Insurance: ALL chapters

Who issues Medigap policies?

Private insurers

How do insurers determine the cost for a group health policy?

The main variables are the ratio of men and women in the group, and the average of the group

How many members must an association have to qualify for group insurance?

100 members

noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective

100%

Who is considered a non resident agent?

An agent who resides and is license in another state, but who is authorized to transact in this state

If an insurer holds a Certificate of Authority, it is known as what type of insurer?

Authorized or admitted

All of the following are lines of insurance that may be transacted under a life and accident /health producer license EXCEPT

Consequential loss insurance

Which if the following best describes a misrepresentation

Issuing sales material with exaggerated statements about policy benefits

If an individual is covered by Medicare and is also covered by his employers health plan, which plan would be considered primary?

The employer plan

How many pints of blood will be paid for by Medicare supplements core benefits

The first 3 pints of blood

How does someone qualify for social security disability income benefits

The insureds must have the proper insured status, meet the definition of disability, and satisfy the waiting period

Who is responsible for the cost associated with the examination of insurers?

The insurer who is being examined

If another governmental agency takes legal action against a license, whose responsibility is it to report the action?

The licensee

According to the Coordination of Benefits provision, if both parents have coverage for a child from their employers' policies, which policy will pay first?

The order of payment will be determined by the birthday rule: the coverage of the parent whose birthday is earlier in the year will be considered the primary

What is a probationary period in group health insurance

The period of time that must lapse before an employee is eligible for group health coverage

All of the following statements about Medicare supplement insurance policies are correct EXCEPT

They cover the cost of extended nursing home care

What do long-term care policies offer to policyholders to account for inflation?

They offer the option of purchasing coverage that raises benefits levels accordingly

To whom may a certificate of authority be issued?

To an insurer authorized to transact business in this state

What is the purpose of Medicare supplement plans

To fill the gaps in Medicare coverage

What is the purpose of a cease and desist order?

To prevent a producer or insurer from further violating laws for transacting insurance

What type of misrepresentation persuades an insured, to his or her detriment, to cancel, lapse, or switch policies from one to another?

Twisting

If the insurer believes that inaccurate or misleading information was provided in the policy application it may contest a claim within how many years

2 years

Whenever the commissioner receives a demand for a hearing, a hearing shall be scheduled to be held within?

30 days

How many eligible employees must be included in a contributory plan?

75%

Individuals who itemize deductions can claim deductions for medical expenses not covered by health insurance that exceed what percent of their adjust gross income

10%

What is the required free look period for Medicare supplement policies?

30 days

Employers health plan must provide primary coverage for individuals with end stage renal disease before Medicare becomes primary for how many months?

30 months

How many parts does Medicare have?

4 (A,B,C,D)

How long does a temp producer license last

6 months

What are the most common penalties for violations of insurance statues?

A cease and desist order, a fine, and license suspension or revocation

Who is an insurance agent?

A person authorized to sell, solicit and negotiate insurance contracts

In health insurance, when would an excess plan pay benefits

After the primary plan has paid its full promised benefits, the excess plan will pay the balance

In which Medicare supplemental policies are the core benefits found?

All plans A-N

All of the following are lines of insurance that may be transacted under a life and accident /health producer license

Annuities, disability income insurance, and group health insurance

If an insurer meets the state's financial requirements and is approved to transact business in the state, it is considered what type of insurer?

Authorized and admitted

What type of licensee represents the insured?

Broker

How is Part B Medicare funded?

By monthly premiums and from the general revenues of the federal government

If the commissioner/superintendent finds a licensee engaging in an unfair method of competition or an unfair practice, what order will be issued?

Cease and desist order

What do individual insureds receive as proof of their group health coverage

Certificate of insurance

Forcing a client to buy insurance from a particular lender as a condition of granting a loan is defined as

Coercion

What are producers required to do in order to renew their license?

Complete continuing education hours and pay a renewal fee

If the insureds share in the cost of health insurance premium with the employer, this would be known as what type of group health plan?

Contributory

If a producer makes maliciously critical statements about another insurer, what is this illegal practice called?

Defamation

if an instance producer is to charge to the client a fee that is in addition to the commission for the sale of an insurance policy, there producer must

Disclose the fee to the client, in writing, and be agreed upon prior to the issuance of the policy

Two individuals who are in the same risk and age class are charged different rates for their insurance policies due to an insignificant factor. what is this called?

Discrimination

What types of groups are eligible for group health insurance?

Employer sponsored and associated sponsored groups

What benefits are provided by Medicare Part C?

Expanded benefits for a fee through private insurance programs such as HMO's or PPO's.

For what reason can a temp license be issued?

