Resolution Health|Health Broker Exam

Health BROKER EXAM



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Resolution Health Broker Exam 2010
 
This is a multiple choice exam. For each question, there is only ONE correct answer.
 
 

  1. Contact Lenses are a benefit on the Fundamental plan?
    1. True
    2. False


  2. In the case of a true emergency, pre-authorisation for hopitalisation must be obtained within:
    1. 48 hours of admission
    2. First working day after admission
    3. a and b
    4. 72 hours of admission


  3. When wisdom teeth are extracted from members on the Progressive and Prestige Plans, the following is applicable:
    1. Hospitalisation will be covered from the risk portion
    2. The specialist will be covered from the Specialist benefit
    3. Pre-authorisation is required
    4. All of the above


  4. Scheme protocols under the Progressive option for Neonatal Intensive Care, entails the following:
    1. Premature babies who have a chance of life, as per the specialist, will be resuscitated
    2. Premature babies weighing 1000 grams or more will be resuscitated
    3. Premature babies of 30 weeks or more will be resuscitated
    4. All premature babies will be resuscitated


  5. The limit for acute medication on the Prestige option for a family of 3 is:
    1. R5000
    2. R2000
    3. R3000
    4. R4200


  6. On the Prestige Plan following a surgical procedure done in-hospital, a wheelchair will be covered from:
    1. Hospitalisation
    2. Overall Annual Limit
    3. External Medical Appliances
    4. Medical Savings Account


  7. The Hospital Plan is aimed at:
    1. Individuals who require a Medical Current Account (Savings)
    2. Individuals who have the ability to manage their own day-to-day healthcare needs
    3. Individuals who require cover for visits to a dentists
    4. Individuals who require day-to-day Benefits


  8. The following is applicable to Medical Schemes:
    1. Underwriting may decline a person for cover
    2. Policy is owned by the insured
    3. Business entity is run by a Board of Directors
    4. Registered entity with the Council for Medical Schemes


  9. A R1 050 casualty benefit is available on the following plan options:
    1. Prestige and Progressive Plans
    2. Hospital, Progressive and Prestige Plans
    3. Hospital, Fundamental, Progressive and Prestige Plans
    4. None of the above


  10. Should a member resign, what is the notice period?
    1. 90 days
    2. 30 days
    3. 15 days
    4. With immediate effect


  11. Which of the following can be registered as a child dependant?
    1. Your children over 21 who are unemployed
    2. Full time students up to the age of 21 years
    3. Your spouse’s children older than 21
    4. Your sister’s children 21 years and younger


  12. Under the preventative care benefit a client has cover for:
    1. Cervical cancer vaccine
    2. Cholesterol, blood pressure and blood sugar tests
    3. PSA/Papsmear
    4. All of the above


  13. Which procedure does not have a co-payment:
    1. Grommets
    2. Spinal surgery
    3. Tonsillectomy
    4. Gastroscopy


  14. 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 limit is R42 000?
    1. The member would have to pay the difference.
    2. The difference would be covered under PMB
    3. Under the Prestige option, the member can pay it out of the Medical Current Account.
    4. The member can use funds from his/her HealthCARD


  15. What is the Oncology benefit on the Hospital Plan?
    1. R225 000
    2. R210 000
    3. R157 500
    4. R200 000


  16. On the Prestige Option, orthodontics are limited to individuals younger than:
    1. 25 years
    2. 30 years
    3. 21 years
    4. 18 years


  17. Under the Fundamental option, you are allowed to visit a specialist after obtaining pre-authorisation, under which of the following circumstances:
    1. Should the patient require a surgical procedure
    2. Should the patient be referred by a CareCross GP and the condition is a PMB
    3. Should the patient be a member of RHMS for more than 6 months
    4. Should the condition be of a not so serious nature


  18. Claims have to be submitted within _________ months from service date?
    1. 2 months
    2. 4 months
    3. 5 months
    4. 3 months


  19. On the Fundamental option, the following benefits are included:
    1. Childhood Immunisations as recommended by the Department of Health up to 18 months
    2. Liver and cornea transplants at provincial hospitals
    3. ResoBaby and ResoTot
    4. Pharmacy Advised Therapy


  20. A Designated Service Provider PMB Hospital admission is limited to R________ per Family per annum on the Fundamental plan?
    1. R150 000
    2. Unlimited
    3. R100 000
    4. R210 000


