Health Deal Final Exam 2024

When was Health Deal established?

2007
2013
2015
2019

What is the primary role of a health insurance agent?

To underwrite insurance policies
To provide financial planning services
To process insurance claims
To assist clients in selecting the best health insurance policy

Which of the following is a benefit of private health insurance in Australia?

Avoid paying medicare levy
Access to Medicare
Free gym memberships
Shorter waiting times for elective surgeries

What does the term “gap fee” refer to in health insurance?

The difference between the Medicare rebate and the doctor's fee
The amount paid by the insurance company
The monthly premium paid by the insured
The amount covered by Medicare

What is the Medicare Levy Surcharge (MLS)?

A penalty for not having private health insurance
An additional tax for high-income earners without private health insurance
A fee for using public hospitals
A charge for prescription medications

Which of the following is NOT typically covered under extras cover?

General Dental
Optical
Physiotherapy
Major surgery

What is Lifetime Health Cover (LHC) loading?

A discount for early enrollment in private health insurance
A government rebate on health insurance premiums
An additional cost for individuals who delay getting private health insurance
A tax incentive for low-income earners

What is the purpose of the Private Health Insurance Rebate?

To penalize high-income earners
To encourage people to purchase private health insurance
To fund public hospitals
To reduce the cost of prescription medications

Which type of health insurance policy typically includes coverage for services like acupuncture and chiropractic?

Hospital cover
Extras cover
Basic cover
Comprehensive cover

Which factor does NOT affect the cost of health insurance premiums?

Age of the insured
Health status of the insured
Income of the insured
Level of coverage chosen

Which of the following is considered a pre-existing condition?

A condition diagnosed after obtaining insurance
A condition diagnosed 12 months after obtaining insurance
A condition diagnosed within 6 months of obtaining insurance
A condition that existed at least 6 months prior to obtaining health insurance

David, Sarah and their 2 year old twins are on Bupa Silver Plus Advanced Hospital $250 Excess & Budget Extras 60. They live in NSW, are both 45 years old, earn $140,000 as a couple, and have told you they have a 20% LHC. How much do they pay for their cover each month?

$526.62
$544.23
$561.59
$573.97

If a customer is covered for joint replacements, but not weight loss surgery, what level of cover are they on?

Gold Cover
Silver Plus Cover
Silver Cover
Bronze Cover

What health fund has “Members First” as their proffered provider network name?

ahm
Australian Unity
Bupa
hif
nib
Westfund

You are switching John from Bupa to Westfund, he is switching silver hospital to silver hospital. He tells you that he hasn’t paid he last fortnightly payment with Bupa, what do you need to tell him when he switches?

Westfund has a 30 day grace period when switching health cover, so even though you have not paid you last 2 weeks, Westfund will not make you re-serve your wait periods, because you've already served them with Bupa.
Westfund has a 7 day grace period for time without cover, meaning if you have 7 days without cover, Westfund will make you re-serve all waiting periods. You need to make sure you are financially up to date before you switch.
Westfund has a 59 day grace period when switching health cover, so even though you have not paid you last 2 weeks, Westfund will not make you re-serve your wait periods, because you've already served them with Bupa.
Westfund has a 0 day grace period for time without cover, meaning if you have even 1 day without cover, Westfund will make you re-serve all waiting periods. You need to make sure you are financially up to date before you switch.

You are switching John from Medibank to nib. John has a $600 general dental limit, with Medibank, and he has claimed $500 between Jan-June. You are switching him to Core Extras, with a general dental limit of $600. How much general dental will John be able to claim when he switches on 1st July?

$0
$100
$500
$600

You are switching Carol to Australian Unity – Top Choice $500. She wants to pay by BSB/Account Number, she wants to start her policy on 1st July, when should you set her first payment date?

Ask customer what date she gets paid, and line it up with that, so theres always money in the account.
You have to put the payment date the same day as the sale date.
You have to put the payment date the same day as the cover start date
You have to put the payment date one billing frequency ahead of the cover start date, so if cover start date was 1 July, you would put 1 August as payment date

New migrants get how long to take out private hospital cover before LHC kicks in?

