life insurance life exam practice !

what is the typical maximum benefit offered by major medical plans ?

$ 1 million

US armed forces reservist called to active duty after august 21,1990 who where covered under a disability policy provided by their employers, have the right to reinstate such coverage upon release from active duty if they apply within how many days of discharge ?

90 days - If they apply within 90 days of discharged or one year after hospitalization continuing after discharged.

How is emergency care covered for a member of an HMO ?

A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area.

what is not utilized by an underwriter in order to underwrite an applicant ?

Birth certificate

the purpose of managed care health insurance plans is to ?

Control health insurance claims expenses.

in what case would an " any occupation " disability income policy pay the benefits ?

The insured's is unable to perform any job in the field related to the insured's education and experience.

The expense for an autopsy covered under the physical exam and autopsy provision is paid by ?

The insurer - where not forbidden by state law, the insurer, at its own expense, may cause an autopsy to be performed on a deceased insured.

Term health policy ?

it is nonrenewable - in term health policies the owner has no rights of renewal

what is the shortest possible elimination period for a group short term disability benefits provided by an employer ?

0 days - if an employer provides short - term disability for its employees, the elimination period can be nonexistent, and the benefits can last as long as two years. the benefit typically spans 70 to 80 % of the insured's income .

what is the elimination period for social security disability benefits ?

5 Months

one of the differences between group underwriting and individual underwriting is that there is little or no medical information required regarding plan participants in groups of ?

50 0r more - in groups of 50 or more, medical information cannot be required of pan participants.

most health insurance policies exclude the following ?

Accidental injury - injuries covered by workers compensation insurance, caused by war, or intentionally self - inflicted are among the exclusion found in major medical insurance policies.

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

Copayment - a copayment is a specific dollar amount of the cost of care that must be paid by the member.

which provisions is mandatory for health insurance policies ?

Physical examination and autopsy - physical examination and autopsy is a mandatory provision required by law.

what documents describes an insured's medical history, including diagnoses and treatments ?

Physician review - an attending physician's statement - APS - is the best way for an underwriter to evaluate an insured's medical history. the report includes past diagnoses, treatments, length recovery time, and prognoses.

If a firm has 30 employees that are actively engaged in business on at least 50% of its working days during the preceding calendar year, what is its classification ?

Small employer - classification rules established by the insurance code state that

A 60 year old participant in a 401 k plan takes a distribution and rolls it over to an IRA within 60 days. which of the following is true ?

The amount of the distribution is reduced by the amount of a 20% withholding tax.

an insurer wishes to compare the information given in an insurance application with previous insurance applications by the same applicant but for different companies. what organization can help the insurer accomplish this ?

The medical information bureau - Members of the medical information bureau - MIB - can request a report on an applicant and receive coded information from any other application for insurance submitted to other MIB members.

What is not true regarding policy loans ?

A policy loan may be repaired after the policy is surrendered. - Money borrowed from the cash value is not taxable. policy loans can be paid at any time, including surrender and death. an insurer can charge interest on outstanding policy loans.

who can make a fully deductible contribution to a traditional IRA ?

An individual not covered by an employer - sponsored plan who has earned income.

which of the following involves the use of medical information exchanged from one site to another vie electronic communications between a medical provider and a patient ?

Telemedicine - is the use of medical information exchanged from one site to another vie electric communications to provide clinical health care. telemedicine includes a growing variety of applications and services using two way video, email, smart phones, wireless tools and other forms of telecommunications technology.

An insurance company wants to obtain the insurance history of an applicant. which source releases coded information to insurers regarding information included on previous insurance applications ?

medical information bureau - The medical Information bureau receives information that an applicant provides in insurance applications and issues it in a coded format to insurers who request these reports. MIB information alone cannot be used to justify declining a risk but it is helpful in providing insurers with information.

What type of benefit will health insurance policy pay for injuries if it includes the narcotics and intoxicants provision ?

no benefits.

what is not true regarding about someone who is considered a standard risk ?

special restrictions on the policy are not necessary - The standard rating indicates that an individual represents a similar level of health and lifestyle quality as other members of the age cohort. these individuals do not need special policy restrictions or are not required to pay higher premiums.

Medicaid is sponsored by what kind of sources ?

state and federal

what is considered a presumptive disability under disability income policy ?

the loss of two limbs

on a disability income policy that contains the " own occupation " definition of total disability, the insured will be entitled to benefits if they cannot perform ?

their regular job - if a disability income policy contains the own occupation definition, then the insured will be considered disable if they cannot perform that particular job, regardless of other jobs that they may be able to do.

