Colorado A&H State Exam ONE

Who funds the Health Reimbursement Arrangement (HRA)?

Entirely funded by the employer

What may cause the Commissioner to issue an emergency cease and desist order without a hearing?

Fraudulent activity, endangering the public, selling insurance without a license

With Disability Income insurance, an insurance company may limit the monthly benefit amount a prospective policy holder may obtain because of the insured's

Gross income at the time of purchase

For which of the following expenses foes a Basic Hospital policy pay?

Hospital room and board

When may the Commissioner issue an emergency cease and desist order?

If there is suspicious of an unauthorized person engaging in insurance business without being licensed

Which of the following is NOT a required provision for an accident and health policy?

Insurance with other insurers

The primary difference between the Colorado Partnership LTC policy and other LTC policies is

Medicaid ASSET PROTECTION

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called

Noncancellable

Which of the following BEST describes a SHORT-TERM expense policy?

Nonrenewable

Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?

Obtain prior approval from the insurer for the medical service

Which of these is considered a mandatory of provision?

Payment of Claims

T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. When T submits a claim, his EMPLOYER'S plan is considered what type of carrier under the Model Group Coordination of Benefits provision?

Primary Carrier

The Legal Actions provision of an insurance contract is designed to do all of the following EXCEPT:

Protect the producer

K failed to pay a renewal premium within the time granted by the insurer (Grace period). K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?

Reinstatement

Which provision allows a portion of any used medical benefits to the restored following a particular amount of benefit has been used, or after the policy has been in effect for a particular period of time?

Restoration of used benefit

What is the intent of a Coinsurance clause in a Major Medical policy

discourages overutilization of the insurance coverage

Insurer

insurance company

incontestable

not able to be doubted or questioned

The benefits under a Disability Buy-Out policy are

payable to the company or another shareholder

Contract of Adhesion

the insured must accept the entire contract with all of its terms and conditions -"Take it or leave it" basis

Time Limit on Certain Defenses

- The policy is incontestable after it has been in force for a period of time. - 2 Years

What is Medicare?

A hospital and medical expense insurance program

Insured

A person covered by an insurance policy

Which of the following statements describe what an Accident and Health policyowner may NOT do?

Adjust the premium payments

What does Guaranteed Renewable Allow

Allows the insurer to change the premium rate for the overall risk class assigned.

Which of the following is NOT required to be disclosed to an applicant for health insurance?

Any contingent compensation received

The federal income tax treatment of employer-provided group Medical Expense insurance can be accurately described as:

Employee's premiums by the employer is deductible to the employer as a business expenditure.

P loses an arm in a farm accident and is paid $10,000 from his Accidental Death and Dismemberment policy. This benefit is known as the

Capital Sum

Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible?

Carryover provision

Waiver of Premium

Continuation of life insurance coverage if the insured becomes totally disabled and is unable to pay the premiums.

In the event of an illness, a(n) _______ _______ policy would reimburse an insured for loss of earnings.

Disability Income

What does the insuring clause identify?

The SPECIFIC type of health care SERVICES that are covered by that policy

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

The maximum amount considered eligible for reimbursement by an insurance company under a health plan

Essential Benefits without annual and lifetime limits are required on any health policy purchased

Through the Federal Marketplace

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is

Time Limit on Certain Defenses

What provision limits the time during which the insurance company may challenge the validity of an insurance claim on the basis of a misstatement made on the insured's application?

Time Limit on Certain Defenses

R becomes disabled and owns an individual Disability Income policy. When is R eligible to receive disability benefits?

Upon satisfying the elimination period requirement

Which of the following phrases refers to the fees charged by a healthcare professional?

Usual, customary, and reasonable expenses

The commissioner may issue an emergency cease and desist order without hearing for all of the following circumstances EXCEPT

Writing controlled business

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the POLICY will CONTINUE if he/she ever becomes totally disabled?

Waiver of Premium Rider

An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.

15 Days

When an employee's coverage terminates under a GROUP HEALTH POLICY, the employee must be offered continuation coverage for

18 Months

How long is the typical free look period for Long Term care insurance policies?

30 Days

An insurer that terminates a producer's appointment must inform the Commissioner within how many days?

30 days

S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations?

36 Months

V is insured under an individual Disability Income policy with a 30-day Elimination period. On July 1, he is involved in an accident and temporarily disabled. He returns to work on December 1. How many months of benefit are payable?

4 months

An underwriter determines that an applicant's risk should be RECATEGORIZED due to a health issue. This policy may be issued with a(n)

Exclusion for the medical condition

Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?

If the employee paid for a qualified medical expenses, the reimbursements may be tax-free

Legal Action provision

Insured can seek legal action against Insurer for denial of claim only after 60 days and up to 3 yrs. after providing proof of loss.

The Coordination of Benefit provision

PREVENTS an insured covered by TWO health plans from making a PROFIT on a covered loss

Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy?

Reimbursement

According the the affordable care act (ACA), a dependent child's eligibility status is determined by

age

Group health plans typically contain a coordination of benefits (COB) provision. This provision's purpose is to

avoid the duplication of benefit payments