Final Exam 1 Iowa Accident and Health
Guaranteed renewable
What is the required renewability status of all Medicare supplement policies?
Irrevocable beneficiary
What kind of accidental death and dismemberment insurance beneficiary requires his/her consent want to change of beneficiary is made
Waiver of premium rider
What type of writer would be added to an accident and health policy if the policy owner wants to ensure the policy will continue if he/she ever becomes totally disabled
Income
When determining the monthly benefit amount for a disability income policy, the factor that limits the amount of prospective insured may purchase is
Insuring clause
Which health policy clause specifies the amount of benefits to be paid
Entire contract
Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract
Single premium
Which mode of payment is not used by health insurance policies
Contract
Which of the following consist of an offer acceptance and consideration
probationary Period.
Which of the following is considered to be the time period After health policy is issued, during which no benefits are provided for illness.
Exclusions
Which of the following is not included in the policy face
Usual, customary, and reasonable expenses
Which of the following phrases refers to the fees charged by a healthcare professional
and insured must wait at least 60 days after proof of loss has been submitted before a lawsuit can be filed
Which of the following statements best describes what the legal actions provision of an accident and health policy requires
They are nonprofit organizations
Which of the following statements is true about most Blue Cross/Blue Shield organizations
Business owner becomes disabled
Which of these circumstances is a Business disability buy sell policy designed to help in the sale of business
Wavior or premium
the provision in a health insurance policy that suspends premiums being paid to the insurer while the insured is disabled is called the
from the date that the policy was issued
under an individual health insurance policy, the time limit of certain defenses provision states that nonfraudulent misstatements first become incontestable two year
6
waiting period for a pre-existing conditions on Medicare supplement policies is ___ months
Is owned exclusively by its policy owner
A stock insurance company
Misrepresentation
Convincing a prospective insured to buy land insurance policy based on exaggerations is called
Major medical with basic hospital/surgical coverage
Comprehensive major medical policy is usually combined
Probability of making timely, premium payments
Consumer reports requested by an underwriter during the application process of health insurance policy can be used to determine
PPOs are not a type of managed care systems
Which of these statements is incorrect regarding a preferred provider organization
Testing positive for marijuana use from a previous screening
Which of these was the medical information bureau identify
Offering payment of approved claims within 30 days after affirming liability
Which of these would not be an unfair claims practice
Warranty
Which parts of health insurance policies are guaranteed to be true
the employer receives the policy and each employee issued a certificate
Which statement is true regarding a group accident & health policy issued to an employer
2
what is the maximum number of activities of daily living and insured must be unable to perform to qualify for long-term care benefits
Outline
when Medicare supplement policy is delivered, disclosure, standards require that an of coverage be provided to the insured
Prospective review
which of the following involves analyzing a case before admission to determine what type of treatment is necessary
Premiums normally increase at time of renewal
which of the following statements about a guaranteed renewable health insurance policy is correct
An insurer exaggerating, its dividends in a magazine advertisement
An example of false advertising would be
after an insured has become totally disabled as defined in the policy
And half insurance policies, a waiver of premium provision keeps the coverage in force without premium payments
Rights primarily controlled business
Are producers license may be suspended or revoked, if the licensee
Monthly
Periodic health claim payment must be made at least
unilateral
in an insurance contract the insurer is the only party who makes a legally enforceable promise. What kind of contract is this?
68-year-old male covered by Medicare
Set individual most likely to buy a Medicare supplement policy would be in
experimental and investigative services
A comprehensive major medical health insurance policy contains an eligible expenses provision, which identifies the type of healthcare services that are covered. All of the following healthcare services are typically covered, except for.
Time deductible
A disability elimination period is best described as a
Irrevocable
A policy owner would like to change the beneficiary on an accidental death and dismemberment insurance policy and make the change permanent. Which type of designation would fulfill this need
10
Before holding a hearing regarding a producers, unfair or deceptive practice, the commissioner must give how many days notice
Be established by the employer
In order to establish a health reimbursement arrangement, it must
3
Iowa requires that an insurance producer must complete hours of continuing education on the subject of law and ethics every reporting period
Twisting
Jay is a producer who has induced and insured through misrepresentation to surrender an existing insurance policy. What is Jay guilty of
Internal Limit
Jay was reviewing her health insurance policy and noticed the phrase " this policy will only pay for a semi private room" this phrase is considered to be an
Unilateral Contracts
Life and health insurance policies are:
15
Once the insurance company receives a notice of claim they have _ days to send the claim form
Closely regulated and requires full disclosure
One definition of replacement is " the act of replacing an existing insurance policy with another" replacement is
P only
P & Q are married and have three children. P is the primary beneficiary on Qs accidental death and dismemberment policy, and Qs sister R is the contingent beneficiary. P & Q & R are involved in a car accident and Q & R are killed instantly. The accidental death benefits will be paid to.
Claim will be denied
P is a major medical policy owner, who is hospitalized as a result of injury, sustained from practicing in car jacking. How will the insurer most likely handle this claim?
