Health quizzes
Jane has a comprehensive major medical policy with a $1,000 basic medical plan. Her deductible is $500 she has an 80/20 coinsurance clause. She incurs a covered loss in the amount of $10,500. How much of this loss will Jane be responsible for?
$2,300 The basic medical plan is a first dollar paid by the insurance company at 100%. We subtract this amount from the $10,500 loss, leaving $9,500. At this point, Jane will pay her $500 deductible, reducing the amount to $9,000. Jane is responsible for paying 20% coinsurance which is an additional $1,800 ($9,000 x .20). When we add the $1,800 coinsurance amount to the $500 deductible, the total amount that Jane is responsible for is $2,300.
Generally, skilled care is provided in:
nursing homes. Explanation Skilled care is considered to be daily nursing and rehabilitative care performed only by a skilled professional, such as a nurse or physical therapist. This level of care is usually performed in a nursing home.
A Business Overhead Expense Policy (BOE) would cover all of the following expenses except: office rent. employee salaries. utilities. owner's salary.
owner's salary.
A residual disability benefit may be payable to someone who has a:
permanent partial disability.
An individual can recover from a disability and relapse weeks or months later. If this occurs within six months after the insured returns to work, it will be treated as a:
recurrent disability.
According to the claim forms provision, if the insurer fails to supply the insured with claim forms with the specified time limit, the insured may:
submit the claim or proof of loss on any form, explaining the occurrence. The insurer should supply a claim form to an insured within 15 days after receiving notice of loss. If the insurer fails to do so within the time limit, the claimant may submit the claim or proof of loss on any form, explaining the occurrence.
With Blue Cross-Blue Shield, insureds are considered:
subscribers.
Basic medical expense policies have all of the following limitations EXCEPT: (X)the dollar amount for surgical procedures. the dollar amount paid for each visit. the number of visits per day. the total number of benefit days annually.
the dollar amount for surgical procedures. Limits are placed on the number of visits per day, the amount paid per visit, and the total number of days benefits will be paid each year.
When a person converts from a group health policy to an individual policy:
the individual plan will not provide the same benefits as the group plan. When converting to an individual plan, benefits will not be the same as the group plan. Benefits under a group plan are not usually as restrictive as individual plans.
With a disability income policy, benefits are based on:
the insured's earned income Disability income benefits are based on a percentage of the insured's income and are generally paid to the insured on a monthly basis.
Disability Income contracts are considered:
valued contracts. Disability Income contracts are valued or stated amount policies. They will pay a specified sum, like $3,000, each month throughout the period of disability.
What group insurance provision is designed to eliminate duplication of benefit payments and overinsurance when an individual is covered by more than one group health plan?
Coordination of Benefits Coordination of benefits (COB) is designed to eliminate duplication of benefit payments and overinsurance when an individual is covered by more than one group health plan. The provision does not limit the maximum amount of benefits the insured is entitled to; rather, it is designed to offer insureds the most coverage possible while eliminating overinsurance.
Outpatient care is sometimes referred to as:
ambulatory care Outpatient care is also referred to as ambulatory care.
The death benefit in an AD&D policy is called:
Principal sum. The policy's face amount is called the principal sum and is payable in two situations: (1) accidental death, or (2) the loss of any two of the primary parts.
Naomi is killed in an auto accident before she is able to pay the semi-annual $80 premium on her $30,000 accident policy. Under the policy's unpaid premium provision, her beneficiary will receive a check for:
$29,920 Under a health insurance policy's unpaid premium provision, any due and unpaid premium (in this case, $80) is deducted from the settlement amount ($30,000). Therefore, Naomi's beneficiary will receive a check for $29,920.
Your customer, John, purchased a major medical policy from you with a $250 deductible and a 80/20 coinsurance clause. About a year after his purchase, he incurs a covered loss in the amount of $4,000. The insurance company only paid $2,881 on this claim. John complains to you that this amount is incorrect. What amount should the company have paid?
$3,000 Based on the information given, the company should have paid $3,000 on this claim. After John paid his deductible of $250, that left a balance of $3,750. John's 20% coinsurance amount is $750, which leaves a balance of $3,000 that the insurance company should have paid.
Janie earns $125,000 a year. With most insurers, the maximum amount of benefit she will receive from her disability income policy is:
$6250 Insurance companies require that there be a relation of earnings to insurance. The typical maximum benefit is 60% of predisability income. In Janie's case, 60% of earnings is $75,000, or $6,250 per month.
Jane has a comprehensive major medical policy with a $1,000 basic medical plan. Her deductible is $500 she has an 80/20 coinsurance clause. She incurs a covered loss in the amount of $10,500. How much of this loss will the insurer be responsible for?