365 days from when they first enter Australia
365 days from when they first apply for a permanent visa
365 days from when their permanent visa is granted
365 days from when they are first elligble for Medicare

Susie is changing from Silver Hospital to Silver Plus Hospital, she has been on her current plan for 2 years. She needs Joint Replacement surgery, how long will she have to wait before she can get this surgery?

Susie has already served her waiting periods because she's been with her previous health fund for 2 years. So 0 days.
2 Months because it is a new condition for her
12 months
6 months

When speaking to a customer, how long do you have before you have to tell them that the call is recorded?

60 Seconds
90 Seconds
120 Seconds
5 minutes

You are speaking to David (56) and Gemma (55) in Victoria. They earn $160K between them and they have twins, Mark & Peter. Mark is 25 and in Full-time University, and Peter is training to be an electrician at his dads company. David tells you the family is with Medibank on Medibank Silver Plus Assured $250 Excess and My Choice Extras Move 75. They pay fortnightly. How much are they paying for their health insurance?

$204.53
$221.57
$269.14
$291.57

Which health fund is the largest on Health Deal’s panel of health funds?

ahm
Australian Unity
Bupa
Health Insurance Fund of Australia
nib
Westfund

Steve is a single guy living in Sydney. He earns $100K and has Hospital Cover with a $1,000 excess. Does Steve pay Medicare Levy Surcharge?

No, Steve has hospital cover, so this prevents him from paying MLS
No, Steve only earns $100K, and this isnt enough to make him pay MLS
Yes, you need hospital AND extras to avoid paying the MLS
Yes, Steve has a $1000 excess and $1K excess does not prevent you paying MLS despite having hospital cover

The financial year in Australia runs:

January – December
April – March
June – July
July – June

Which Health Deal health fund DOES NOT have any proffered dental providers?

Australian Unity
AHM
Bupa
Health Insurance Fund of Australia
nib
Westfund

Why do you think it’s important that we select the correct lead source in the CRM when running comparisons for customers?

We as a business need to see what lead sources are converting into sales and which are not, so that we can invest in to better performing leads
So QA can ensure that we are not putting through fraudulent sales
To get better reviews on trust pilot
Because we like clean data

When should you stop asking questions during hospital needs analysis?

When a customer says that they require a basic hospital cover with joint replacements
When a customer says there is a specific procedure he requires without advising you of any pre existing conditions
When a customer says yes to a procedure on the needs analysis page as everything below it is covered
You always have to ask EVERY hospital proceedure during hospital needs analysis, this is required by QA

At what age does the loading start to apply?

30th Birthday
31st Birthday
July 1 after your 31st birthday
July 1 after your 30th birthday

True or False: A person switching from a corporate gold hospital cover to a normal Silver plus cover will be charged LHC due to downgrading their hospital cover

True
False

What is the maximum percentage of LHC loading that can be added to health insurance premiums?

100%
70%
50%
2%

Which factor does NOT influence the level of LHC loading?

Age at which hospital cover is taken
Income level
Continuous duration of hospital cover
Days of absence of more than 1094 days

True or False: Lifetime health cover loading decreases for every year a person has private hospital cover. E.g Steve takes up Hospital cover at 40 and pays 20% loading, for every year he has hospital cover his LHC drops by 2%.

True
False

Which of the following people are exempt from paying LHC?

June, who has never held hospital cover in her life, but is 91 years old
David on $100K per year as a single, with extras cover only
Stacey on $120k per year, with hospital only cover. $1,000 excess
Gerrard, is 60, has had extras cover his entire life, but not hospital cover

While filling RAS which of the following dictates what AGR tier a person falls under?

Number of years a person has had PHI and income
Number of years a person has had PHI and Age
Age and Income
Age & State

True or False: Is the following statement CORRECT – On a couple policy, if the customer does not know the DOB of his/her partner we can put in a dummy date and figure it out later?

True
False

Which of the following statements are correct when identifying LHC to a person aged 45 years old?

