Final Practice for Health Exam
The beneficiary is then responsible for a portion of prescription drug costs
Once the initial benefit limit in Medicare Part D is reached, how is the beneficiary affected?
Prospective and concurrent review
Utilization management consists of an evaluation of the appropriateness, necessity and quality of health care and may include
10 days
What is the grace period for a monthly policy?
January 1 through March 31 each year
What is the time period for the general enrollment period for Medicare Part B?
All insureds under the policy
Which of the following insureds must be covered for maternity benefits under a group health policy?
Intermediate care
Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care>
Medicare Advantage Plans
Which of the following used to be called Medicare + Choice Plans?
A rate amendment is later made part of the original policy
Which of the following would be considered an example of incorporation by reference in insurance contracts?
20 days
Within how many days of the original hearing and financial issuance of an order (regarding an order issued by the Commissioner) may an aggrieved person request a re-hearing?
Alzheimer's disease
Long-term care insurance policies must cover which of the following?
Accidental Injury
Most health insurance policies exclude all of the following EXCEPT
$30,000
Policies that cover hospital expenses must provide at least how much coverage (per year) for hospital inpatient and outpatient treatment of kidney disease?
The insurer will return a percentage of the premiums paid.
Regarding the return of premium option for LTC policies, what happens to the premium if the policy lapses?
Received income tax free by the individual
The benefits in Medical Expense Insurance are
Insurers and their agents
The principle of immunity in cancellation or insurance policies applies to which of the following
Health Care Accounts and Dependent Care Accounts
What are the 2 types of Flexible Spending Accounts?
In franchise insurance underwriting is done for each person
What is the main difference between franchise and group insurance?
5 days
If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply? 5 days 7 days 10 days 3 days
An unfair trade practice
If an insurance company makes a statement that its policies are guaranteed by the existence of the Insurance Security Fund, that would be considered
Retention
If an insured purchases an insurance policy with a large deductible, what risk management technique is the insured exercising?
There are no restrictions on how the actual charges must resemble the estimate
If an insurer issues a good faith estimate
Must appear as a separate paragraph and be clearly labeled.
In a long-term care policy, pre-existing conditions limitations
Avoids unnecessary care
In dental insurance, "Predetermination of Benefits" or "Precertification" does which of the following?
Prior to the time of application
In the case of producer solicitation, at what point must a long-term care Shopper's Guide must be presented to the applicant?
Defined Benefit Plan
In which of the following qualified plans are the benefits linked to the employee's number of years of service and/or the amount of compensation earned?
60
An insurer decides to renew a life policy but at a higher premium rate, starting on the renewal date. How many days in advance must the insured be notified?
3 days
An insurer must notify the consumer in writing that an investigative consumer report has been requested, within how many days of the initial request?
90 days
An insurer plans to discontinue a specific type of group health insurance coverage. How much prior notice must the insurer give each employer and plan participant?
Apparant
Because an agent is using stationary with the logo of an insurance company, applicants for insurance assume that the agent is authorized to transact on behalf of that insurer. What type of agent authority does this describe?
Darryl's loss of income
Darryl is involved in an automobile accident with another motorist. Darryl was at fault. Darryl was injured and hospitalized for 2 months. The other motorist suffered $15,000 of medical expense as a result of the accident. Darryl's disability income policy will pay
180 days
How many days after passing their state examination does an applicant have to apply for a license?
60 days
A policy is issued for an indefinite term. If the insurer decides to cancel the policy on its anniversary date, how much notice must the policyowner be given?
Cost of Living Adjustment Rider (COLA)
After a year of receiving disability income benefits, the insured notices that her monthly benefit has increased slightly. Which rider does the policy most likely have that would cause this?
Both group and individual plans are renewable
All of the following apply to short-term disability plans EXCEPT
Coverage applies both on and off the job
All of the following are true about group disability income insurance EXCEPT
Reports may be sent to anyone who requests one
All of the following are true regarding the federal Fair Credit Reporting Act EXCEPT a)the customer must be notified if adverse action is taken as a result of a report b)reports must be sent to anyone who requests them c)insurers are not required to give customers a copy of the report d)it applies to credit reports ordered in connection with insurance, banking, and employment
An association of 35 people
All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT
SIS rider
An individual was denied coverage under Social Security because his disability did not meet the strict definition of total disability used by SS. Which of the following would provide disability income coverage?
Fee for service
An insured has a routine exam, blood work, and a follow-up appointment with a specialist. The insured receives a bill for each service provided. What type of plan does the insured have?
They cover the cost of extended nursing home care
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
Always representing the insured
An agent is acting ethically in all of the following situations EXCEPT
Medicare and Medigap policies provide coverage for long-term custodial or nursing home care
Which of the following is INCORRECT? a)medicare and medigap policies provide coverage for long-term custodial or nursing home care b)m and m supplements does not cover skilled nursing care c)medicaid does not pay for nursing home care in any case d)m and m policies do not provide coverage for long-term custodial or nursing home care
Contracting with insurance companies
Which of the following is NOT a characteristic or service of an HMO plan? a)contracting with insurance companies b)providing free annual checkups c)encouraging early treatment d)providing care on an outpatient basis
Dental procedure due to birth defect
Which of the following is NOT a common exclusion found in most health policies?
The insurer can increase the policy premium on an individual basis
Which of the following is NOT a feature of a guaranteed renewable provision?
Child day care
Which of the following is NOT a typical type of Long-Term Care coverage?
Skilled care
Which of the following is a daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician?
Premiums are tax deductible and benefits are not taxed
Which of the following is correct regarding the taxation of group medical expense premiums and benefits?
The advertisement must include an outline of coverage
Which of the following is true regarding an advertisement that includes an invitation to apply for a specific individual policy?
Continuation provision
Which of the following provisions must be included on the first page of a Medicare supplement policy, which states the insurer's right to change premium amounts?
They are temporary insuring aggreements
Which of the following statements regarding conditional receipts is true?