$8,200 The basic medical plan is a first dollar paid by the insurance company at 100%. We subtract this amount from the $10,500 loss, leaving $9,500. At this point, Jane will pay her $500 deductible, reducing the amount to $9,000. The insurance company is responsible for paying 80% coinsurance which is an additional $7,200 ($9,000 x .80). When we add the $7,200 coinsurance amount to the $1,000 basic medical payment, the total amount the insurer pays is $8,200.
You were covered by an employer group plan for two years before leaving your job. You acquired coverage under your new employer's group plan; however, there was a break between the two plans of 45 days during which you had no health insurance. Since the break in coverage did not exceed ____ days, the new insurer must credit you for ____ years of coverage and cannot apply a preexisting condition limitation.
63/2 Explanation Since the break in coverage did not exceed 63 days, the new insurer must credit you for 2 years of coverage and cannot apply a preexisting condition limitation.
Patricia has a health insurance policy for which she pays a semi-annual premium. If the premium is due on July 1, 2011, her grace period will end on:
07/31/2011 00:00:00 A semi-annual premium policy usually has a 31-day grace period in which the policyowner can pay the premium due. For policies with weekly premium payments, the grace period is seven days, and policies with monthly premiums have 10-day grace periods.
If a company has 2,000 employees eligible for a contributory group life insurance program, how many would be required to participate?
1,500 A contributory group life insurance requires a minimum participation of 75% of eligible employees.
What is the minimum number of group members required for maternity benefits to be covered on the same basis as nonmaternity benefits in a group medical expense plan?
15 If maternity benefits are included as a part of a group plan, the group must have 15 members or more to include maternity benefits on the same basis as nonmaternity benefits.
According to the claim forms provision, the insurer should supply a claim form to an insured within how many days after receiving notice of loss?
15 The company must transmit the claim forms to the policyowner/ insured within 15 days of claim notification.
If a company has 2,000 employees eligible for a noncontributory group life insurance program, how many would be required to participate?
2,000 Noncontributory group life plans require 100% participation.
A written notice of claim must be given to the insurer or agent within how days after the occurrence?
20 the company must be notified of a loss within 20 days or as son thereafter as reasonably possible
Which of the following is the usual grace period for a semi-annual premium policy?
31 days The minimum grace periods that may be specified are typically 7 days for policies with weekly premiums, 10 days for policies with premiums payable on a monthly basis and 31 days for other policies.
Mark is covered under his wife's group health plan. After she is killed in an auto accident, Mark is eligible to continue coverage under COBRA for how long?
36 months
Under the standard cancellation provision, a company has the right to cancel a policy at any time with how many days written notice to the insured?
5 days Under the standard cancellation provision, the company has the right to cancel the policy at any time with 5 days' written notice to the insured. This provision is nevertheless prohibited in many states.
Continuous period of creditable coverage means the period during which a person was covered by creditable coverage, if during the period of the coverage the individual had no breaks in coverage greater than:
63 days.
Withdrawals from HSA's to cover medical or medically related costs are not taxable, unless used for non-medical purposes if taken out prior to age:
65 Withdrawals from the HSA to cover medical or medically related costs are never taxable, but HSA funds used for non-medical purposes are always taxable and, prior to age 65, subject to a 10% penalty.
You were covered by an employer group for 7 months before leaving your job. You acquired new coverage under your new employer within ten days of losing your old plan. The new plan must credit ___ months to the preexisting condition limitation, leaving you a maximum of ____ months during which those conditions may be limited or denied.
7/5 The new plan must credit 7 months to the preexisting condition limitation, leaving you a maximum of 5 months during which those conditions may be limited or denied.
AD&D policies include a death benefit which must be accidental and not contributed to by any other cause. If the insured suffers a serious accidental injury and is not expected to live, death must occur within how many days of the accident for the policy to pay?
90 The definition of accidental death is narrowed to death which must be accidental, not contributed to by any other cause and must occur within 90 days of the accident.
You must provide written proof of loss to the insurance company within how days of the loss?
90 You must provide written proof of loss to the insurance company within 90 days of the loss, if reasonably possible.
Under an individual disability income (DI) insurance policy, written proof of loss must be furnished to the insurer within how many days after the date of the loss?
90 For a health insurance policy, including DI, written proof of loss must be furnished to the insurer within 90 days after the date of the loss.
By paying your medical insurance premiums monthly, the company will extend a _____ day grace period.
A 10-day grace period is extended to those with monthly premiums.
Of the following, which individuals would probably not be considered a qualified beneficiary under COBRA?
A dependent child of the employee not currently covered under the employee's health plan. A qualified beneficiary is any individual who is covered under group health plan on the day before a qualifying event. Children adopted or born during the coverage period are considered qualified beneficiaries.
