Exam FX Iowa Accident & Health or Sickness

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Under the mandatory uniform provision Notice of Claim, written notice of a claim must be submitted to the insurer within what time parameters

20 days

policy holder have to return medicare supplement

30 days

a disability income policy has a waiting period of 7 days. if the insured is disabled for 15 days, how many days of benefits will the policy pay

8 days

which federal act defines rules pertaining to protected health information

HIPAA

according to the fair credit reporting act, all of the following statements are true except

If an applicant is declined for an insurance policy, he or she has no right to know what was in the report

An applicant gives her agent a completed application and the initial premium. What can the agent issue her that acknowledges the initial premium payment?

conditional receipt

the purpose of fair credit reporting act is to

protect consumers against the circulation of inaccurate or obsolete personal or financial information

purpose of hipiowa

provide health insurance to individuals who have been denied coverage

an insured had a heart attack while jogging, but is expected to return to work in approximately 6 weeks. the insureds disability income policy will

replace a percentage of his lost income

a hospital indemnity policy will pay

a benefit for each day the insured is in a hospital

a notice regarding replacement of medicare supplement coverage must be signed by

agent and applicant

insurance companies must be members of the Iowa individual health benefit reinsurance association

all capital stock insurance companies authorized to transact casualty insurance in Iowa

in which medicare supplemental policies are the core benefits found

all plans

with respect to the entire contract clause in health policies, who has the authority to make changes to an existing policy

only an executive officer of the company

insurance contracts are unilateral in nature. what does that mean?

only one party makes a promise

all of the following are true regarding key person disability income insurance except

premiums are tax deductible as a business expense

on an accidental death and dismemberment policy, the death benefit payable is known as the

principal sum

used to define any person, firm, or corporation appointed by an insurer that possesses the authority to transact insurance

producer

an insured purchased a health insurance policy with a renewability clause that states the policy is guaranteed renewable. this means that as long as the required premiums are paid, the policy will continue until the insured

reaches 65

An employee is covered under COBRA. His previous premium payment was $100 per month. His employer now collects $102 each month. Why does the employer collect an extra $2?

to cover the employers administration cost

Elaine's basic hospital expense policy has a $500 per day limit for room and board in a hospital with a max of 5 days. Elaine got sick and had to spend 3 days in the hospital at $650 a day. How much will elaine have to pay to cover the rest of her room and board charges?

$450

Core benefits are included in all Medicare supplemental policies. What percentage of Part B coinsurance is required?

20%

A long-term care insurance policy shall provide coverage for at least

24

in Iowa to be marketed as long term care the policy must cover

24 months

within how many days of requesting an investigative consumer report must an insurer notify the consumer in writing that the report will be obtained

3 days

how soon after the receipt of a properly complete claim form and proof of loss must a health insurance company accept and pay or dent a claim

30 days

if a producer changes his address, the commissioner must be notified within

30 days

if the commissioner receives a certificate of noncompliance from the child support recovery unit the producer will have his or her license suspended for how many days

30 days

period coverage for events such as death or divorce under cobra

36 months

which of the following statements is not true regarding health insurance policy provisions

All additional provisions written by insurers are cataloged by their respective states

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

attending physician

document describes an insureds medical history

attending physicians statement

accidental death and dismemberment policy loses her left arm

capital amount in lump sum

an order issued by the commissioner that required someone to stop engaging in unfair method of competiton or an unfair deceptive act

cease and desist order

a leader who conditions approval of a loan on the condition that the borrower purchase insurance from that lender may be guilty of

coercion

An applicant for an individual health policy failed to complete the application properly before being able to complete the application and pay the initial premium she is confined to a hospital this will not be covered by the insurance because she has not met conditions specified in the

consideration clause

which of the following includes information regarding a persons credit, character, reputation, and habits.

