SDLAHP - South Dakota Life Accident and Health Producer

Question 21: A retired worker who is about to turn sixty five and has enough work history under the Social Security system asks her agent which federal health program she will soon become eligible for automatically. Which program is the agent describing?

Medicaid

a Medicare supplement policy

Medicare

a group retiree health plan

Question 22: One type of medical expense plan pays scheduled, limited benefits toward specific hospital, surgical, or medical charges with no deductible required, while another type applies a deductible and coinsurance across a broad range of covered expense up to a high overall limit. Which statement correctly contrasts these two approaches?

both apply the same deductible structure

basic plans always cost more

major medical never uses coinsurance

basic plans pay scheduled limited benefits

Question 23: A patient is admitted for an overnight stay in the hospital following emergency surgery, and her family wants to know which portion of Medicare will pay for the inpatient hospital room and related hospital services. Which part of Medicare covers this situation?

Medicare Part A

Medicare Part B

Medicare Part D

a Medicare Advantage plan only

Question 24: A newly issued individual policy pays a fixed daily amount toward room and board plus certain ancillary charges during a covered hospital stay, but it does not extend to a surgeon's operative fee or to routine physician office visits outside the hospital. Which type of plan does this description match?

comprehensive major medical coverage

basic hospital expense coverage

basic surgical expense coverage

supplementary major medical coverage

Question 25: A federal law requires an insurer to give consumers a notice describing how the insurer collects, uses, and shares their nonpublic personal financial information, and to offer consumers a chance to opt out of certain disclosures to unaffiliated third parties before those disclosures are made. Which law imposes this requirement?

the Health Insurance Portability and Accountability Act

the Fair Credit Reporting Act

the Gramm-Leach-Bliley Act

the Genetic Information Nondiscrimination Act

Question 26: A managed care plan builds its network similarly to a preferred provider organization but pays no benefit at all for non-emergency care received from a provider outside that network, effectively making network use mandatory for coverage to apply. Which plan type does this describe?

a preferred provider organization

a point of service plan

a health reimbursement arrangement

an exclusive provider organization

Question 27: A Medicare beneficiary wants help paying for the several prescription medications she takes regularly for chronic conditions and asks her agent which optional part of Medicare covers outpatient prescription drugs. Which part of Medicare is the agent most likely to recommend she consider?

Medicare Part D

Medicare Part A

Medicare Part B

a hospital indemnity policy

Question 28: Two managed care models both use a primary care physician who coordinates care and issues referrals for the richest in-network benefit level, yet only one model also permits a member to seek care outside the network, accepting a reduced benefit for that choice. Which statement is accurate?

a health maintenance organization allows out-of-network

a point of service plan allows out-of-network

both models forbid a primary care physician

neither model uses referrals for specialists

Question 29: A long term care policyowner learns that once she qualifies for benefits, she must still pay for her own care out of pocket for a set number of days before the insurer's daily benefit payments actually begin. Which policy provision describes this initial waiting period?

the benefit period

the grace period

the elimination period

the probationary period

Question 30: A Medicare beneficiary chooses to receive her hospital and medical benefits through a private insurer that also bundles in extra benefits such as routine vision and hearing coverage, rather than staying with original Medicare. Which part of the Medicare program does her chosen plan fall under?

Medicare Part A

Medicare Part D

a Medicare supplement plan

Medicare Part C

Question 31: A married couple, both enrolled in original Medicare, wants to buy one shared Medicare supplement policy that covers both spouses together under a single certificate, the way a family health plan might work. Which statement correctly describes whether this is possible?

each spouse needs a separate policy

one joint policy covers them both

only the older spouse can apply

the policy automatically adds each spouse

Question 32: A small business with only a handful of workers offers a group health plan, and when one employee is terminated, she is told the company is too small for federal continuation coverage to apply. Which factor most likely explains why federal continuation law does not cover her?

she never signed an application

the employer has too few employees

her plan is fully self funded

she worked less than a year

Question 33: A group health plan sets its annual deductible above a minimum threshold set each year under federal guidelines and caps total out-of-pocket cost at a maximum amount, and meeting both thresholds lets the enrollee fund a certain tax-advantaged account. Which plan type does this describe?