  21. 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 Preventative Care benefit on the Hospital, Progressive, Prestige options. Is this statement true or false?
    1. False
    2. True


  22. The R500 benefit for antenatal classes are paid from:
    1. ResoBaby benefits
    2. Maternity in-hospital benefits
    3. Alternative Healthcare
    4. Preventative care


  23. What is the annual contribution towards the MCA on the Progressive option for a single member?
    1. R864
    2. R765
    3. R576
    4. R288


  24. Under the Fundamental Option, the optometry benefit allows for one eye test per beneficiary every 24 months.
    1. Yes
    2. No


  25. On the Prestige Option, a family will receive the following benefit in Rand value for speech therapy and audiology, subject to annual overall limits
    1. R1500
    2. R500
    3. R2000
    4. R1050


  26. Denis administers the Dental benefits on the Fundamental Plan.
    1. False
    2. True


  27. What is the new call centre number where members can direct their dentistry questions for 2010?
    1. 011 791 6425
    2. 0861 796 6400
    3. 0860 101 110
    4. 0861 74 3367


  28. Can the difference between the tax benefit and the actual medical scheme premium be taken into account when calculating the 7, 5% threshold?
    1. No
    2. Yes


  29. What is the Rand value for the Oncology benefit on the Prestige Plan?
    1. R262 500
    2. R210 000
    3. R120 000
    4. R250 000


  30. At what rate are the professional fees in hospital covered on the Prestige Plan?
    1. 100%
    2. 150%
    3. 80%
    4. 200%


  31. The Prestige Plan provides orthodontic treatment to children under the age of 18
    1. True
    2. False


  32. Preventative care includes the following benefits:
    1. Full medical examination and cholesterol testing
    2. Blood sugar testing and antenatal classes
    3. Flu vaccinations, childhood immunisations and blood pressure testing
    4. HIV Testing and glaucoma screening


  33. The hospice benefit on the Prestige plan is R26 250
    1. False
    2. True


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


  35. Which one of the following chronic conditions is NOT a PMB condition?
    1. Osteoporosis
    2. Glaucoma
    3. Cardiac Failure
    4. Parkinson’s Disease


  36. Mr. Joubert must have a mole removed in-hospital as the doctor thinks it might be skin cancer. Will he have a co-payment?
    1. There is a co-payment of R1250 on a gastroscopy procedure
    2. This is cosmetic and is a Scheme exclusion
    3. Skin lesions has a R1 250 co-payment
    4. There is a co-payment of R3 000 on reflux surgery


  37. Does Resolution Health Medical Scheme offer international cover on the Fundamental plan?
    1. Yes
    2. No


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


  39. Members are notified of claims payments by means of:
    1. Electronic claim updates on the web page
    2. Hardcopy updates which are posted to the members
    3. Members don’t get notified
    4. a and b


  40. Should PMB (Prescribed Minimum Benefits) be applicable on the Progressive plan, what would your benefit be as a single member if hospitalised:
    1. R420 000 of NRPL
    2. Unlimited - limited to Provincial Cost
    3. R210 000 of NRPL
    4. Unlimited- subject to Scheme protocols and only PMB related conditions after R210 000


  41. Expectant moms registered on ResoBaby, will not have access to the following benefits:
    1. Discount vouchers for Huggies nappies
    2. 1 Additional specialist visit
    3. Ante-natal classes to the value of R500
    4. 2 x 2D ultra sound scans


  42. The Progressive option covers External Medical Appliances at
    1. R9 900 per annum
    3. No Benefit
    4. R2 600 per annum


  43. Are all cancers PMB?
    1. No
    2. Yes


  44. Dentistry forms part of the Overall Annual Limit.
    1. Yes
    2. No


  45. HIV Anti-retroviral medication forms part of the Chronic Medication benefit.
    1. No
    2. Yes


  46. How many additional specialist visits does a pregnant member qualify for apart from the Scheme benefits, should she register with ResoBaby?
    1. None
    2. Three
    3. Two
    4. One


  47. Members on the Prestige option will have access to the following wards when hospitalised:
    1. Private Wards
    2. General Wards


  48. Are certain Maxillo Facial procedures covered in-hospital on the Prestige Plan?
    1. No
    2. Yes


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


  50. Which psychiatric disorders are not PMB related?
    1. Alcohol and Drug abuse
    2. Anorexia
    3. Attention Deficit Disorder
    4. Post Traumatic Stress
 



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