HL 2

What is the maximum period that an insurer would pay benefits in accordance with an Additional Monthly Benefit rider?

1 year

An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?

102

HIPAA applies to groups of

2 or more

Under which condition would an employee's group medical benefits be exempt from income taxes?

An employee's group medical benefits are generally exempt from taxation as income.

Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?

Attending Physician

What document describes an insured's medical history, including diagnoses and treatments?

Attending Physicians statement

A health insurance plan that covers all accidents and sicknesses that are not specifically excluded from the policy is referred to as a

Comprehensive plan

If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 31 days?

Conversion

Which of the following is the term for the specific dollar amount that must be paid by an HIC member for a service?

Copayment

A policy which covers medical costs related to a specific condition is called a

Dread Disease Policy

An association could buy group insurance for its members if it meets all of the following requirements EXCEPT

Has at least 50 members

In long-term care (LTC) policies, as the benefit period lengthens, the premium

Increases

Which insurance principle states that if a policy allows for greater compensation than the financial loss incurred, the insured may only receive benefits for the amount lost?

Indemnity

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the

Insuring clause

Under the Fair Credit Reporting Act, individuals rejected for insurance due to information contained in a consumer report

Must be informed of the source of the report

Which of the following factors would be an underwriting consideration for a small employer carrier?

Percentage of participation

Which of the following provisions is mandatory for health insurance policies?

Physical examination and autopsy

In Medicare prescription drug plans, step therapy refers to

Prior authorization

Under the Fair Credit Reporting Act, if the consumer challenges the accuracy of the information contained in his or her report, the reporting agency must

Respond to the consumer's complaint

When an employee covered under a health reimbursement account changes employers, the HRA

Stays with the employer

Which of the following entities established the Do-Not-Call Registry?

The Federal Trade Commission

Which of the following is true about the requirements regarding HIV exams?

The applicant must give prior informed written consent.

If a telemarketer wants to make an unsolicited sales call to a potential customer, what is the earliest time the telemarketer can call the prospect's residence?

8 AM

All of the following would fall under the definition of Durable Medical Equipment EXCEPT

Hospital Blankets

What is the elimination period for Social Security disability benefits?

5 months

What is the maximum amount that can be contributed to an MSA of the high-deductible plan for individuals?

65%

An insured's health claim internal appeal was denied. The insurer must do all of the following EXCEPT

Offer a payment plan

An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do?

Offer the supplement policy on a guarantee basis

When an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called

Overinsurance

A participating insurance policy may do which of the following?

Pay dividends to the policyowner

Which of the following is an example of a peril covered in an accident and health insurance policy?

Sickness

The insuring clause of a disability policy usually states all of the following EXCEPT

The method of premium payment

Regarding Medicare SELECT policies, what are restricted network provisions?

They condition the payment of benefits

When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees

To renew the policy until the insured has reached age 65

How often must a specialty health care insurer provide current company information, providers list, methods of operation and other reports to its insured?

Biennially

A small business owner is the insured under a disability policy that funds a buy-sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following?

Cash to the owner's business partner to accomplish a buyout

An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement?

Cost-Containment