Guarantee
Point of Service Plan
Hybrid of HMO & PPO w/ greater flexibility on choosing specialists outside network w/ benefits still provided but @ higher co-pay.
which of the following bets describes presumptive disability?
one that is severe enough that the insured automatically qualifies for full disability benefits
Carlos's health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. Carlos's policy provides benefits on a
scheduled basis
Notice of claim written notice has to be submitted to insurer in
20 days
a person received his medicare supplement policy and is not satisfied. how long does he have to return it after first look?
30 days
when an agent changes address of their resident or office, the insurance department must be notified within
30 days
An insured undergoes a minor surgical procedure. the insured owes the insured 500 in medical claims. however the last premium of 200 due was never paid. how much should the insured get in claims?
300
the Omnibus budget reconciliation act of 1990 requires that large group health plans (100 employees or more) must provide primary coverage for nonretired disabled people under the age of
65
Omnibus Budget Reconciliation Act (OBRA)
Federal law that regulates the education and testing of nursing assistants
which statement best described agreement as it relates to insurance contracts?
one party accepts the exact terms of the other party's offer
which of the following is Not a common exclusion found in most health policies
Dental procedure due to a birth defect
managed care plan
a type of health-care plan in which the insurance company contracts with specific doctors, hospitals, and other health-care providers to deliver medical services and preventive care to members at reduced cost
an underwriter is reviewing an applicant with an extensive medical history. which of the following would give the underwriter a better understanding of how the applicant has been treated
attending physicians statement
regarding health insurance, all of the following are tax0deductible EXCEPT
employee paid group disability income
regarding health insurance, all of the following are tax deducible except
employer paid group long term care
which of the following is NOT correct concerning taxation of a disability income benefit?
if paid by the individual , the premiums are tax deductible
coordination of benefits provision
in group health insurance is designed to prevent overinsurance and the duplication of benefits if one person is covered under more than one group health insurance plan
with a conditionally renewable policy, the premiums are more likely to be
increased
an insured's hospital states that it will pay him a flat fee of 75 per a day for each day he is hospitalized. the policy pays benefits on what basis?
indemnity
Insured's have the right to do which of the following if they have not received the proper claim forms within 15 days of their notice to the insurer of a coverage loss a major medical policy
submit the description in their own words on a plains sheet of paper
AD&D
Accidental Death and Dismemberment insurance. A limited form of Health insurance that covers accident only. It is the only type of Health insurance that covers death. AD&D policies do not follow the Principle of Indemnity, in that they pay in addition to any other coverage the insured has.
conditional receipt
In Life and Health insurance, a Conditional Receipt provides that if premium accompanies the application, coverage shall be in force from the date of application (whether the policy has yet been issued or not) provided the insurance company would have issued the coverage on the basis of facts as revealed by the application and other usual sources of underwriting information. Remember, there is never any coverage unless the premium has been paid!
an insurer can decide not to renew an optionally renewable policy
On premium due dates
When may HIV-related test results be provided to the MIB?
Only if the individual is not identified
A core Medicare supplement policy (Plan A) will cover all of the following expenses EXCEPT a) Part A deductible b) The first 3 pints of blood c) 20% if Part B coinsurance amounts for Medicare-approved services d) Part A coinsurance
Part A deductible
which of the following is NOT true regarding term health coverage
The owner may renew the policy for a specified term.
probationary period
The period of time between the effective date of a health insurance policy and the date coverage for all or certain conditions begins.
Time of payment of claims provision
monthly
on an accidental death and dismemberment (AD&D) policy, the death benefit payable is known as the
principle sum
an insured has a heart attack while jogging, but is expected to return to work in 6 weeks. the insured's disability income policy will
replace a % of his lost income
HMOs are known as what type of plan
service
a man is an attorney when he applies for a health policy. he decides to become a professional bungee jumper. he files a claim. what should happen
the insurance company will pay the claim according to the benefits available if the correct premium had been paid
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 PPC plan which of the following is true
the insured can select any specialist but non network specialists will have a higher out of pocket cost
Medicare is a health insurance program for all the following except
those with low income and low assets
if an application submits the initial premium with an application, which action constitutes acceptance?
underwriter approves the contract