Have you had continuous hospital cover for the past 10 years
Have you had hospital cover for the past 10 years
Have you had continuous cover for the past 10 years
Have you had continuous hospital cover since 31

True or False: Having hospital cover with a $500 excess prevents high earners from paying Medicare Levy.

True
False

John is on a $500 excess, you switch him to a $750 excess. John goes into hospital for a pre-existing procedure after 3 months of being on the new policy. What excess will John pay?

$0 Excesss
$500 Excess
$750 Excess
$1,250 Excess

What is a yearly limit on extras?

The amount someone can spend on their hospital cover in a year
The maximum amount someone can spend on their hospital cover in a year
The total amount someone can pay in premiums in a year
The maximum amount someone can claim on a service over the year

True or False: The Medicare Levy is a 2% tax that almost all Australian adults pay, regardless of if they have private hospital cover or not.

True
False

What is gap cover in the context of private health insurance?

Type of dental insurance
Coverage for the difference between the medical fees charged by a doctor and the amount covered by Medicare and private health insurance
Insurance for covering the gap in prescription medication costs
What Medicare pays towards surgery costs

True or False: Gap cover eliminates all out-of-pocket expenses for medical treatments.

True
False

True or False: Gap cover is mandatory for all private health insurance policies in Australia.

True
False

What is the “gap amount” in a medical bill?

The total cost of the medical procedure
A discount provided by the healthcare provider
The difference between the Medicare benefit and the actual cost, which the patient may have to pay

What is the primary purpose of gap cover in private health insurance?

To reduce or eliminate out-of-pocket expenses for the policyholder
To cover all medical expenses
To provide coverage for non-medical expenses

True or False: Gap cover is only applicable for in-hospital treatments and doesn’t apply to outpatient services.

True
False

What are 3 benefits of private hospital cover? (Pick 3)

Choose your own doctor
Always get 100% of the costs covered
Always get a private room
Choose your own hospital
Avoid public wait lists
Always get gap free dental

Medicare does not cover: (Select the items which Medicare DOES NOT cover)

Private patient hospital costs
Pubic hospital costs
Optometrist tests (Eye Tests)
Glasses
Ambulance
Physio

What is an “Extras rebate”?

What you get back when you swipe your card
A discount from the government on extras
The maximum amount you can claim for the year on an extras service
The government rebate applied on the premiums

How many absence days are allowed when lapsing private hospital cover before there is LHC implications?

365 Days
3 years
1000 Days
1094 Days

What document is required for LHC purposes when someone has been overseas for a period of time and has recently settled back in Australia?

Medicare Entitlements Letter
Inernational Movement Record
Transfer Certifcate
All of the above

When we upgrade customers from bronze to silver plus what should we advise in terms of Waiting Periods?

They will not have any waiting periods to serve when they switch
They will have to re-serve all wait periods, because they are upgrading
They will not re-serve any wait periods for the bronze proceedures, but will have to wait 2 months for anything pre-exisiting on any new item.
They will not re-serve any wait periods for the bronze proceedures, but they will have to wait 2 months for new conditions and 12 months for pre-existing on the upgraded surgeries.

Which state gives their citizens free emergency ambulance cover?

Victoria
New South Wales
Queensland
Western Australia
South Australia

What is the minimum period of time a customer can suspend their cover for, when they travel overseas?

2 Weeks
1 Months
2 Months
2 Years

What is the maximum period of time a customer can suspend their cover for when travelling overseas?

2 Months
6 Months
12 Months
18 Months
24 Months
10 Years

Why is it so important to understand what date a customer lapsed their previous policy when they have communicated their previous cover has recently lapsed?

So you know if the customer has LHC or not
So you know if the customer will have to re-serve wait periods or not
All of the above

Which of our health funds has a 0 day grace period for days without cover? Meaning if there is even 1 day without continuous hospital cover between switching, they will make the customer re-serve all wait periods.

Australian Unity
ahm
Bupa
hif
nib
Westfund

Which of our health funds has a 59 grace period for waiting periods? Meaning there can be a lapse in cover between transferring health funds for up to 59 days without the need of re-serving wait periods?