consumer report

which of the following reports will provide the underwriter with the information about insurance applicants credit

consumer report

medicare supplement may

contain pre existing condition limitations

which of the following is not an exclusion in medical expense insurance policies

coverage for dependents

which is not true regarding basic surgical expense coverage

coverage is unlimited

which of the following programs expands individual public assistance programs for people with insufficient income

medicaid

all of the following statements concerning medicaid are correct except

medicaid is a state funded program that provides health care to persons over age 65 only

long term partnership creates partnerships with

medicaid recipients

all of the following are excluded from coverage in an individual health insurance policy except

mental illness

which of the following is not a mandatory health insurance provision

misstatement of age

in health insurance, the length of the grace period varies according to the

mode of premium payment

premium payments for personally owned disability income policies

not tax deductible

which provision concerns the insureds duty to provide the insurer with reasonable notice in the event of a loss

notice of claim

Hospital indemnity/hospital confinement indemnity policy provides payment based only on

number of days confined in a hospital

all of the following are the most common variations in a long-term care policy except

number of family dependents

In long-term care insurance, what type of care is provided with intermediate care?

occasional nursing or rehabilitative care

A brain surgeon has an accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for losses

own occupation - less

which of the following cases would a credit disability policy be issued

if an individual is in debt to a specific creditor, payments will be made for him/her until the return of work

which of the following is not correct concerning taxation of disability income benefits?

if paid by the individual, the premiums are tax deductible

which of the following riders would not increase the premium

impairment rider

locations would skilled care most likely be provided

in an institutional setting

elimination period gets shorter, the premium

increases

underwriting a group health insurance plan that is paid for by the employer requires all of the following except

individual members may select the level of benefits for their own coverage

policy owner names his 5 children

remaining 4 primary

an application for a disability insurance policy has a heart condition of which they are unaware and therefore they answer no to the questions

representation

A stop-loss feature in a major medical policy is intended to

Establish a maximum amount of out-of-pocket expense that an insured will have to pay for medical expense in a calendar year

which of the following was designed to investigate and collect evidence relating to insurance fraud

insurance fraud bureau

all of the following must sign an application for health insurance except

insurer

legally bind coverage

insurer

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

which of the following beneficiary designations cannot be changed by an insured without first receiving the consent of the beneficiary

irrevocable

a fraternal benefit society

is operated for the benefit of its members

a guaranteed renewable disability insurance policy

is renewable at the insured option to a specified age

After a hearing, if the Commissioner finds that a producer is in violation of unfair business practices, his or her initial action will be to

issue a cease and desist order

not a benefit of POS plan

it allows guaranteed acceptance of all applicants

Which of the following statements is not correct concerning the COBRA ACT of 1985?

it requires all employers, regardless of the number or age of employees, to provide extended group health coverage

which of the following time periods is the general enrollment period for Medicare Part B

jan 1 - march 31

in a group health policy, a probationary period is intended for people who

join the group after the effective date

an agreement that is enforceable by law is known as what kind of contract

legal

provision which prevents the insured from bringing any legal action against the company for 60 days

legal action

Under workers compensation, which of the following benefits are NOT included?

legal benefits

which of the following does the insuring clause not specify

list of available doctors

which of the following terms relates to disability income insurance

residual benefits

An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?

revocable

Under the Payment of Claims provision, to whom will the insured's benefits be paid if the insured is deceased?

the insureds primary beneficiary's

which of the following is not a feature of a guaranteed renewable provision

the insurer can increase the policy premium on an individual basis

which of the following is not a feature of a noncancellable policy

the insurer may terminate the contract only at renewal for certain conditions

the insuring clause of a disability policy usually states all of the following except

the method of premium payment

An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action?

the old policy should stay in force until the new policy is issued

which is not a requirement for a partnership qualified LTC policy

the policy must have been issued before jan 1, 2010

A policy with a 31- day grace period implies

The policy will not lapse for 31 days if the premium is not paid when due

when health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost it is called

PPO

Medicare Part d provides

Prescription drug benefit

federal fair credit reporting act

Regulates consumer reports

what does the application of contract of adhesion mean

Since the insured doesn't participate in preparing the contract, and ambiguities would be resolved in favor of the insured

all of the following are correct about the required provisions of a health insurance policy except

a reinstated policy that provides immediate coverage for illness

the benefits for group disability plans are based on

a percentage of the workers income

not true regarding partial disability

form of insurance that covers part-time workers

what phase begins after a new policy is delivered

free-look period

experiencing at least one year of disability

fully insured status

the guaranteed purchase option is also referred to as the

future increase option

true of PPO

goal to channel patients to providers that discount services

most LTC plans have which of the following features

guaranteed renewability

following types of LTC care is not provided in an institutional setting

home health

if an insured is injured while committing an illegal act and the insured's health policy contains the illegal occupation provision, what percentage of the claim will be paid

