Health insurance
The "stop loss" feature on 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
In which of the following scenarios would a producer be allowed to obtain insurance through an unauthorized insurer?
If there are no authorized insurers for a specific type of coverage in this state
With a conditionally renewable policy, the premiums are more likely to be
Increased
Under what conditions may a small employer insurer deny coverage to certain individuals in the group?
Late enrollees
Which of the following used to be called Medicare + choice plans
Medicare advantage plans
Which statement best describes "agreement" as it relates to insurance contracts?
One party accepts the exact terms of the other party's offer
Regarding the PPACA health care tax credit, which of the following is true?
Persons receiving medicaid are not eligible
Paula applied for a Medicare supplement policy 1 month before her 65th birthday. The policy was issued on her birthday, Jan. 31, 1998. Her producer mailed the policy by certified mail, and Paula received the policy on feb. 5, 1998. How long does Paula have to examine the policy and decide whether or not to keep the policy?
30 day from the date it was received.
Bill is approaching retirement age and is concerned about having proper coverage should he have to be placed in a LTC facility. Bill's agent told him that LTC policies would provide coverage at all of the following levels EXCEPT
Acute
An elimination (waiting) period may NOT have to be satisfied for a disability in which of the following?
An insured suffers a relapse of a prior disability within 6-months of the initial covered disability
In addition to participation requirements, how does an insurer guard against adverse selection when underwriting group health?
By requiring that the insurance be incidental to the group
Which of the following is not normally and excluded cause of disability in an individual disability income policy?
Complications from pregnancy
Regarding the consideration clause, which of the following is not correct?
Consideration of the insurer and the insured must be equal
The guaranteed purchase option is also referred to as the
Future increase option
In group insurance, the primary purpose of the coordination of benefits provision is to
Prevent over-insurance
Which of the following statements is incorrect?
The insurer does not have the right to conduct an autopsy
What is the purpose of a benefit schedule?
To state what and how much is covered in the plan.
In order for a foreign insurer to obtain a certificate of authority, it must file all of the following documenta EXCEPT
Copy of appointment of authority of its US manager
In order for an alimni association to be eligible to purchase group health insurance for its members, all of these statements must be true EXCEPT when the association
Has been active for 5 years mimimum
Person is disabled on June 1st for 15 days and is under 30 day elimination period. When will he collect benefits?
He won't collect anything
Which of the following is NOT a medicaid qualifier
Insurability
If an insurer is charged with fraud, who must notify the director of the charge?
Insurer
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
Which of the following is NOT true regarding an optionally renewable policy?
Insurer can only cancel the policy for reasons stipulated in the contact.
The director received a written request that a trial be held to contest an order written against an insurer. The trial will be held before the order is to be executed. The trial lasts longer than expected, extending into the period during which the order would take effect. Which of the following is true?
The order will be suspended until the court case is completed.
Which of the following is NOT true regarding term health coverage?
The owner may renew the policy for a specified term.
All of the following are characteristics of group health insurance plans EXCEPT
The parties that hold a group health insurance contract are the employees and the employer.
Which of the following is true regarding coverage for alcoholism and drug abuse treatment in group disability insurance?
Those services must be covered up to an established dollar limit
Medicare is a health insurance program for all the following individuals EXCEPT
Those with low income and low assets
How much is the coinsurance for Medicare part B
20%
A major medical expense policy would exclude coverage for all of the following treatments EXCEPT
Drug addiction
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
In contrasting stock insurers with mutual imsurers, which statement is true?
Stock insurers are owned by the shareholders, and issue nonparticipating policies
Insureds 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 covered loss under a major medical policy?
Submit the description in their own words on a plain sheet of paper