What part of a health policy contains details about the policy coverage?
Benefit provisions
Medical expense insurance provides benefits to pay the costs of medical care for what type(s) of perils?
Accident or sickness Medical expense insurance provides benefits to pay the costs of medical care if you become sick or injured in an accident.
Under the misstatement of age provision in a health insurance policy, what can a company do if it discovers that an insured gave a wrong age at the time of application?
Adjust the benefits
Dave started work at ABC Plumbing on May 15. ABC offers a noncontributory group life insurance plan to its employees after a probationary period. If the probationary period is the normal time period, Dave will be eligible for group life insurance on:
August 15. The typical probationary period is 90 days.
Barney and Betty are a young married couple with 2 small children. Each have employer-sponsored major medical coverage for the entire family. Barney was born on July 22, 1982, and Betty was born on February 14, 1987. Under the birthday rule, whose plan is primary for the children?
Betty''s plan If each parent names his or her children as dependents under his or her group policy, the order of payment under the birthday rule states that the coverage of the parent whose birthday is earliest in the year will be considered primary.
Barney and Betty is a young married couple with two small children. They both have employer sponsored major medical coverage for the entire family. Barney was born on July 22, 1982, and Betty was born on February 14, 1987. Under the gender rule, whose plan is primary for the children?
Barney's plan If each parent names his or her children as dependents under his or her group policy, the order of payment under the gender rule states that the father's coverage is always considered primary.
Which of the following explains why Bob would NOT be a good applicant for a long-term care insurance policy?
Bob has a very small amount of income and must rely on Medicaid to pay the cost of long-term care. Explanation If a person is impoverished, Medicaid will pay the cost of a long-term care. A large savings account will not pay the cost of long-term care for long, since the cost of long-term care can often run as much as $50,000 or more annually. Medicare supplement or disability policies do not pay LTC costs.
Health insurance companies use which of the following methods to help reduce the number small claims?
Deductibles Health insurance companies use deductibles and coinsurance (cost sharing) to reduce the frequency of small claims.
All of the following are characteristics of group health insurance except:
Each insured receives a policy. Each insured receives a certificate of insurance rather than an individual policy.
All of the following can help insurers control adverse selection EXCEPT: Preexisting conditions clause Probationary period Exclusions (X)Elimination period
Elimination period Insurers use a variety of mechanisms to help control adverse selection including limitations and exclusions. An elimination period is used as a time deductible that helps assist insurers with small claims or claims for disability lasting only a short period of time.
In disability insurance policies, the time deductible that must be satisfied before benefits will start is called the:
Elimination period. The elimination period is the time period between when an injury or illness begins and receiving benefit payments from an insurer.
Health insurance companies use which of the following methods to reduce the problem of paying claims for preexisting conditions.?
Exclusions You will find that in health contracts, companies use probationary periods, exclusions and definitions to reduce the problem of paying claims for preexisting conditions.
All of the following statements pertaining to health insurance policy notice of claim and claim forms provisions are correct EXCEPT: (X)Charlotte is injured January 5. Later, she wishes to file a policy claim for expenses incurred in connection with the injury. Generally, she would be required to submit a notice of claim to the company by February 5. Rex, the insured in a disability income policy, has been totally disabled and receiving benefits for 25 months. The notice of claims provision in his policy requires that he submit proof of loss every 6 months. Gail submits notice of claim to her insurance company after she becomes totally disabled. The company is to supply a claim form to her within 15 days. Furnishing claim forms is the responsibility of the insurance company.
Generally, a claimant must notify the insurance company within 20 days of an accident under a health insurance policy. Proof of loss must be submitted within 90 days of the loss, but if it is not reasonably possible for the insured to do so, the deadline will be extended to 1 year. The company must supply its claim forms to the insured within 15 days of notice of a claim.
The renewability provision of a Medicare Supplement policy or long-term care policy must provide the insured with which of the following options?
Guaranteed Renewable Medicare Supplement and long-term care policies must be issued with no less than guaranteed renewable.
Joe returns to work after a sickness disability. He is on the job for two weeks when he becomes sick again and is no longer able to work. He will likely receive benefits immediately for which of the following reasons?
He is covered under his disability income insurance policy's recurrent disability provision. Under a disability income policy's "recurrent disability" provision, disabled individuals are encouraged to return to work on a part-time basis. If they become disabled again with the same disability, there is generally no second elimination period. AD&D policies generally do not pay benefits for illness. Social Security requires a waiting period before the start of benefits. Also, with most disability income policies, partial disability, when available, pays benefits only after a period of full disability.