For contribution of business in case the licensed producer dies or becomes disabled

In group insurance, who is issued a certificate of insurance

Individual insured

All of the following are differences between induvial and group health insurance EXCEPT

Individuals insurance does not require medical examinations, while group insurance does require medical examinations

Medicare Part A will pay for what type of services?

Inpatient hospital care, skilled nursing facility care, home health care, and hospice care

In general, who can be excluded from producers licensing and examination requirements?

Insurance company officers, directors, or any other employees who do not transact insurance and who do not receive commissions for their services (usually their responsibilities include administrative, executive or clerical)

Applicants for which type of insurance license are exempt from Alabama prelicensing education requirements

Limited license

Which type of care is not covered by Medicare

Long term care

When compared with the administrative cost found in individual coverage, the per captia administrative cost in group health insurance is

Lower

Which of the following best described the unfair trade practice of defamation

Making derogatory oral statements about another insurers finical condition

In group insurance, what is the name of the policy

Master policy

What type of Medicare policy requires insureds to use specific health care providers and hospitals has restricted network provisions

Medicare SELCECT

Can Alzheimer's disease be excluded from coverage under a long-term care policy?

No, must be covered

Does group health insurance require medical examinations?

No, the underwriter evaluates the group as a whole, rather than each induvial member

Which renewal provision must be included in a long term care policy issued to an induvial

Noncancelable and guaranteed renewable

Who may share in the commission from the sale of a life insurance policy?

Only producers properly license for the type of insurance transactions

What part of Medicare is known as hospital insurance?

Part A

Who can usually be granted a temp license?

Producer's spouse or designee in case the licenses producer dies or becomes disabled

An agent offers a client free tickets to a sporting event in exchange for the purchase of an insurance policy. What is the agent guilty of?

Rebating

which of the following is NOT specially prohibited by state law as an unfair trade practice

Reducing the premiums paid by the employers for group insurance based on loss experience

What type of license represent the insurance company

The agent

In applying for an original certificate of authority, an insurer must submit an application with the approtiate fees and the following information EXCEPT

The amount of insurance it intends to write

What is a birthday rule in a coordination of benefits provisons?

The coverage of the parent whose birthday is earlier in the year is considered primary

Who must be notified of a producers change of address?

The department of insurance (commissioner)

An insured with Medicare part D has reached the initial benefits limit and must now pay a portion of prescriptions drug cost. What is the term for this hap in coverage

The donut hole

Who are the parties in a group health contract?

The employer and the insurer

If a group health policy covers individuals that reside in more than one state, which state has jurisdiction over the group policy?

The state in which the policy was delivered

What is the purpose of COBRA?

To allow continuation of health insurance coverage for terminated employees

What is the purpose of respite care in long term care insurance

To provide relief from a major caregiver (family member)

When is the initial enrollment period for Medicare part A?

When an individual first becomes eligible for Medicare, starting 3 months before turning age 65 and ending 3 months after the 65th birthday

When can the Commissioner or Director examine insurers?

Whenever deemed necessary, but at least once every few years (5)

Which of the following determines whether disability insurance benefits are taxed

Whether the premiums were tax deductible

At what age do individuals qualify for Medicare?

age 65

A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as

critical illness

Regarding long-term care coverage, as the elimination period gets shorter, the premium

gets higher

All of the following are activites of daily living EXCEPT

speaking

if seeking repayment of Medicaid funds per the Medicaid estate recovery act would cause a hardship to survivors, states may

waive the estate recovery requirement

Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days?

20 days

Which of the following coverages is NOT monitored by the employee retirement income security act

Golden parachutes

What is another name for Medicare supplement plan

Medigap

Which of the following is the term used when a person, in fiduciary position, has used funds in manner for which they were not intended such as the wrongful taking or use of money belonging to another

Misappropriation of funds

On it's advertisement, a company claims that is has funds in its possession that are, in fact, not available for the payment of losses or claims. what is the company guilty of?

Misrepresentation

What illegal act does a producer commit when the producer represents a policy in a more favorable light than the policy really is?

Misrepresentation

What are the activities of daily living

Mobility, bathing, dressing, eating, toileting, and continence

When must the outline of coverage be provided to the insureds?

No later than policy delivery

The classification small employer means any person actively engaged in a business that on at least 50% of its working days during the proceeding quarter employed

No more than 50 employees

What Medicare part helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care?

Part A

What Medicare part will cover lab services or diagnostic tests?

Part B

What part of Medicare is known as medical insurance?

Part B

Who is eligible for part B Medicare

Part B is optional, and is offered to everyone who enrolls in Part A

What is another name for Medicare advantage plans

Part C

What Medicare part provides a prescription drugs benefit?

Part D

Who qualifies for Medicare?

Persons 65 years or older, people with permanent kidney failure, person who has been on some social security program for at least 24 months

A long term care shopper guide must be presented at what point

Prior to the time of the application