CertsChief Guaranteed Success with Accurate & Updated Questions. Questions & Answers PDF For More Information - Visit: https://www.certschief.com/ ProductFull Version Features: 90 Days Free Updates 30 Days Money Back Guarantee Instant Download Once Purchased 24/7 Online Chat Support Finance Health-Insurance Health Insurance Licensing – Core Essentials Visit us athttps://www.certschief.com/health-insurance/ Latest Version: 6.0 Question: 1 Long-term care policies may not exclude all the following I. Certain illnesses, II. Accidents, III. Dementia, IV. Doctor-ordered treatments. A. I, II, III, IV B. I, II, III C. I D. I, II Answer: A Explanation: Long-term care policies may not exclude any condition, disease, illness or treatment. Question: 2 A 27-year-old just got his first job working for a very small business that does not have a health insurance plan. He is concerned about what would happen if he was hospitalized for a long time, but cannot afford a regular medical plan. He should consider a(n): A. Catastrophic Plan B. Disability insurance C. Fee-for-service plan D. Individual Plan Answer: A Explanation: A catastrophic plan is for persons under 30 years old or those with a hardship exemption. With high deductibles, it covers doctor and hospital services after deductibles are met. An Individual Plan or Fee- for-service Plan would be more expensive and a disability plan would not cover hospital costs. Question: 3 During the Open Enrollment period, a Medicare eligible person may do all the following, except: A. Add a Medicare Supplement B. Cancel a Medicare Supplement C. Change Medicare Advantage Plans D. Submit claims under a new plan Visit us athttps://www.certschief.com/health-insurance/ Answer: A Explanation: The Medicare open enrollment period allows eligible persons to compare Medicare Advantage plans, add supplements or cancel supplements. Claims may be submitted under the new plan when the plan year starts (generally, January 1st). Question: 4 An insured’s health policy lapses. The insurer notifies him of the lapse and he gives his agent a check for back premiums and an application to reinstate the policy. The insurer does not respond to the application. On day 55 after he submits the application, the insured visits his doctor for an annual physical. The doctor’s visit: A. Must be paid out-of-pocket B. Has no coverage C. Is covered under the policy D. Will have a higher co-pay than before the lapse Answer: C Explanation: If an insurer fails to reject a reinstatement application, the policy is automatically reinstated after 45 days from the application. All usual policy benefits will apply. Question: 5 An employer has a fully-insured group health plan. Who is responsible for paying medical benefits? A. The insurer B. The employer C. Both the insurer and the employer D. The State’s exchange from which the employer purchased the plan Answer: A Explanation: With a fully-insured group health plan, the insurer is responsible for paying medical benefits. Employers are fiduciaries and must oversee plan administration. Question: 6 An insured sustains a sports injury. In the hospital, he develops pneumoni a. Which of the following is true? Visit us athttps://www.certschief.com/health-insurance/ A. The group plan does not cover the injury or the pneumonia because they are outside of work hours B. Group health insurance covers both C. The injury is covered under his plan, but the hospital covers the pneumonia D. The group plan does not cover the injury because the insured chose to participate in the sport, but the pneumonia is covered Answer: B Explanation: Group health and accident insurance covers injuries on the job and off the job, equally. Hospitals do not cover coincidental sickness. Question: 7 Once a child is qualified for the Children’s Health Insurance Program (CHIP), the State must provide coverage for a minimum of: A. One year B. Eighteen months C. Nine months D. Six months Answer: A Explanation: Eligible CHIP participants have State coverage for a minimum of 1 year. Question: 8 An orchestra conductor has an any occupation disability policy. A tragic medical condition leaves him unable to work as a conductor. After a few months, he is able to work as a music instructor. Under the policy, benefits: A. Are not payable B. Will continue C. Continue at a lower rate D. Will stop Answer: D Explanation: Under the any occupation clause, an insured who is disabled and becomes employed in another kind of work is not eligible for benefits. Question: 9 Visit us athttps://www.certschief.com/health-insurance/ A new agent prepares a “one sheet” advertisement that lists the health plans he markets and sends it to his friends. It tells readers to contact him directly. The advertisement: A. Helps his friends find the right coverage B. Saves clients money C. Announces the agent’s new business D. Violates State insurance rules Answer: D Explanation: Advertising rules vary from State to State but generally require an insurer’s approval. The agent did not get an approval and therefore violated the State’s rules Question: 10 The Advance Premium Tax Credit (APTC) helped a family pay health insurance premiums last year. They will lose their APTC if they: A. Fail to file their Income Tax form B. Change insurers C. Move from one employer to another D. Leave the State Answer: A Explanation: Failing to file Income Tax forms stops Advance Premium Tax Credits. Visit us athttps://www.certschief.com/health-insurance/ Page | 1 http://www.certschief.com/exam/0B0-104/ For More Information - Visit: http://www.certschief.com/ Discount Coupon Code: CERTSCHIEF10 Powered by TCPDF (www.tcpdf.org) Visit us athttps://www.certschief.com/health-insurance/