a health reimbursement arrangement

a flexible spending account

a high deductible health plan

a basic hospital expense plan

Question 34: Before each plan year begins, an employee elects a fixed dollar amount to be withheld from paychecks and deposited into an account used to reimburse eligible medical expenses, and that full elected amount is available from the first day of the plan year. Which funding method does this describe?

employer notional credits under an arrangement

pretax payroll contributions to savings accounts

capitation payments under a health maintenance organization

salary reduction funding of accounts

Question 35: A company's group health plan states that a newly hired worker must complete a set number of days of continuous employment before becoming eligible to enroll in the plan. Which term names this delay between the hire date and eligibility for coverage?

the probationary waiting period

the elimination period

the grace period

the free look period

Question 36: A long term care insurer wants to cancel an individual policyholder's coverage because she has begun filing frequent claims, but the policy's renewability provision only allows the insurer to raise premiums for an entire class of similar policyholders instead. Which renewability feature limits the insurer this way?

optionally renewable

guaranteed renewable

conditionally renewable

cancelable at will

Question 37: An insured is hospitalized for several days following surgery and receives a fixed cash payment for each day of confinement directly from her supplemental policy, regardless of what her actual hospital bill or her major medical plan separately pays. Which type of policy is paying this fixed daily benefit?

a major medical policy

a Medicare supplement policy

a hospital indemnity policy

a long term care policy

Question 38: A Medicare beneficiary keeps facing out of pocket costs such as deductibles and coinsurance that original Medicare does not pay, so she buys a private policy specifically designed to pay many of those remaining costs. Which type of policy has she purchased?

a Medicare Advantage policy

a long term care policy

a Medicaid spend down plan

a Medicare supplement policy

Question 39: An elderly man needs ongoing help with bathing, dressing, and eating because of frailty, but he has no skilled medical need and is not recovering from a recent hospital stay. Which statement best describes how Medicare Part A treats this type of long term custodial assistance?

Part A generally excludes custodial care

Part A pays for custodial care

Part A pays half of the cost

Part A covers it after a deductible

Question 40: An insured recovering from an illness prefers to remain in her own residence and receives nursing visits, physical therapy, and assistance with daily activities delivered to her there instead of moving into any type of facility. Which level of long term care benefit is being provided to her?

adult day care

home health care

respite care

intermediate facility care

SDLAHP South Dakota Life Accident and Health Producer - Set 5 - Part 2

Question 21: A retired worker who is about to turn sixty five and has enough work history under the Social Security system asks her agent which federal health program she will soon become eligible for automatically. Which program is the agent describing?

Question 23: A patient is admitted for an overnight stay in the hospital following emergency surgery, and her family wants to know which portion of Medicare will pay for the inpatient hospital room and related hospital services. Which part of Medicare covers this situation?

Question 26: A managed care plan builds its network similarly to a preferred provider organization but pays no benefit at all for non-emergency care received from a provider outside that network, effectively making network use mandatory for coverage to apply. Which plan type does this describe?

Question 29: A long term care policyowner learns that once she qualifies for benefits, she must still pay for her own care out of pocket for a set number of days before the insurer's daily benefit payments actually begin. Which policy provision describes this initial waiting period?

Question 31: A married couple, both enrolled in original Medicare, wants to buy one shared Medicare supplement policy that covers both spouses together under a single certificate, the way a family health plan might work. Which statement correctly describes whether this is possible?

Question 32: A small business with only a handful of workers offers a group health plan, and when one employee is terminated, she is told the company is too small for federal continuation coverage to apply. Which factor most likely explains why federal continuation law does not cover her?

Question 33: A group health plan sets its annual deductible above a minimum threshold set each year under federal guidelines and caps total out-of-pocket cost at a maximum amount, and meeting both thresholds lets the enrollee fund a certain tax-advantaged account. Which plan type does this describe?

Question 35: A company's group health plan states that a newly hired worker must complete a set number of days of continuous employment before becoming eligible to enroll in the plan. Which term names this delay between the hire date and eligibility for coverage?

Question 38: A Medicare beneficiary keeps facing out of pocket costs such as deductibles and coinsurance that original Medicare does not pay, so she buys a private policy specifically designed to pay many of those remaining costs. Which type of policy has she purchased?

Question 39: An elderly man needs ongoing help with bathing, dressing, and eating because of frailty, but he has no skilled medical need and is not recovering from a recent hospital stay. Which statement best describes how Medicare Part A treats this type of long term custodial assistance?

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