Free Rhode Island Accident & Health practice questions

Answer: A. providing a comprehensive fix for health care affordability

Section 27-50-2(a) lists the chapter's purposes, among them preventing segmentation of the health insurance market based on health risk, requiring disclosure of rating practices to purchasers, and limiting the use of preexisting condition exclusions. Section 27-50-2(b) says the reverse about affordability: the chapter is not intended to provide a comprehensive solution to the affordability of health care or health insurance.

Answer: C. A plan established by a union fund's trustees for the union's retired members

Section 7.3(B) excludes from the Part a policy or contract of employers, labor organizations, or trustees of a fund set up by them, covering employees, former employees, members or former members. A union fund's plan for its retired members fits that exclusion. Section 7.3(A) brings within the Part individual Medicare supplement policies delivered or issued for delivery in Rhode Island on or after the Part's effective date, and certificates issued under group Medicare supplement policies delivered in the state. A fraternal benefit society is listed in the Part's definition of issuer, so its individual Medicare supplement policy is covered like any other issuer's.

Answer: C. The signer's own examination, including a review of the insurer's records and the actuarial assumptions and methods it used to set attachment points

Under the Act's definition, the certification is signed by a member of the American Academy of Actuaries or another individual the commissioner accepts, and it must rest on that individual's own examination. The examination must include a review of the insurer's records and of the actuarial assumptions and methods the insurer used in setting attachment points and related determinations. An employer's claims summary accepted without reviewing the insurer's records, or a commissioner's report adopted instead of the signer's own examination, skips the examination the definition requires. A comparison of other insurers' premium rates is not part of the review the definition describes.

Answer: A. Setting a uniform order in which plans determine and pay claims

Section 2.2(A) gives three purposes: a uniform order of benefit determination under which plans pay claims, less duplication of benefits by letting plans that do not pay first reduce their benefits, and more efficient claims processing when a person has more than one plan. Requiring full payment from every plan would produce the duplication the rule aims to reduce. The rule addresses people who hold more than one plan rather than forbidding it, and it orders plans into first and later payers instead of dividing claims equally.

Answer: B. A plan provided directly to employees by the state or a state instrumentality

Sec. 27-38.2-2(2) defines a group health plan by reference to the federal ERISA definition of an employee welfare benefit plan. It then says that, for this chapter, a plan giving health benefits directly to employees or their dependents does not count, with one exception: a plan provided by the state or an instrumentality of the state. The exception turns only on who provides the plan. A private employer's size, a labor union sponsor and a nonprofit hospital sponsor are not named in it, so a direct-pay plan of any of those kinds stays outside the definition.

Answer: B. Chapter 27-4.1 neither applies to the plan nor affects how the corporation operates it.

R.I. Gen. Laws Sec. 27-4.1-1 carves nonprofit prepaid legal services plans out of the legal services insurance chapter. Nothing in chapter 27-4.1 applies to or affects such a plan when it is run in Rhode Island by a nonprofit prepaid legal services corporation subject to chapter 20.3. Because the chapter does not reach the plan at all, it imposes no duty to refile the plan as a legal services insurance policy, does not reclassify it as accident and health insurance, and does not split control so that chapter 27-4.1 sets the plan's rates.

Answer: A. Yes, because the employer is located in Rhode Island, wherever the trust sits

Chapter 27-20.4 applies to policies and certificates issued, delivered or renewed in Rhode Island, and it also reaches certificates of multiple employer trusts located in other states when the employer is located in Rhode Island. The trust's out-of-state location therefore does not take these certificates outside the chapter. The section sets no condition based on another state's law or on where individual workers live; the employer's location is what brings the out-of-state trust certificates in.

Answer: B. No, nonenrollment in another available plan is not a basis to reduce

Section 2.5(D)(1) forbids a COB provision that lets a plan reduce its benefits because another plan exists and the covered person did not enroll in it. Section 2.5(D)(2) likewise bars reducing benefits because a person could have been covered under another plan, with an exception only for Part B of Medicare. Reduction by a secondary plan works among plans that actually cover the person, and Section 2.5(D) offers no exception tied to employer sponsorship or to open enrollment timing.

Answer: A. Life insurance policies that accelerate their benefits to cover long-term care

230-RICR-20-35-1, Sec. 1.3(A) says the regulation applies to all long-term care insurance as defined in R.I. Gen. Laws Sec. 27-34.2-4, including qualified long-term care contracts under Section 7702B(b) of the Internal Revenue Code and life insurance policies that accelerate benefits for long-term care, where the coverage is delivered or issued for delivery in Rhode Island on or after the effective date of the 2008 amendments to the Part. Medicare supplement, workers' compensation and hospital indemnity policies are not among the products that subsection names.

Answer: A. Add an HMO membership option to the plan it offers for the following calendar year

R.I. Gen. Laws Sec. 27-41-27(a)(1) requires an employer that averaged at least 25 employees during any calendar quarter to include, in the benefits plan offered in the calendar year beginning after that quarter, the option of membership in licensed HMOs qualified under Sec. 42-62-9 that provide basic health services in service areas where at least 25 of its employees reside. This employer averaged 60 employees and 26 live in the HMO's service area, so both thresholds are met. The employee trigger is 25, not 100, and the residence test counts 25 employees in the service area rather than a majority of the workforce. The statute requires HMO membership to be offered as an option in the plan, not substituted for the employer's other coverage.