Worker's compensation plans provide complete medical care for work-connected injuries with no waiting period.
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In most short-term disability contracts, there is no waiting period for disabilities resulting from accidents.T (1-7 days for illness. Short-term disability usually from nonoccupational illness or accidents)Short-term plans most often have a benefit reduction for older employees.F (Short-term plans do not usually have a benefit reduction for older employees since the duration of the benefit is limited.)Short-term disability plans are often integrated with other disability income benefits.F (If only nonoccupational injuries are covered, there is no need for integration with Worker's Compensation Benefits).Employer contributions to disability income plans are fully deductible as an ordinary and necessary business expense if the overall compensation of the employee is reasonable.TEmployer contributions for disability income insurance do not result in taxable income to an employee.T (However, benefit may be taxable, particularly if they are funded with employer contributions.)Employers are less likely to provide disability coverage than either life insurance or medical expense benefits.TPremiums for salary continuation plans (sick leave) are usually paid by the employer.F (Uninsured by definition)Usually, sick leave plans are uninsured by definition.TIn primary integration, the LTD (long-term disability) benefit is reduced only by the amount the disabled worker receives from Social Security, not by the amount his/her family receives.TWhich of the following statements concerning salary continuation plans is (are) correct? I. Most plans require an employee to satisfy a probationary period before becoming eligible for benefits. II. Most plans are designed to provide benefits equal to no more than 50 percent of an employee's regular pay. A. I only B. II only C. Both I and II D. Neither I nor IIAAll the following statements concerning group disability income contracts are correct EXCEPT? A. The insurance company usually offers a conversion policy to any terminating employee who was covered under the contract for at least 2 years. B. The insurance company has the right to have a disabled employee examined by a physician of its own choice. C. The insurance company has no obligations to make benefit payments until a proof of loss has been filed. D. The insurance company often allows a worker to enter a trial work period in rehabilitative employment without having benefits totally terminated.AAll the following statements concerning the eligibility requirements of insured disability income plans are correct EXCEPT? A. Most plans require an employee to be actively at work before coverage will commence. B. Long-term plans often limit eligibility to salaried employees only. C. Short-term plans tend to have longer probationary periods than do long-term plans. D. Short-term plans sometimes limit eligibility to union employees only.CWhich of the following statements concerning insured group disability income benefits is correct? A. Short-term plans typically pay benefits for a duration of between 2 and 5 years. B. Short-term plans usually reduce either the duration or periodic amount of benefits for older workers. C. Most long-term plans have a shorter waiting period for disabilities arising from accidents than for disabilities arising from sickness. D. Both long-term and short-term plans usually place a dollar maximum on periodic benefits, regardless of worker(s earnings.DWhich of the following statements concerning the typical group short-term disability insurance contract is correct? A. Partial disabilities are covered. B. Occupational injuries are covered. C. There is a waiting period of 30 to 60 days before benefits for sickness begin. D. The maximum benefit period applies to each separate disability.DAll the following causes of disability are covered under a typical group short-term disability income contract EXCEPT: A. self-inflicted injuries. B. drug addiction. C. mental disorders. D. alcoholism. E. all of the above are excluded from coverageAPeter Nelson has been totally and permanently disabled for the past 3 years. Peter is single and has annual investment income of $5,000 in addition to social security benefits and $6,000 in annual long-term disability benefits from Peter's employer's group disability income plan. While Peter was actively employed, Peter was required to pay 40 percent of the cost of his coverage under the employer plan. How much of Peter's disability benefit from the employer's plan is includible in Peter's gross income for federal income tax purposes? A. $0 B. $2,400 C. $2,400 D. $3,600D ($6,000 x .60 = $3,600)Long-term disability income plans are usually integrated with all the following EXCEPT: A. Social Security. B. Worker's Compensation laws. C. earnings from other employment. D. individual disability income contracts purchased by employees.DWhich of the following statements concerning the definition of disability under long-term disability income plans is (are) correct)? I. The definition during early years is usually the same as the definition used by social security. II. The definition usually becomes less restrictive after an employee has been disabled for a period of time. A. I only B. II. Only C. Both I and II D. Neither I nor IIDWhich of the following statements concerning temporary disability laws is (are) correct? I. Benefits must be equal to 100 percent of an employee(s average weekly wage for some period prior to disability. II. The entire cost of coverage must be borne by the employer. A. I only B. II only C. Both I and II D. Neither I nor IID (Temporary disability Laws currently only exist in about 7 states. The requirement for whom pays (employer, employee, or both) varies by state. These temporary disability laws deal with coverage for non-occupational disabilities.Cost-containment techniques for medical expense coverage include which of the following: The encouragement by