Final Exam 1 Iowa Accident and Health

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Guaranteed renewable

What is the required renewability status of all Medicare supplement policies?

Irrevocable beneficiary

What kind of accidental death and dismemberment insurance beneficiary requires his/her consent want to change of beneficiary is made

Waiver of premium rider

What type of writer would be added to an accident and health policy if the policy owner wants to ensure the policy will continue if he/she ever becomes totally disabled

Income

When determining the monthly benefit amount for a disability income policy, the factor that limits the amount of prospective insured may purchase is

Insuring clause

Which health policy clause specifies the amount of benefits to be paid

Entire contract

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract

Single premium

Which mode of payment is not used by health insurance policies

Contract

Which of the following consist of an offer acceptance and consideration

probationary Period.

Which of the following is considered to be the time period After health policy is issued, during which no benefits are provided for illness.

Exclusions

Which of the following is not included in the policy face

Usual, customary, and reasonable expenses

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

and insured must wait at least 60 days after proof of loss has been submitted before a lawsuit can be filed

Which of the following statements best describes what the legal actions provision of an accident and health policy requires

They are nonprofit organizations

Which of the following statements is true about most Blue Cross/Blue Shield organizations

Business owner becomes disabled

Which of these circumstances is a Business disability buy sell policy designed to help in the sale of business

Wavior or premium

the provision in a health insurance policy that suspends premiums being paid to the insurer while the insured is disabled is called the

from the date that the policy was issued

under an individual health insurance policy, the time limit of certain defenses provision states that nonfraudulent misstatements first become incontestable two year

6

waiting period for a pre-existing conditions on Medicare supplement policies is ___ months

Is owned exclusively by its policy owner

A stock insurance company

Misrepresentation

Convincing a prospective insured to buy land insurance policy based on exaggerations is called

Major medical with basic hospital/surgical coverage

Comprehensive major medical policy is usually combined

Probability of making timely, premium payments

Consumer reports requested by an underwriter during the application process of health insurance policy can be used to determine

PPOs are not a type of managed care systems

Which of these statements is incorrect regarding a preferred provider organization

Testing positive for marijuana use from a previous screening

Which of these was the medical information bureau identify

Offering payment of approved claims within 30 days after affirming liability

Which of these would not be an unfair claims practice

Warranty

Which parts of health insurance policies are guaranteed to be true

the employer receives the policy and each employee issued a certificate

Which statement is true regarding a group accident & health policy issued to an employer

2

what is the maximum number of activities of daily living and insured must be unable to perform to qualify for long-term care benefits

Outline

when Medicare supplement policy is delivered, disclosure, standards require that an of coverage be provided to the insured

Prospective review

which of the following involves analyzing a case before admission to determine what type of treatment is necessary

Premiums normally increase at time of renewal

which of the following statements about a guaranteed renewable health insurance policy is correct

An insurer exaggerating, its dividends in a magazine advertisement

An example of false advertising would be

after an insured has become totally disabled as defined in the policy

And half insurance policies, a waiver of premium provision keeps the coverage in force without premium payments

Rights primarily controlled business

Are producers license may be suspended or revoked, if the licensee

Monthly

Periodic health claim payment must be made at least

unilateral

in an insurance contract the insurer is the only party who makes a legally enforceable promise. What kind of contract is this?

68-year-old male covered by Medicare

Set individual most likely to buy a Medicare supplement policy would be in

experimental and investigative services

A comprehensive major medical health insurance policy contains an eligible expenses provision, which identifies the type of healthcare services that are covered. All of the following healthcare services are typically covered, except for.

Time deductible

A disability elimination period is best described as a

Irrevocable

A policy owner would like to change the beneficiary on an accidental death and dismemberment insurance policy and make the change permanent. Which type of designation would fulfill this need

10

Before holding a hearing regarding a producers, unfair or deceptive practice, the commissioner must give how many days notice

Be established by the employer

In order to establish a health reimbursement arrangement, it must

3

Iowa requires that an insurance producer must complete hours of continuing education on the subject of law and ethics every reporting period

Twisting

Jay is a producer who has induced and insured through misrepresentation to surrender an existing insurance policy. What is Jay guilty of

Internal Limit

Jay was reviewing her health insurance policy and noticed the phrase " this policy will only pay for a semi private room" this phrase is considered to be an

Unilateral Contracts

Life and health insurance policies are:

15

Once the insurance company receives a notice of claim they have _ days to send the claim form

Closely regulated and requires full disclosure

One definition of replacement is " the act of replacing an existing insurance policy with another" replacement is

P only

P & Q are married and have three children. P is the primary beneficiary on Qs accidental death and dismemberment policy, and Qs sister R is the contingent beneficiary. P & Q & R are involved in a car accident and Q & R are killed instantly. The accidental death benefits will be paid to.

Claim will be denied

P is a major medical policy owner, who is hospitalized as a result of injury, sustained from practicing in car jacking. How will the insurer most likely handle this claim?