0%

after hearing a civil penalties imposed by the commissioner for each unfair method of competition may not exceed

1,000

pays $100 monthly

10 day grace period

commissioner believes an individuals unfair trade practice the hearing may be no sooner then

10 days

max fine for cease and desist order

10,000

group nonprofit

1000

how many consecutive months of coverage

12 months

how long must producer maintain records of completing continuing education

4 years

If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?

5 days

how often do commissioner of insurance required to examine

5 years

if producer knowingly violates an insurance law, the producer may be fined up to what amount per violation

5,000

If a producer knowingly violates the insurance code the maximum aggregate penalty cannot exceed

50,000 in 6 month

which of the following best defines the probationary period in group health policies

A specified period of time that a person joining a group has to wait before becoming eligible for coverage

the corridor deductible applies between

Basic and major medical coverage

under the individual health insurance reform act who is responsible for establishing the rule for renewing health insurance policy

Iowa individual health benefit reinsurance association

not correct regarding medicare

Medicare Advantage must be provided through HMO's

what is the primary difference between medigap and medicare select policies

Medicare select policies contain restricted network provisions

an example of an alien insurer doing business in this state is one formed under the laws of

Mexico

in health insurance what is coinsurance?

a percentage of the cost of service that the insured and the insurer share

what is the purpose of a benefit schedule

To state what and how much is covered in the plan

following is a feature of a disability buyout plan

a lump sum benefit payment option

take it or leave it basis are classified as

adhesion contracts

another term for authorized user

admitted

Which of the following long term care benefits would provide coverage for functionally impaired adults on a less than 24 hour basis

adult day care

Group health insurance is characterized by all of the following EXCEPT?

adverse selection

all of the following would be considered rebating except

an agent misrepresents policy benefits to convince a policy owner to replace policies

disability income coverage specifies that the policy covers the insured if he is unable

any occupation more

not the consideration in a policy

application given to prospective insured

in a replacement situation, all of the following must be considered except

assets

skilled nursing care provided under home health care coverage must

be ordered by a license physical

which of the following statements regarding business overhead expense policies is not true

benefits are usually limited to six months

which of the following meets the insureds personal needs, and is provided by a nonmedical personnel

custodial care

A waiver of premium provision may be included with which kind of health insurance policy

disability income

which of the following is considered a qualifying event under COBRA

divorce

who can provide skilled nursing care

doctor

Which of the following best describes the aleatory nature of an insurance contract?A. Ambiguities are interpreted in favor of the insured

exchange of unequal values

items stipulated in the contract that the insurer will not provide coverage are found in the

exclusions

in iowa, the individual health insurance reform act was enacted to promote

fair access to health insurance plans

which of the following is consideration on the part of an insurer

paying the claim

prevent insurance company from paying a reimbursement

payment of claims

regarding the PPACA health tax credit, which of the following is true

person receiving medicaid are not eligible

a guaranteed renewable health insurance policy allows the

policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class

in group insurance, the primary purpose of the coordination of benefits provision is to

prevent overinsurance

A Medicare SELECT policy does all of the following EXCEPT?

prohibit payment for regularly covered services if provided by non network providers

insurers may change which of the following on a guaranteed renewable health insurance policy

rates by class

An insured, who is 44 years old, falls while mountain climbing on vacation. He is left paralyzed. After a year, doctors feel he will never recover from his injuries. From which of the following programs will he be able to collect disability income?

