course materials

1. Exam 412757rr – group medical expense benefits
Exam: 412757RR – Group Medical Expense BenefitsWhen you have completed your exam
and reviewed your answers, click Submit Exam. Answers will not be recorded until you hit
Submit Exam. If you need to exit before completing the exam, click Cancel Exam.Questions 1
to 20: Select the best answer to each question. Note that a question and its answers may be
split across a page break, so be sure that you have seen the entire question and all the
answers before choosing an answer.1. Which of the following statements concerning
extended-care facility benefits is correct?A. Benefits are usually provided only if 24-hour-a-
day nursing care is needed.B. Benefits are not contingent upon a prior hospitalization.C.
Benefits usually are provided for domiciliary care for the aged.D. Benefits usually are
provided for inpatient treatment of drug or alcohol abuse.2. An HMO that contracts solely
with two or more independent groups of physicians to provide medical services to its
subscribers is called aA. mixed-model HMO.B. group-model HMO.C. network-model HMO.D.
individual practice association.3. Which of the following statements about second opinions
is correct?A. If the first and second opinion conflict, the patient must make a decision or pay
for a third opinion out of pocket.B. More plans are requiring mandatory second opinions
because it has proven to contain costs.C. Mandatory provisions often apply only to a
specified list of procedures.D. Voluntary provisions require the insured to accept the final
opinion or face financial consequences.4. Which of the following statements concerning the
NAIC Small Employer Health Insurance Availability Model Act is correct?A. Insurance
companies can use the same policies in multiple states.B. If coverage is made available to
employees, it must also be made available to their dependents.C. All providers of medical
expense coverage are required to offer coverage to small employers.D. Pre-existing
conditions provisions are not allowed.5. The use of health savings accounts and other self-
directed medical expense plans typically involve the use of medical expense policies.A. Blue
Cross and Blue ShieldB. self-insuredC. high-deductibleD. traditional6. When Blue Cross first
began, it was in the business of providing coverage forA. physician care for the financially
needy.B. physician care for the elderly.C. hospitalization.D. prescriptions.7. State reactions
to managed care backlash include prohibitions against which of the following?A. Point-of-
service optionsB. Direct access to specialistsC. Any-willing-provider lawsD. Provider gag
clauses8. All the following expenses are often subject to internal limitations under major
medical policies exceptA. diagnostic X-rays and laboratory services.B. home healthcare
benefits.C. treatment for mental and nervous disorders.D. hospital room and board.9. The
medical expense insurance-like organizations that eventually came to be called Blue Cross

2. plans were initially run byA. charity organizations.B. employers.C. physicians.D.
hospitals.10. Jim and Betty are married with one child, and both are employed by the same
company. Jim, who was born on February 9, 1968, has been with the company for 10 years.
Betty, who was born on May 12, 1965, has been with the company for 8 years. Who is the
primary provider of health care coverage for the child?A. Betty, because she’s older than
JimB. Jim, because of his date of birthC.Both Betty and Jim, because they have the same
insuranceD. Jim, because he’s been with the company longer than Betty11. Mary goes to the
doctor and pays for her visit. When she gets home, she must fill out a form and submit it to
the insurance company so she can be reimbursed. What type of insurance does she most
likely have?A. HMOB. The BluesC. IndemnityD. POS12. Which of the following would
typically be covered under home healthcare benefits?A. 24-hour nursing careB. Prescription
drugsC. Physical therapyD. Diagnostic testing13. Which of the following statements
concerning the Mental Health Parity Act is correct?A. It requires employers to make benefits
available for mental illness.B. The provisions of the act only apply to employers with more
than 50 employees.C. It requires alcoholism and drug addiction to be treated like any other
mental illness.D. It prohibits different cost-sharing provisions for mental health benefits and
other medical and surgical benefits.14. Which of the following statements concerning basic
medical expense benefits is correct?A. Hospital expense coverage usually provides coverage
for emergency room treatment of accidental injuries at any time following an accident.B.
Surgical expense coverage usually provides benefits for surgery in a hospital only.C.
Hospital expense coverage usually expresses room-and-board benefits as the full cost of
semiprivate accommodations.D. Physicians’ visits expense coverage must always include
out-of-hospital visits.15. A benefit that does not try to cure a person’s ailments, but rather
attempts to make a patient comfortable in his or her last days or weeks before death, is
calledA. home health care.B. terminal care.C. extended care.D. hospice.16. Which of the
following statements concerning point-of-service plans is correct?A. The term point-of-
service implies a lesser degree of managed care than is found in most PPOs.B. They are
hybrid arrangements that combine aspects of an HMO with a PPO.C. A member of a point-of-
service plan can never go outside the plan’s network without informing the plan.D. They
prohibit treatment outside an exclusive-provider network unless the network does not
contain an appropriate specialist.17. Company X must make sure that it provides HMO
coverage as an option in its benefit-selection process. What act would require Company X to
do this?A. Financial Services Modernization ActB. Health Insurance Portability and
Accountability ActC. Americans with Disabilities ActD. Health Maintenance Organization
Act18. Which of the following types of medical expense plans has the highest degree of
managed care?A. Point-of-service plansB. Independent practice association HMOsC. Closed-
panel HMOsD. Preferred provider organizations19. A benefit plan that provides a less
expensive choice for treatment is often a smart way to reduce costs. An example of this type
of plan isA. implementing maximum benefits.B. allowing the use of birthing centers.C.
allowing longer hospital stays.D. requiring higher deductibles.20. Which of the following
statements concerning multiple-option plans is correct?A. Because the plans are subject to
experience rating, costs may be higher.B. Non-federally qualified HMOs are never used in
multiple-option plans.C. They may allow experience rating of an employer’s entire medical

3. expense plan, including HMO coverage.D. They increase administrative complexity if an
employer offers more than one type of medical expense coverage.