employers of external cost-control systems, such as health systems agencies II. The use by insurers of utilization review A. I only B. II only C. Both I and II D. Neither I nor IICWhich of the following benefit plan design features focuses on shifting costs to employees rather than reducing costs? A. Maximum benefit provisions B. Second surgical opinions C. Coverage for the use of alternatives to hospitals, such as home health care D. Preadmission testingAWhich of the following types of medical expense plans has the highest degree of managed care? A. Independent practice association HMOs B. Preferred-provider organizations C. Point-of-service plans D. Closed-panel HMOsDAll the following statements concerning the effect of the Health Insurance Portability and Accountability Act on group health plans are correct EXCEPT: A. The act applies to both insured and self-insured plans. B. The act allows a higher premium to be charged for any individual or dependent who is disabled. C. The act makes new dependents eligible for coverage under special enrollment rules. D. With some exceptions, the act requires providers of group health insurance coverage that operate in the small group market to accept all small employers.BWhich of the following statements concerning the effect of the Health Insurance Portability and Accountability Act on group health plans is (are) correct? The act allows premium discounts or other financial benefits to persons who adhere to programs of health promotion or disease prevention. II. The act allows higher premiums to be charged for any person covered under a group health plan if his or her physical or mental condition is below prescribed standards. A. I only B. II only C. Both I and II D. Neither I nor IIAWhich of the following statements concerning health insurance purchasing cooperatives (HIPCs) is (are) correct? They negotiate alternative plans of coverage on the basis of price and quality. Their use has been encouraged by federal antitrust laws. I only II only Both I and II Neither I nor IIAWhich of the following Federal Legislation Acts that were passed in the 1970's most affected the growth of HMO's? The Social Security Act The Americans with Disabilities Act (ADA) The Civil Rights Act Employee Retirement Income Security Act (ERISA) Health Maintenance Organization Act of 1973EWhich of the following is NOT a reason for significant increases in the cost of health care? A. overcapacity of medical facilities B. AIDS C. technological advances D. aging population E. increases in third-party paymentsAIn Group Medical Expense Plans, employers can use the following measures for cost containment EXCEPT: claims review. increasing eligible benefits. managed care. health education and preventive care. Group medical expense plans use all of these measures.BWhich of the following benefit plan design features focuses on shifting costs to employees rather than reducing costs? Maximum benefit provisions Second surgical options Coverage for the use of alternatives to hospitals, such as home health care Pre-admission testing Claims reviewAWhile a certain degree of cost containment is within the control of employers, proper control of costs is an ongoing process that requires participation by: consumers. government. providers of health care services. All of the above None of the aboveDA managed care plan should have all of the following characteristics EXCEPT: preventative care. high quality care. open access to medical providers. risk sharing. All of the above are characteristics of a managed care plan.CWhich of the following is a characteristic that should be contained in a managed care plan? preventative care comprehensive case management risk sharing high quality care All of the aboveEControlling rapidly increasing costs and the lack of coverage for a large segment of the population are the primary objectives of which of the following? Medical Savings Accounts National Health Insurance Medicaid Single Payer PlansBAll of the following statements concerning managed competition plans as an approach to national health insurance are correct EXCEPT: Preexisting-condition provisions would be allowed as long as they expire within 24 months of an individual's coverage. The insurance agent's role would be virtually eliminated. Health insurance purchasing cooperatives (HIPCs) would be established under state regulation and operate in a specific geographic region. Subscribers to HIPCs would be provided with information on the quality care of available medical expense plans.AAll of the following are provisions of the Health Insurance Portability and Accountability Act, EXCEPT which of the following? Increased tax-deductibility of medical expense premiums for the self-employed. Increased availability of medical expense coverage. Favorable income tax treatment for long-term care insurance. Decreased eligibility for COBRA benefits.DThe Health Insurance Portability and Accountability Act prohibits any of the following health related factors as a reason to exclude an employee or department from coverage under a group health insurance plan EXCEPT: medical history. disability. claims experience. genetic information. All of the above are prohibited by The Health Insurance Portability and Accountability ActDAll group health insurers must renew existing health insurance coverage unless one of the following circumstances exists. Which one does not apply? The plan sponsor failed to pay premiums, or the issuer of health insurance coverage failed to receive timely premiums. The plan sponsor performed an act of fraud or made an intentional misrepresentation of material fact under the terms of the coverage. The coverage was lost because of loss of eligibility under the other coverage. The employer is no longer a member of the association that sponsors a plan.CIf an employee does not enroll in his/her employers plan because they are covered on someone else's plan, how many days do they have to enroll in the plan provided after their other coverage has been eliminated? 10 30 90 60 4530