her spouse loses that job and the coverage ends, she asks whether she may now join her own employer's plan outside the normal annual enrollment period. Which right applies?

A coordination of benefits right

A special enrollment period right

A guaranteed renewability right

A conversion privilege

Question 29: A retiree is admitted to the hospital for several days of inpatient treatment following emergency surgery, and her federal Medicare coverage pays the bulk of the hospital's charges for that stay. Which part of Medicare primarily covers inpatient hospital care of this kind?

Medicare Part B

Medicare Part D

Medicare Part A

Medicare Part C only

Question 30: A long-term care policy states that once benefits begin, the insurer will continue paying covered claims for up to a stated span of years before the maximum duration of coverage under the policy is reached. What is this maximum span of time the policy will pay benefits called?

The elimination period

The grace period

The renewal period

The benefit period

Question 31: A retiree visits his physician for a routine outpatient checkup and later receives durable medical equipment prescribed by that doctor, both of which his federal Medicare coverage helps pay for after he meets an annual deductible. Which part of Medicare covers these outpatient physician and equipment expenses?

Medicare Part B

Medicare Part A

Medicare Part D

Medicaid

Question 32: An insured undergoes a scheduled operation, and the policy pays the surgeon a benefit taken from a fee schedule that lists a maximum allowance for each type of procedure, regardless of the surgeon's actual bill. Which coverage is being described in this situation?

Basic hospital expense insurance

Basic surgical expense insurance

Major medical insurance

Comprehensive medical insurance

Question 33: A family relocates outside the geographic boundaries within which their HMO has contracted with hospitals and physicians, and the plan explains that routine nonemergency care obtained outside those boundaries will not be covered because the family now lives beyond it. What has the family left?

The plan's grace period

The plan's open enrollment period

The plan's service area

The plan's coordination period

Question 34: A consumer reviews a report an insurer used in underwriting and believes certain information in the file is inaccurate, so under a federal law the consumer may dispute that information with the reporting agency, which must then investigate and correct or delete any information found inaccurate. What right is this?

The right to guaranteed issue

The right to portability credit

The right to a fiduciary accounting

The right to dispute inaccurate information

Question 35: A federal health reform law requires group and individual health plans that cover dependent children to continue offering that dependent coverage until the child reaches a specified age, regardless of the child's student status, marital status, or financial dependency on the parent. What concept does this describe?

Extended dependent coverage to a set age

A guaranteed issue requirement

An essential health benefits mandate

A special enrollment right

Question 36: At the end of the calendar year, an employee notices that the balance remaining in her tax-advantaged medical savings account does not disappear but instead carries forward and remains available to her for qualified medical expenses in future years. Which account feature does this description best illustrate?

A use-it-or-lose-it rule

Unused funds roll over

An employer-owned notional balance

A coordination of benefits clause

Question 37: Beyond routine doctor visits and hospital stays, a Medicaid recipient who requires an extended nursing home stay for ongoing custodial assistance finds that the program continues paying for that stay once her own assets have been sufficiently spent down. Which statement best reflects this scope of Medicaid coverage?

It never covers nursing home stays

It covers only preventive checkups

It can cover long-term nursing home care

It covers only prescription drugs

Question 38: An employee already carries a basic group hospital and surgical plan, and the employer adds a second policy that begins paying benefits only after the basic plan's benefits are exhausted or after a corridor deductible is satisfied. Which type of coverage has the employer added?

Comprehensive major medical insurance

Basic surgical expense insurance

A flexible spending account

Supplementary major medical insurance

Question 39: A consumer shopping for a Medicare Supplement policy learns that a plan labeled with a particular letter must offer the identical core benefits no matter which insurance company sells it, though premiums for that same lettered plan can vary between companies. What concept explains this uniform benefit structure?

Standardized benefit plans

Guaranteed issue underwriting

Community rating by law

Coordination of benefits

Question 40: Before a long-term care policy will begin paying benefits, the insurer typically checks whether the insured needs substantial help performing a set of basic self-care tasks, such as bathing, dressing, eating, toileting, transferring, and maintaining continence. What are these basic tasks collectively called?

Instrumental tasks of independence

Activities of daily living

Cognitive impairment markers

Elimination period requirements

NMLAHIP New Mexico Life Accident and Health Insurance Producer - Set 5 - Part 2

Question 21: Under a group health plan, employees must pay part of the monthly premium themselves through payroll deduction, so the insurer requires that a minimum percentage of eligible employees actually enroll before the plan can take effect. What type of plan is being described?

Question 29: A retiree is admitted to the hospital for several days of inpatient treatment following emergency surgery, and her federal Medicare coverage pays the bulk of the hospital's charges for that stay. Which part of Medicare primarily covers inpatient hospital care of this kind?

Question 30: A long-term care policy states that once benefits begin, the insurer will continue paying covered claims for up to a stated span of years before the maximum duration of coverage under the policy is reached. What is this maximum span of time the policy will pay benefits called?

Question 32: An insured undergoes a scheduled operation, and the policy pays the surgeon a benefit taken from a fee schedule that lists a maximum allowance for each type of procedure, regardless of the surgeon's actual bill. Which coverage is being described in this situation?

Question 38: An employee already carries a basic group hospital and surgical plan, and the employer adds a second policy that begins paying benefits only after the basic plan's benefits are exhausted or after a corridor deductible is satisfied. Which type of coverage has the employer added?

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