Australian Unity
ahm
Bupa
HIF
nib
Westfund

Where the customer is paying by Credit Card on a monthly frequency for an Australian Unity sale, what should the Ongoing Payment Date be if the sale was processed on 01/08/24?

01/08/24
01/09/24
Set it as the cover start date – As the payment date and coverstart date needs to be the same
Set it one month after the cover start date

What sort of signs would you look out for that might indicate a vulnerable customer?

The customer seeems forgetful
The customer tells you that their son or daughter always handles these type of things for them
The customer seems nervous
Customer says they have just taken strong medication
All of the above

If the customer is downgrading their hospital cover, what MUST we tell them?

Make sure they are fully aware that if they remove procedures now, that they will have to wait 12 months to add them back on if they need it later, and make sure they are happy with that
That they'll be saving hundreds of dollars off the policy
That they should ring you back if they need to upgrade, further down the track,
We dont need to tell them anything, as long as we have read the exclusions correctly and they have agreed, then we are OK

You are switching Gary to an Australian Unity policy. He wants to pay by credit card. The sale date 1st July, and his policy start date is 7th of July. What do you need to tell him?

Even though your policy start date is in 7 days time, Australian Unity will deduct money from your account within 24 hours.
You need to line up your policy start date and the payment date to the same day
Let the customer know thatif he's paying by credit card, you must change the policy start date to today.
Let him know that his premium will be increasing by 4% if he pays by credit card.

You are switching a customer to Bupa, they decide they want to pay fortnightly. What do you need to tell them when selecting the policy start date?

Bupa can only take payments on a Thursday for fortnightly payments
Bupa do not allow a fortnighly payment for their first payment. The customer will always have to pay 1 month premium first, then it will revert to fortnightly.
Nothing special, Bupa can take fortnighly payments whenever – This is a trick question
You have to select the cover start date the same day as payment date with Bupa on fortnightly payments

Not saying the participating private hospital statement is what type of QA fail?

Customer Experience
Serious
Critical

What age does nib class customers kids as “adults” for the purposes of health insurance if they are not in full time university?

18
21
23
25

What age does Westfund class customers kids as “adults” for the purposes of health insurance if they are not in full time university?

18
21
23
25

What age does Australian Unity class customers kids as “adults” for the purposes of health insurance if they are not in full time university?

18
21
23
25

What age does Bupa & ahm class customers kids as “adults” for the purposes of health insurance if they are not in full time university?

18
21
23
25

What age does HIF class customers kids as “adults” for the purposes of health insurance if they are not in full time university?

18
21
23
25

With the aged-based discount, how much discount will a 30 year old receive, if taking out a cover for the first time?

0%
2%
8%
10%

What age range gets 10% on the aged based discount?

18-21 Year Olds
18-23 Year Olds
18-25 Year Olds
18-29 Year Olds

True or False: A 18 year old who takes out a hospital policy will always be entitled to the aged based discount

True
False

When a customer has the aged-based discount on a policy, on what birthday does the ABD start to decrease by 2%? (What age does it go from 10% down to 8%)

30
31
40
41

The maximum a customer can pay in MLS is what?

1% of income
1.5% of income
2% of income
$10,000

What is the earliest we are allowed to call a customer in Australia?

11am Fiji Time
9 AM in Melbourne
9 AM in their specific state
8 AM

Which one of these times are we allowed to call customers?

State Public Holidays
National Public Holidays
Sundays
5pm-8pm On Saturday

PHIIA Stands for:

Private Health Insurance Information Association
Public Health Insurance Intermediaries Association
Private Health Insurance Industry Association
Private Health Insurance Intermediaries Association

Which of the following best describes the role of PHIIA?

Regulates all private health insurance providers in Australia.
Represents intermediaries, such as brokers and comparison websites, in the private health insurance sector.
Provides public health insurance to Australian citizens.
Is the name of the health insurance ombudsman in Australia

Which of the following is a core principle of PHIIA?