Insuring clause
The clause in an accident and health policy, which defines the benefit amounts the insurer will pay is called the
10
The free locked. And Iowa for individual health insurance policies is __ days.
6 months
The maximum time period that pre-existing conditions can be excluded in long-term care policies is.
notify an insurer of a claim within a specified time
The notice of claims provision requires a policy owner to
Payment of claims
The provision that defines to whom the insurer will pay benefits to is called
Exclusions
The sections of an insurance contract which limit coverage are called
May cancel the policy for nonpayment only
Under a guaranteed renewable health insurance policy, the insurer
26
Under the affordable care act, health coverage is provided for dependents up to the age of
A hospital and medical expense insurance program
What is Medicare?
Promise to pay the death benefit to a named beneficiary
What is the consideration given by an insurer in the consideration clause of a life policy?
Insured must be under a physicians care
What is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision?
Application containing statements from the insured
What is the initial source of underwriting for an insurance policy?
12 months
What is the maximum benefit. That must be offered by a long-term care policy
Losses result from accidental injuries
insured losses are covered immediately after a health policy is reinstated when
Beneficiary
Who is not required to sign a health insurance application?
Insuring clause
which of the following health insurance policy provisions specifies the healthcare services a policy will provide
Substandard applicants are never decline by underwriters
which of the following statements about the classification of applicants is incorrect?
Statements and representations on the application are part of the consideration for issuing a policy
why must an accident and health insurance Applicant answer all questions on the application
The insurer will adjust the benefit to what the premiums paid would have purchased at the insureds actual age
Jay, an accidental death and dismemberment policy holder, dies after injury, sustained in an accident. Jay's age, as stated on the application five years ago, was found to be understated by 10 years which of the following actions will the insurance company take
Guaranteed renewable
Long-term care policies issued in Iowa must be
free lock period has expired.
M completes an application for health insurance, but does not pay the initial premium. All of these actions must occur before Ms policy goes into effect, except
Available to those who are enrolled in Medicare, part a and part B
Medicare part C is
Upon satisfying the elimination period requirement
R becomes disabled, and owns an individual disability income policy. When is R eligible to receive disability benefits
Time limit on certain defenses
T files a claim on his accident and health policy after being treated for an illness. The insurance company believes that tea misrepresented his actual health on the initial insurance application and is, therefore, disputing the claims validity. The provision that limits the time period during which the company may dispute a claims validity is called.
Immediately
T send proof of loss to her insured for an acceptable medical expense claim under her individual health insurance policy. Upon receipt, the insurer must pay the benefits.
Conservation
T the producer is trying to dissuade a policy owner from replacing an existing insurance policy. This action take by T is called
Guaranteed renewable
Which type of renewability best describes a disability income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class
Misrepresentation
Which unfair trade practice involves a producer suggesting that an insurance policy is like a share of stock?
Gross income at the time of purchase
With disability income insurance, and insurance company may limit the monthly benefit amount of prospective policyholder may obtain because of the insured
30
Within how many days must a licensee notify the insurance division of change in address?
100%
XYZ company pays the entire premium for its group health plan. The maximum percentage of eligible employees that must be covered is
31 days
according to the mandatory uniform policy provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?
Assignment
an ___ of benefits of health policy transfers payments to someone other than the policy owner
20
an insured must notify and insurer of medical claim within days after an accident
$1000
an unintentional violation of Iowa insurance, so I could lead a producer to a fine of up to ___ per violation
Temporary insurance license
b the producer has died and leaves behind a spouse. In order for bs clients to continue being serviced, the commissioner has ability to issue the producer spouse an
To pay benefits to the corporation or other shareholders
A Business disability buy a plan policy is designed
Disability income
A CEO's personal assistant suffered injuries at home, and as a result, was unable to work for four months. Which type of policy will pay a monthly benefit to the personal assistant
Nonpayment
A Medicare supplement policy can be canceled by the insurer for
Monthly
According to the time payment of claims provision, the insurer must pay disability income benefits, no less frequently than which of the following options
Disability income
B is a teacher who was injured in a car accident and cannot work. She is now receiving monthly benefits as a result of this accident. Which type of policy does B have?
Dental, Vision, & other Prescription drugs
Common exclusions to the continuation of group coverage include
through the federal marketplace
Essential benefits without annual in lifetime limits are required on any health policy purchased
$10,000
If an insured receives a cash payment in excess of it must report this act as stated by the USA patriot act
Protect the producer
Illegal actions, provision of an insurance contract is designed to do all of the following, except
Foreign company
In Iowa, an insurer license to conduct business in Iowa, but domiciled in New Jersey is called
Business overhead expense
Which type of policy would pay an employee salary if the employer was injured in a bicycle accident and out of work for six weeks?
Health maintenance organizations
Which type of provider is known for stressing preventative medical care in routine physical examinations
3 years
how long does a business entity's license remain in effect
10 days
in Iowa monthly premium health insurance policies must provide a grace period of at least
Guaranteed
in Iowa, long-term care policy must be renewable