social security

a provision found in insurance policies which prevents the insured from collecting twice

subrogation

the transfer of an insureds right to seek damages from a negligent party to the insurer is found in which of the following clauses

subrogation

which of the following statements concerning group health insurance is correct

the employer is the policy holder

which of the following is true regarding optional benefits with long term care policies

they are available got additional premiums

notifies a company he is disabled, claims must be paid immediately

time of payment of claims

according to the rights of renewability rider for cancelable policies, all of the following are correct about the cancellation of an individual insurance policy except.

unearned premiums are retained by the insurance company

if one party to an insurance contract has made a legally enforceable promise what kind of contract

unilateral

a medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic are is known as

usual, customary, and reasonable

according to the time limit on certain defenses provision, statements or misstatements made in the application at the time of issue cannot be used to deny a claim after the policy has been in force for a minimum of how many years

2 years

all of the following could qualify as a group for the purpose of purchasing group health insurance except

an association of 35

the benefits from business overhead expense insurance policy

are limited to covered expenses and are taxable to the business

a long-term care policy, certificate or rider may provide coverage to an insured on any of the following bases except

deferred

a medicare supplement policy cannot

duplicate benefits provided by medicare

what advantage does the recurrent disability provision provide to the insured under a disability income policy

eliminates the imposition of a second elimination period for the same disability

An insurer incorporated under the laws of the state in which it is operating is considered to be a(n):

foreign

the commissioner is appointed to a 4 year term by the

governor

an insured has an individual disability income policy with a 30 day elimination period. he becomes disabled on June 1 for 15 days. when will he collect his disability income payments

he won't collect anything

following a covered loss, the time payment of claims provision requires that an insurance company pay disability income benefits no less frequently than

monthly

Among people in the same class and life expectancy, which of the following factors can be used to influence premium rates?

occupation

all individual and group health insurance policies in this state must provide coverage for low dose screening mammograms for deterring the presence of breast cancer. how much for women over 50

one annual mammogram

The legal process that gives the insurer, after payment of a loss, the right to seek recovery from a third party that was responsible for the loss is known as

subrogation

all of the following would be classified as limited insurance coverage except

supplement social security coverage

what organization protects insureds against failure to perform contractual obligations due to impairment or insolvency of an insurer

the Iowa life and health guaranty association

under a debtor group insurance policy, who must be the beneficiary of proceeds

the creditor

an employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. this results in a long hospitalization period. which of the following is true

the group plan will not pay because the employee was injured at work

all of the following are characteristics of group health plans except

the parties that hold a group health insurance contract are the employees and the employer

With regard to labor unions group, which of the following statements are not correct

the premium can be paid solely from insureds fund

what is the purpose of the impairment rider in a health insurance policy

to exclude coverage for a specific impairment

premiums are paid by self employed sole proprietors or partners for medical expense insurance are

totally tax deductible

which of the following services will not be provided by an HMO

unlimited coverage for treatment for drug rehabilitation

an employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA

within 60 days

if a premium is required to provide coverage for a newly born child how many days

60 days

in order to maintain coverage under COBRA, how soon from termination of employment must an employee exercise extension of benefits

60 days

Under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss?

90 days

An applicant misstates his age on his app for a health insurance policy. He states that that he is 39, but is actually 49. When he files a cliam, what most likely will happen?

Benefits paid will be those that would have been purchased at the correct age

An insured is anxious to get treatment for a health condition, and is convinced that a specialist is needed to cure the condition. If the insured has a PPO plan, which of the following is true?

The insured can select any specialist, but non-network specialist will have higher out of pocket costs

regarding consideration clause, which of the following is not correct

consideration of the insurer and insured must be equal

what is the purpose of the gatekeeper in an HMO

control cost

to be valid, an insurance policy must have all of the following except

countersignature

which of the following is not true regarding a noncancellable policy

insurer can increase the premium above what is stated in the policy if claims experience is greater than expected

any provision for long term care established by the Iowa department of insurance cannot be

less favorable

a health policy providing for third party or repayment of health or medical expenses will not provide coverage for benefits for the costs associated with diabetic

low carb foods

which of the following would not be considered a limited coverage policy

major medical expense insurance


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