Promoting transparency and consumer protection in the private health insurance sector
Ensuring government control over private health insurance policies
Limiting competition among private health insurance providers
Setting premium rates for all private health insurance plans

According to PHIIA’s code of conduct, how must members handle consumer complaints regarding private health insurance products?

Forward all complaints directly to the insurance providers without addressing them.
Resolve complaints internally without any documentation.
Provide a clear, documented process for handling complaints and ensure timely resolution.
Refer all complaints to government regulatory bodies.

What are the 3 parts of the comparison wheel?

Tell customer what to think, explain rebates with imagery, ask for applause
Tell customer what to think, explain rebates, ask for applause
Tell customer what to think, explain rebates with imagery, check in
Tell customer what to think, explain rebates with imagery, ask for the sale

The Health Deal sales methodology has how many parts?

1
5
7
10
15

Health Deal has 6 health funds. 5 of them run on a calendar year and one of them runs on a financial year. Which health fund resets its limits on a financial year?

Australian Unity
ahm
Bupa
HIF
nib
Westfund

You are switching Daniel to nib Core Extras. You are at the payment section and he says he wants to pay by credit card. What must you tell him?

Nothing, this is a trick question
nib will deduct money from your account within 24 hours
nib will charge you 4% more than the price I told you if you pay by credit card
I need to put your payment date, one month after your policy start date

You are speaking to Roger (66) and Mary (55), they both earn $120k between them. What is their AGR tier?

8.202%
12.303%
24.608%
28.710%

Mark and Stacey are a couple. Mark has 10% LHC and Stacey has 0% LHC, what LHC % will be applied to their policy?

10%
5%
20%
0%

What is the waiting period for major dental?

2 Months
6 Months
12 Months
36 Months

What is the waiting period for a pre-existing condition when you are new to cover?

0 Months
2 Months
6 Months
12 Months

True or False: Every single customer you speak to on the phones, regardless of their lead source type, can have their cover start date be the same day as sale date.

True
False

True or False: Health Deal has a 4.9/5 Rating on Trust Pilot

True
False

True or False: Every sale you make will be quality checked by the QA team, and an email will be sent to your customer so their can rate you on Trust Pilot

True
False

True or False: If you cancel your hospital insurance after your Lifetime Health Cover base day to go overseas for at least one continuous year, the days you spend outside of Australia are not counted towards the 1094 Days of Absence

True
False

If you have a LHC loading on your hospital premium, it is removed once you have held LHC loading on your hospital cover for:

5 Years
10 Years
The loadind reduces by 2% each year until it reaches 0%
1094 days

Which of these extras is NOT claimable on private health insurance

Naturopathy
Chinese Medicine
Accupuncture
Remedial Massage

What clinical category has a special rule? Which allows customers to upgrade their cover and use this straight without serving a waiting period (provided they have held hospital cover for at least 2 months)

Heart and Vascular Sytem
Chemotherapy
Brain and Nervous System
In-Hospital Psychiatric

A customer tells you they are with Apia, what health fund on our panel can you NOT sell?

Australian Unity
ahm
Bupa
HIF
nib
Westfund

When a customer goes for surgery, how much does the health fund have to cover for the surgery?

25% of the MBS fee
75% of the MBS fee
100% of the MBS fee
All of the surgery costs

Maggy lives in Tasmania, she’s 45 and earns $65,000. She tells you she’s with Australian Unity on the policy called Starter Classic Combination (Bronze Plus) $500 Excess. She pays by monthly credit card, how much is getting deducted from her credit card each month?

$162.54
$156.04
$153.72
$147.57

You are speaking to John who has been with nib on Core extras for 5 years, you are switching him to ahm Black 60 in July. He tells you have he claimed $250 on his glasses in March. When John switches, how much optical limit will he have with ahm?

$0 – he claimed for his glassed in March
$250 – He's served a $250 waiting period, so he gets it straight away
$200 – ahm reset their limits on 1st July

When selecting a policy for a customer, what should we always try to do?

Lower customers premium
Improve customers benefits
Lower premium, increase benefits
Lower premium, lower benefits (as long as savings are worth it)

Average score
Your score

Health Deal Final Exam 2024

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