OLAHI - Oklahoma Life Accident and Health Insurance Exam

Question 1: A managed care plan requires each member to select a primary care physician who coordinates care and must provide a referral before the member can see a specialist, and the plan generally covers only care delivered by its own network providers. Which of the following managed care plans is described here?

A preferred provider organization

An indemnity plan

A health maintenance organization

A point of service plan

Question 2: A managed care plan contracts with a network of providers who accept discounted fees, but it also allows members to use providers outside that network at a higher out-of-pocket cost, and it does not require a referral to see a specialist. Which of the following plans is described here?

A health maintenance organization

A preferred provider organization

An exclusive provider organization

A basic hospital plan

Question 3: A managed care plan combines features of two models by giving members a primary care physician but also allowing them to seek care outside the network, paying more when they do so rather than losing coverage entirely for out-of-network care. Which of the following plans is described here?

An indemnity plan

A basic surgical plan

A specified disease plan

A point of service plan

Question 4: A health insurance plan is designed to cover a broad range of medical expenses, including hospital, surgical, and physician charges, up to a high overall limit, protecting the insured against the large costs of a serious illness or injury. Which of the following plans is described here?

A major medical plan

A hospital indemnity plan

A dental plan

A specified disease plan

Question 5: A supplemental health policy pays the insured a fixed dollar amount for each day spent in the hospital, paid directly to the insured regardless of the actual hospital charges or of other insurance the insured may have. Which of the following plans is described here?

A major medical plan

A preferred provider organization

A hospital indemnity plan

A disability income plan

Question 6: A limited health policy pays benefits only if the insured is diagnosed with one particular illness that is named in the policy, such as cancer or heart disease, and pays nothing for unrelated conditions. Which of the following plans is described here?

A major medical plan

A comprehensive plan

A basic medical plan

A specified disease plan

Question 7: Under a health insurance policy, the insured must pay a set amount of covered expenses out of pocket each year before the insurer begins to pay benefits for covered services. Which of the following cost-sharing features is described here?

Coinsurance

The deductible

A copayment

The stop-loss limit

Question 8: After the insured satisfies the deductible on a major medical policy, the plan and the insured share the remaining covered costs by a stated percentage split, such as the plan paying eighty percent and the insured paying twenty percent. Which of the following features describes this percentage sharing?

Coinsurance

The deductible

A copayment

The elimination period

Question 9: A health policy provides that once the insured's out-of-pocket spending on covered expenses reaches a stated maximum for the year, the plan pays one hundred percent of further covered expenses for the rest of that year. Which of the following features is described here?

The deductible

A copayment

The stop-loss limit

The waiting period

Question 10: A health policy requires the insured to pay a small fixed dollar amount, such as a set charge for each office visit or prescription, at the time the service is received, with the plan covering the balance. Which of the following cost-sharing features is described here?

Coinsurance

The deductible

The coordination of benefits

A copayment

Question 11: A disability income policy provides that after the insured becomes totally disabled, a waiting period must pass before any benefits begin to be paid, so short disabilities do not trigger benefits. Which of the following terms describes this waiting period before benefits start?

The elimination period

The benefit period

The probationary period

The grace period

Question 12: A disability income policy pays benefits if the insured cannot perform the duties of the insured's own occupation, even if the insured could work at some other job, at least during an initial period of the claim. Which of the following definitions of disability is described here?

Any occupation

Presumptive disability

Own occupation

Residual disability

Question 13: A disability income policy pays benefits only if the insured is unable to work at any job for which the insured is reasonably suited by education, training, and experience, a stricter test than being unable to perform one's own job. Which of the following definitions is described here?

Own occupation

Any occupation

Partial disability

Recurrent disability

Question 14: A disability income policy provides that if the insured suffers certain severe losses, such as total and permanent loss of sight in both eyes or the loss of two limbs, the insured is automatically considered totally disabled even if able to work. Which of the following describes this feature?

Residual disability

Recurrent disability

Partial disability

Presumptive disability

Question 15: A disability income policy pays a reduced benefit based on the actual percentage of income the insured has lost after returning to work part-time following a period of total disability, rewarding the insured for going back to work. Which of the following benefits is described here?

