Resolution Health|Health Broker Exam

Health BROKER EXAM



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Resolution Health Broker Exam 2012
 
This is a multiple choice exam. For each question, there is only ONE correct answer.
 
 

  1. How many conditions in total are covered under the Chronic Medication Benefit on the Prestige option?
    1. 23 conditions
    2. 25 conditions
    3. 26 conditions
    4. 49 conditions


  2. Resolution Health Medical Scheme will cover the following confinement procedures:
    1. Elective Caesarean Section
    2. Water birth
    3. Clinically appropriate Caesarean Section
    4. b and c


  3. What is the internal Prostheses benefit on the Hospital option?
    1. R45 000
    2. R33 850
    3. R44 500
    4. R55 000


  4. Claims are paid ________ per month:
    1. Once
    2. Twice
    3. Three times
    4. Four times


  5. Which benefits are payable from the Saver benefit on the Progressive Saver Option?
    1. Pathology, Radiology, Extended Pharmacist Benefit, specialised dentistry, physiotherapy, acute medication, GP's
    2. Acute medication, alternative healthcare, specialised dentistry, optometry
    3. Conservative dentistry, GP's, Specialists, alternative healthcare, radiology and pathology, acute medication, physiotherapy, psychology, speech therapy and audiology
    4. OTC, specialised dentistry, psychology


  6. Scheme protocols for Neonatal Intensive Care, entails the following:
    1. Premature babies who have a chance of life, as per the specialist, will be resuscitated
    2. All premature babies will be resuscitated
    3. Premature babies of 30 weeks or more will be resuscitated
    4. Premature babies weighing 1 000 grams or more will be resuscitated


  7. The percentage savings available on the Progressive Saver option per member is:
    1. 25% of annual premium
    2. 30% of annual premium
    3. 20% of annual premium
    4. 15% of annual premium


  8. The overall limit for the Plus benefit under the Prestige option for a family of 3 is:
    1. R10 100
    2. R7 420
    3. R9 540
    4. No limit


  9. Acute medication forms part of the Focus benefit under the Prestige option
    1. True
    2. False


  10. Specialised dentistry forms part of the Saver benefit under the Progressive Saver option
    1. True
    2. False


  11. A waiting period applicable to PMB may be imposed on the following applicant:
    1. A new member not part of a scheme for 3 months or longer
    2. An applicant who has had membership for less than 2 years
    3. An applicant who has had membership for more than 2 years
    4. An applicant who is changing options


  12. Within how many days must a member inform Resolution Health of a change of address?
    1. 1 week
    2. 10 days
    3. Immediately
    4. 30 days


  13. If you have not registered for Resolution Health's HIV Management Programme through CareWorks, you will be entitled to the following facilities on the Prestige option:
    1. Provincial hospitals
    2. Private hospitals
    3. Network hospitals
    4. None


  14. What is the benefit for professional fees in hospital on the Hospital option?
    1. 150% of scheme rate
    2. 100% of scheme rate
    3. 200% of scheme rate
    4. 300% of scheme rate


  15. What types of procedures are funded under the specialised radiology benefit?
    1. CT, MRI
    2. PET
    3. Nuclear medicine scans
    4. All of the above


  16. On the Prestige option, orthodontics is limited to individuals younger than:
    1. 38 years
    2. 21 years
    3. 25 years
    4. 30 years


  17. How many specialist visits does a pregnant member receive should she register with ResoBaby on the Progressive Flex option?
    1. 2
    2. 4
    3. 6
    4. 9


  18. Following a surgical procedure to the feet done in hospital, crutches will be covered from which benefit under the Progressive Saver plan?
    1. Shield benefit
    2. Risk benefit
    3. Saver benefit
    4. Guardian benefit


  19. Which of the following can be registered as a child dependant?
    1. Your children over 21 who are unemployed
    2. Your spouses children older than 21
    3. Your sisters children 21 years and younger
    4. Full time students up to the age of 25 years


  20. Does the Progressive Flex option offer the same Rand value for multifocal lenses as on the Progressive Saver option?
    1. Yes
    2. No


  21. Which procedure does not have a co-payment on all the options except for Prestige?
    1. Gastroscopy
    2. Tonsillectomy
    3. Grommets
    4. Spinal surgery


  22. Should a member need two procedures with co-payments done and the procedures are related to the same area in the body at the same time, the member will pay:
    1. Both co-payments
    2. The lesser co-payment of the two procedures
    3. The larger co-payment of the two procedures
    4. An average of the two procedures


  23. Can a member backdate their inception date even if there is outstanding information (PMA, Terms not signed, etc. )?
    1. Yes
    2. No


  24. Which conditions are excluded under the Foundation option for private hospitalisation?
    1. Dental hospitalisation
    2. Joint replacement and rotator cuff surgery
    3. Functional nasal surgery
    4. a,b and c


  25. What is the oncology benefit under the Foundation option?
    1. R157 500
    2. Unlimited, based on ICON network and protocols
    3. No benefit
    4. R210 000


  26. Should a member undergo Voluntary Counselling and Testing for HIV, Resolution Health will cover the costs of the test from:
    1. HIV Management Programme (if registered)
    2. Preventative Care
    3. Alternative Healthcare Services
    4. a and b


