NYLAHI New York Life, Accident & Health Insurance exam - Set 4 - Part 2

Test your knowledge of technical writing concepts with these practice questions. Each question includes detailed explanations to help you understand the correct answers.

Question 21: In an HMO, the physician who coordinates a member's care and must authorize referrals to specialists is commonly referred to as which of the following?

The utilization reviewer

The attending specialist

The medical director

The primary care physician

Question 22: A major medical plan that pays a covered charge only up to the prevailing fee charged by similar providers in the same area is using which standard?

The usual, reasonable, and customary standard

The scheduled benefit standard

The indemnity standard

The capitation standard

Question 23: The amount of covered medical expense an insured must pay out of pocket each year before the plan begins paying its share is known as which of the following?

The copayment

The coinsurance

The deductible

The premium

Question 24: After the deductible is met, the percentage of covered costs the insured continues to share with the plan, such as twenty percent, is known as which of the following?

The copayment

The coinsurance

The deductible

The out-of-pocket maximum

Question 25: The yearly limit on what an insured pays in deductible, coinsurance, and copayments, after which the plan pays the full cost of covered care, is known as which of the following?

The out-of-pocket maximum

The lifetime maximum

The deductible

The benefit schedule

Question 26: A small fixed dollar amount a member pays at the time of each office visit or prescription, separate from the deductible, is best described as which of the following?

Coinsurance

A premium

A deductible

A copayment

Question 27: When an insured is covered by two health plans, the rule that prevents collecting more than the actual expense by designating one plan primary is known as which of the following?

Subrogation

Utilization review

Coordination of benefits

The exclusion ratio

Question 28: The process by which a health plan reviews proposed or ongoing care to confirm it is medically necessary and appropriate is best described as which of the following?

Utilization review

Coordination of benefits

Underwriting

Capitation

Question 29: New York and federal law require coverage for mental health and substance use treatment to be no more restrictive than coverage for medical and surgical care. This requirement is known as which of the following?

Coordination of benefits

Mental health parity

Guaranteed issue

Utilization review

Question 30: Under the federal Affordable Care Act, a plan that offers dependent child coverage must let an adult child stay on a parent's plan until reaching which age?

Age twenty-one

Age twenty-five

Age thirty

Age twenty-six

Question 31: Under the Affordable Care Act, a comprehensive major medical plan is prohibited from placing which kind of restriction on essential health benefits?

A network of preferred providers

A yearly deductible

A lifetime or annual dollar limit

A copayment for office visits

Question 32: A central consumer protection of the Affordable Care Act prevents an insurer in the individual market from denying coverage or charging more based on which of the following?

An applicant's preexisting health conditions

The applicant's choice of plan

The applicant's county of residence

The applicant's selected deductible

Question 33: Federal law generally requires health coverage to be renewed at the policyholder's option, allowing nonrenewal only for narrow reasons such as nonpayment or fraud. This protection is known as which of the following?

Coordination of benefits

Portability of credits

Community rating

Guaranteed renewability

Question 34: Long-term care insurance is designed mainly to pay for which kind of assistance that ordinary medical insurance and Medicare largely do not cover?

Emergency surgery

Extended custodial and personal care

Prescription medications

Short hospital stays

Question 35: Daily nursing or rehabilitative care ordered by a physician and delivered by licensed medical personnel is the highest level of long-term care, known as which of the following?

Custodial care

Intermediate care

Skilled care

Adult day care

Question 36: Help with everyday activities such as bathing, dressing, and eating, which can be provided by nonmedical personnel, is the level of long-term care known as which of the following?

Custodial care

Skilled care

Intermediate care

Respite care

Question 37: Most long-term care policies begin paying benefits when the insured can no longer perform a stated number of routine personal activities. These activities are commonly called which of the following?

Instrumental tasks

Essential health benefits

Presumptive activities

Activities of daily living

Question 38: Long-term care services delivered to an insured in their own residence rather than in a facility are best described as which of the following?

Adult day care

Respite care

Home health care

Skilled nursing care

Question 39: Short-term long-term-care services that give an unpaid family caregiver temporary relief from their caregiving duties are best described as which of the following?

Respite care

Custodial care

Adult day care

Skilled care

Question 40: A long-term care setting that provides supervision and assistance during daytime hours for adults who live at home with family is best described as which of the following?

Assisted living

Adult day care

Skilled nursing care

Respite care

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