Residual disability

Presumptive disability

The elimination period

The probationary period

Question 16: A health condition for which an insured received medical advice or treatment during a stated period before the coverage took effect may have its benefits limited or excluded for a time after the policy begins. Which of the following terms describes such a condition?

An elective procedure

A presumptive disability

A preexisting condition

A covered peril

Question 17: A person is covered under two group health plans, one as an employee and one as a dependent of a spouse, and the plans follow rules to decide which pays first so the person does not collect more than the total expense. Which of the following provisions governs this?

Subrogation

The free-look provision

The incontestability clause

Coordination of benefits

Question 18: A health policy gives the insured the right to renew the coverage each period to a stated age and forbids the insurer from raising the premium for that individual, though rates may change for an entire class. Which of the following renewal provisions is the most favorable to the insured?

Cancellable

Noncancellable

Conditionally renewable

Optionally renewable

Question 19: A health policy guarantees that the insurer must renew the coverage to a stated age as long as premiums are paid, but it permits the insurer to raise the premium for an entire class of insureds, not just one individual. Which of the following renewal provisions is described here?

Noncancellable

Cancellable

Guaranteed renewable

Nonrenewable

Question 20: The part of Medicare that helps pay for inpatient hospital stays, care in a skilled nursing facility following a hospital stay, hospice care, and some home health care is funded largely through payroll taxes and requires little or no premium for most beneficiaries. Which part of Medicare is this?

Part A

Part B

Part C

Part D

OLAHI Oklahoma Life Accident and Health Insurance Exam - Set 5 - Part 1

Question 2: A managed care plan contracts with a network of providers who accept discounted fees, but it also allows members to use providers outside that network at a higher out-of-pocket cost, and it does not require a referral to see a specialist. Which of the following plans is described here?

Question 4: A health insurance plan is designed to cover a broad range of medical expenses, including hospital, surgical, and physician charges, up to a high overall limit, protecting the insured against the large costs of a serious illness or injury. Which of the following plans is described here?

Question 5: A supplemental health policy pays the insured a fixed dollar amount for each day spent in the hospital, paid directly to the insured regardless of the actual hospital charges or of other insurance the insured may have. Which of the following plans is described here?

Question 6: A limited health policy pays benefits only if the insured is diagnosed with one particular illness that is named in the policy, such as cancer or heart disease, and pays nothing for unrelated conditions. Which of the following plans is described here?

Question 7: Under a health insurance policy, the insured must pay a set amount of covered expenses out of pocket each year before the insurer begins to pay benefits for covered services. Which of the following cost-sharing features is described here?

Question 9: A health policy provides that once the insured's out-of-pocket spending on covered expenses reaches a stated maximum for the year, the plan pays one hundred percent of further covered expenses for the rest of that year. Which of the following features is described here?

Question 10: A health policy requires the insured to pay a small fixed dollar amount, such as a set charge for each office visit or prescription, at the time the service is received, with the plan covering the balance. Which of the following cost-sharing features is described here?

Question 11: A disability income policy provides that after the insured becomes totally disabled, a waiting period must pass before any benefits begin to be paid, so short disabilities do not trigger benefits. Which of the following terms describes this waiting period before benefits start?

Question 12: A disability income policy pays benefits if the insured cannot perform the duties of the insured's own occupation, even if the insured could work at some other job, at least during an initial period of the claim. Which of the following definitions of disability is described here?

Question 13: A disability income policy pays benefits only if the insured is unable to work at any job for which the insured is reasonably suited by education, training, and experience, a stricter test than being unable to perform one's own job. Which of the following definitions is described here?

Question 15: A disability income policy pays a reduced benefit based on the actual percentage of income the insured has lost after returning to work part-time following a period of total disability, rewarding the insured for going back to work. Which of the following benefits is described here?

Question 16: A health condition for which an insured received medical advice or treatment during a stated period before the coverage took effect may have its benefits limited or excluded for a time after the policy begins. Which of the following terms describes such a condition?

Question 17: A person is covered under two group health plans, one as an employee and one as a dependent of a spouse, and the plans follow rules to decide which pays first so the person does not collect more than the total expense. Which of the following provisions governs this?

Question 19: A health policy guarantees that the insurer must renew the coverage to a stated age as long as premiums are paid, but it permits the insurer to raise the premium for an entire class of insureds, not just one individual. Which of the following renewal provisions is described here?

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