  27. Denis administers the dental benefits on the Foundation option
    1. True
    2. False


  28. Benefits for fillings will be granted at:
    1. Once per tooth in a 5 year cycle
    2. Once per tooth in a 7 year cycle
    3. Once per tooth in a 1 year cycle
    4. Once per tooth in a 2 year cycle


  29. What would happen if a member needs a prosthesis to prevent loss of life, or to assist a life-changing event that costs R50 000 and the prosthesis limit is R42 000?
    1. The member would have to pay the difference.
    2. Under the Prestige option, the member can pay it out of the Medical Current Account.
    3. The difference would be covered under PMB
    4. The member can use funds from his/her Zurreal Healthcard


  30. When can a member elect to migrate between options?
    1. 1st of January of each year
    2. Every second last day of the month
    3. 1st of July of each year
    4. Every six months


  31. Mr. Joe Slo (aged 50) is married to Mrs. Slo (age 40) and have two children (aged 10 and 12). They have not been members of a medical scheme before. Mr. Slo has hypertension and Mrs. Slo takes chronic medication for female menopause. On which option will Mrs. Slos chronic condition be covered?
    1. Hospital option
    2. Foundation option
    3. Progressive Saver option
    4. Prestige option


  32. Resolution Health Medical Scheme pays for childhood immunisations (all vaccinations as required by The Department of Health to the age of 18 months) under the Guardian Benefit on the Hospital, Progressive, Prestige options. Is this statement true or false?
    1. True
    2. False


  33. The Hospital Option is aimed at:
    1. Individuals who require day-to-day benefits
    2. Individuals who have the ability to manage their own day-to-day healthcare requirements and seeking advanced in-hospital cover
    3. Individuals who require cover for visits to a dentist
    4. Individuals who require a Medical Current Account (Savings)


  34. The Progressive Saver plan is ideally suited for -
    1. Young and healthy individuals who are able to manage their own day-to-day healthcare requirements
    2. Young couples and/or healthy families that requires sufficient day-to-day benefits as well as hospitalization
    3. Families who prefer managing their own day-to-day benefits by means of a savings vehicle
    4. Larger families who require comprehensive cover


  35. Oral hygiene includes scale and polish treatment. Do the Progressive Flex and Prestige options cover these benefits?
    1. Yes - One treatment per beneficiary per year
    2. Yes - Two treatments per beneficiary per year
    3. Yes but only the Prestige option
    4. No, this is not covered at all as this is a cosmetic procedure


  36. At what rate are the professional fees in hospital covered on the Progressive Saver option?
    1. 200% of scheme rate
    2. 100% of scheme rate
    3. 210% of scheme rate
    4. 150% of scheme rate


  37. What is the rand value for External Medical Appliances on the Prestige option?
    1. R9 500 per annum
    2. R11 150 per annum
    3. R10 500 per annum
    4. No benefit


  38. The Hospice benefit on the Hospital option is R26 250
    1. True
    2. False


  39. International Cover entails the following:
    1. Up to R2 000 000 international cover
    2. 30 days uninterrupted international travel cover
    3. Registration for the cover prior to the departure
    4. a, b and c.


  40. The following benefits are offered across all plans:
    1. Trauma counselling
    2. Maximum of 7-day medicine supply when discharged from hospital
    3. ResoBaby
    4. All of the above


  41. A family of 4 members (member, adult dependant and 2 child dependants) will contribute the following on the Prestige option:
    1. R5 623
    2. R4 167
    3. R5 177
    4. R4 987


  42. At what rate are the professional fees in-and out of hospital covered on the Progressive Flex option:
    1. 150% of scheme rate
    2. 100% of scheme rate
    3. 200% of scheme rate
    4. 220% of scheme rate


  43. The Foundation option offers an optometry benefit of one eye test per beneficiary every 24 months.
    1. Yes
    2. No


  44. On the Foundation option, the benefit for a clinically appropriate caesarean section in a private hospital, is:
    1. 3 days & 2 nights
    2. 4 days & 3 nights
    3. R16 000
    4. R18 800


  45. Which of the following treatments and/or tests are covered under the Guardian Benefit, excluding the Foundation option?
    1. Cervical cancer vaccine
    2. Cholesterol, blood pressure and blood sugar tests
    3. PSA/Papsmear
    4. All of the above


  46. Resolution Health's loyalty/rewards programme is called:
    1. Reality
    2. Voila!
    3. Zurreal4life
    4. Vitality


  47. Pre-authorisation is required for the following procedures:
    1. Laughing gas in dental rooms
    2. Specialised dentistry
    3. Emergency ambulance services
    4. Acute medication


  48. The Flexi benefit allows the utilisation of an allocated amount across a range of healthcare needs
    1. Yes
    2. No


  49. The Extended Pharmacist Benefit is available on which of the following options?
    1. Hospital and Foundation
    2. Progressive Saver and Prestige
    3. Progressive Flex and Prestige
    4. All the plans


  50. Dental benefits on the Prestige and Progressive options are administered by?
    1. Denis
    2. Resolution Administrators
    3. Agility Global Health Solutions
    4. CareCross
 



Members handbook

The Members Handbook is your guideline in terms of your annual benefits, contributions, all protocols and scheme rules.

Chronic Authorisation Application

Click on the link below to download a PDF version of the Chronic Authorisation Application form