Insuring clause

The clause in an accident and health policy, which defines the benefit amounts the insurer will pay is called the

10

The free locked. And Iowa for individual health insurance policies is __ days.

6 months

The maximum time period that pre-existing conditions can be excluded in long-term care policies is.

notify an insurer of a claim within a specified time

The notice of claims provision requires a policy owner to

Payment of claims

The provision that defines to whom the insurer will pay benefits to is called

Exclusions

The sections of an insurance contract which limit coverage are called

May cancel the policy for nonpayment only

Under a guaranteed renewable health insurance policy, the insurer

26

Under the affordable care act, health coverage is provided for dependents up to the age of

A hospital and medical expense insurance program

What is Medicare?

Promise to pay the death benefit to a named beneficiary

What is the consideration given by an insurer in the consideration clause of a life policy?

Insured must be under a physicians care

What is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision?

Application containing statements from the insured

What is the initial source of underwriting for an insurance policy?

12 months

What is the maximum benefit. That must be offered by a long-term care policy

Losses result from accidental injuries

insured losses are covered immediately after a health policy is reinstated when

Beneficiary

Who is not required to sign a health insurance application?

Insuring clause

which of the following health insurance policy provisions specifies the healthcare services a policy will provide

Substandard applicants are never decline by underwriters

which of the following statements about the classification of applicants is incorrect?

Statements and representations on the application are part of the consideration for issuing a policy

why must an accident and health insurance Applicant answer all questions on the application

The insurer will adjust the benefit to what the premiums paid would have purchased at the insureds actual age

Jay, an accidental death and dismemberment policy holder, dies after injury, sustained in an accident. Jay's age, as stated on the application five years ago, was found to be understated by 10 years which of the following actions will the insurance company take

Guaranteed renewable

Long-term care policies issued in Iowa must be

free lock period has expired.

M completes an application for health insurance, but does not pay the initial premium. All of these actions must occur before Ms policy goes into effect, except

Available to those who are enrolled in Medicare, part a and part B

Medicare part C is

Upon satisfying the elimination period requirement

R becomes disabled, and owns an individual disability income policy. When is R eligible to receive disability benefits

Time limit on certain defenses

T files a claim on his accident and health policy after being treated for an illness. The insurance company believes that tea misrepresented his actual health on the initial insurance application and is, therefore, disputing the claims validity. The provision that limits the time period during which the company may dispute a claims validity is called.

Immediately

T send proof of loss to her insured for an acceptable medical expense claim under her individual health insurance policy. Upon receipt, the insurer must pay the benefits.

Conservation

T the producer is trying to dissuade a policy owner from replacing an existing insurance policy. This action take by T is called

Guaranteed renewable

Which type of renewability best describes a disability income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class

Misrepresentation

Which unfair trade practice involves a producer suggesting that an insurance policy is like a share of stock?

Gross income at the time of purchase

With disability income insurance, and insurance company may limit the monthly benefit amount of prospective policyholder may obtain because of the insured

30

Within how many days must a licensee notify the insurance division of change in address?

100%

XYZ company pays the entire premium for its group health plan. The maximum percentage of eligible employees that must be covered is

31 days

according to the mandatory uniform policy provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?

Assignment

an ___ of benefits of health policy transfers payments to someone other than the policy owner

20

an insured must notify and insurer of medical claim within days after an accident

$1000

an unintentional violation of Iowa insurance, so I could lead a producer to a fine of up to ___ per violation

Temporary insurance license

b the producer has died and leaves behind a spouse. In order for bs clients to continue being serviced, the commissioner has ability to issue the producer spouse an

To pay benefits to the corporation or other shareholders

A Business disability buy a plan policy is designed

Disability income

A CEO's personal assistant suffered injuries at home, and as a result, was unable to work for four months. Which type of policy will pay a monthly benefit to the personal assistant

Nonpayment

A Medicare supplement policy can be canceled by the insurer for

Monthly

According to the time payment of claims provision, the insurer must pay disability income benefits, no less frequently than which of the following options

Disability income

B is a teacher who was injured in a car accident and cannot work. She is now receiving monthly benefits as a result of this accident. Which type of policy does B have?

Dental, Vision, & other Prescription drugs

Common exclusions to the continuation of group coverage include

through the federal marketplace

Essential benefits without annual in lifetime limits are required on any health policy purchased

$10,000

If an insured receives a cash payment in excess of it must report this act as stated by the USA patriot act

Protect the producer

Illegal actions, provision of an insurance contract is designed to do all of the following, except

Foreign company

In Iowa, an insurer license to conduct business in Iowa, but domiciled in New Jersey is called

Business overhead expense

Which type of policy would pay an employee salary if the employer was injured in a bicycle accident and out of work for six weeks?

Health maintenance organizations

Which type of provider is known for stressing preventative medical care in routine physical examinations

3 years

how long does a business entity's license remain in effect

10 days

in Iowa monthly premium health insurance policies must provide a grace period of at least

Guaranteed

in Iowa, long-term care policy must be renewable


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