An employee quits her job where she has a balance of $10,000 in her qualified plan. The balance was paid out directly to the employee in order for her to move the funds to a new account. If she decides to rollover her plan to a traditional IRA, how much will she receive from the plan administrator and how long does she have to complete the tax - free rollover ?

$8,000 , 60 days - IRA rollovers must be completed within 60 days from the time the money is taken out of the first plan. if the distribution from the first plan is paid directly to the participant, 20% of the distribution must be withheld by the payor.

what is a blanket ?

A policy that covers all of the participants without naming them individually is a blanket policy

The main purpose of ERISA is to ensure that ?

Employees receive the pension and other benefits promised by their employers - erisa - employee retirement income security act of 1974 was enacted to ensure that employees receive the pension and other benefits promised by their employers.

what type of group ratings uses the actual experience of the group as a factor in developing the rates to be charged ?

Experiencing rating - the actual loss experience of the group, in part, determine the rates charged by the insurer.

which of the following terms is used to name the nontaxed return of unused premiums ?

Premium Return - The return of unused premiums is called a dividend. Dividends are not considered to be income for tax purposes, since they are the return of unused premiums.

what would a physician utilize if they wanted to know if a treatment is covered under an insured's plan and at what rate It will be paid ?

Prospective review - under the prospective review or precertification provision, the physician can submit claim information prior to providing treatment to know in advance if the procedure is covered under the insured's plan and at what rate it will be paid.

In a disability income policy, all of the following are considered presumptive disabilities except ?

loss of one eye - presumptive disability is usually a total loss of sight, speech, hearing or the use of any two limbs.

What is the penalty for IRA distribution that are below the required minimum for the year ?

50% - If there are no distributions at the required age, or if the distributions are not large enough, the penalty is 50% of the shortfall from the required annual amount.

health insurance can ?

it can help provide payments for loss of income.

what is a revocable beneficiary ?

revocable beneficiary - would be the policy owner and could make changes to the contract.

what is not the purpose of HIPAA ?

to provide immediate coverage to new employees who had been previously covered for 18 months.

what condition would a disability income policy most likely not require in order to qualify for benefits ?

a specific income status amount before the disability

in comparison to a policy that uses the accidental means definition, a policy that uses the accidental bodily injury definition would provide a coverage that is ?

broader in general - a policy that uses the accidental bodily injury definition will provide broader coverage than a policy that used the accidental means definition.

what process will the insurance company use the monitor the insured's hospital stay to make sure that everything is proceeding according to schedule ?

concurrent review - under the concurrent review process, the insurance company will monitor the insured's hospital stay to make sure that everything is proceeding according to schedule and that the insured will be released from the hospital planned.

what is Not true about group disability income insurance ?

coverage applies both on and off the job - employees who are injured on the job are covered by workers compensation insurance. group disability income insurance is designed to cover employees only while they are off the job.

If an IRA annuitant pays the entire fund's premiums before her death, what effect will this have on her estate when she dies ?

only partial value of the premiums will be included. - if a person dies after paying all IRA premiums, the entire value of the premiums and benefits would be included in the gross estate. if only part of the premiums were paid, the partially paid amount would be directed to the gross estate.

Under disability income policy, the insurer does not pay a monthly benefit that is equal to the insured's previous income. the reason for paying a benefit amount that is less than the insured's income is to ?

prevent overutilization and malingering - the insurer wants the insured to have a financial incentive to return to work.

every small employer carrier must actively offer to small employers at least how many health benefits plans?

2 plans.

what type of benefit helps pays for accidental injuries that are not severe enough to qualify as disabilities ?

Medical reimbursement - MRB help pay medical cost for accidental injuries that are not considered to be disabling.

in cases where a covered employee is eligible for Medicare benefits to treat end - stage renal disease - ESRD - with dialysis or kidney transplant, which of the following is correct ?

Medicare is the secondary payer during the first 30 months of treatment.

can an individual who belongs to a POS plan use an out - of - network physician ?

Yes - and they may use any preferred physician, even if not part of the HMO

the free - look provision allows for what ?

a right to return the policy for a full premium refund - the free look period is a mandatory provision found in health insurance policies that allows the applicant to examine the policy and if dissatisfied for any reason, return the policy for a full refund.

If a life insurance policy develops cash value faster then a seven- pay whole life contract is ?

An accelerated policy - any cash value life insurance policy that develops cash value faster then a seven - pay whole life contract is called a modified endowment contract. It loses the benefits of a standard life contract.