A health savings account (HSA), is a tax-advantaged medical savings account available to individuals who are enrolled in a:
High Deductible Health Plans (HDHP). A health savings account (HSA), is a tax-advantaged medical savings account available to individuals who are enrolled in a High Deductible Health Plan (HDHP).
Thomas, an insured, submits a claim and proof of loss for medical expenses covered by his major medical policy. According to the time of payment of claims provision, how soon must the company pay the claim?
Immediately According to the time payment of claims provision of a major medical policy, the company must pay the claim immediately.
Your customer, John, purchased a major medical policy from you with a $250 deductible and a 80/20 coinsurance clause. About a year after his purchase, he incurs a covered loss in the amount of $4,000. The insurance company only paid $2,881 on this claim. Joe complains to you that this amount is incorrect. Which of the following may account for the difference?
Inside limits & Internal Limits When benefit limitations are placed on certain coverages in a major medical policy, these limits are referred to as inside or internal limits. For instance, the policy may limit the amount it will pay for room and board, and limit the number of days that will be paid. Convalescent care may be limited to a certain number of days, or the number of x-rays paid under one claim may be limited
Which of the following statements regarding to the conversion privilege in group health insurance policies is false?
Insureds who voluntarily leave or who are terminated have 180 days to convert their coverage to an individual policy. With the conversion privilege in group health insurance, an employee who quits their job or is terminated has 31 days to exercise their right to convert without having to show evidence of insurability.
The reinstatement provision requires all of the following EXCEPT: a new application. proof of insurability. past due premium. (X)an application fee.
Insurers will usually require a reinstatement application, all back premium paid, proof of insurability before a decision is made.
Just as the death of an important employee can cripple a business, so can a prolonged disability. What type of DI plan can be used to fund a salary continuation plan?
Key Employee A Key Employee disability policy will pay directly to the business which gives the employer the option of using the money to temporarily replace the key employee or use the money to continue paying the key employee while he or she is disabled.
A business could purchase and be the beneficiary of a disability income policy to help allow the business to continue paying an employee during the disability period. What type of disability policy would this be?
Key employee A business could purchase and be the beneficiary of a key employee disability income policy to help allow the business to continue paying an employee during the disability period.
For those who have group health coverage and want to work past the age of 65, which coverage becomes secondary?
Medicare Explanation For those who want to work past the age of 65, Medicare becomes the secondary payer while their group insurance remains the primary payer. The group health plan will pay first, while Medicare pays secondary.
All of the following conditions are typically covered in a long-term insurance policy except: Alzheimer's disease. senile dementia. (X)alcohol dependency. Parkinson's disease.
Most LTC insurance policies exclude coverage for drug and alcohol dependency, acts of war, self-inflicted injuries, and nonorganic mental conditions. Organic cognitive disorders, such as Alzheimer's disease, senile dementia, and Parkinson's disease are almost always included.
What renewal provision guarantees you that the insurer cannot make any changes to your premium or policy benefits, to a certain age, unless you request it?
Non-cancellable A non-cancellable policy guarantees you that the insurer cannot make any changes to your premium or policy benefits to age 65 or a certain age, unless you request it.
A business overhead expense policy would exclude which of the following: Office rent Employee salaries (X)Owner's salary Insurance premiums
Owner's salary The policy would provide coverage for business expenses such as rent, employee salaries (excluding the owner's salary), taxes, utilities, and insurance premiums.
Hubert, the insured, changes to a more hazardous job than the one he had when he applied for his disability income policy. According to the policy's change of occupation provision, what will happen when the insurer learns of his job change?
Policy benefits will be reduced to an amount the premiums would have purchased originally based on the more hazardous occupation. According to the policy's change of occupation provision, policy benefits will be reduced to an amount the premiums would have purchased originally based on the more hazardous occupation. Had Hubert changed to a less hazardous occupation (one that calls for a lower premium), the insurer would pay the full benefit for the loss and refund the excess premium to him.
Adverse selection can be reduced with health insurance policies by:
Preexisting conditions Preexisting conditions limitations are used to help reduce adverse selection
Which of the following is true about conversion from group health insurance to an individual policy?
Premiums for the new policy will be based on the insured's attained age.
What type of disability automatically qualifies the insured for full benefits without proof of loss of time or duties?
Presumptive disability A presumptive disability specifies that under certain conditions the insured automatically qualifies for full benefits. Because of the severity of the insured's physical condition, the insured is presumed to be totally disabled even if he or she is able to work.
Jennifer is a small business owner who has recently returned back to work after a three month disability. She found a stack of past due bills, no employees, and an overdrawn bank account. What could Jennifer have done prior to her disability that may have helped her avoid this situation?
Purchased a business overhead expense policy A business overhead expense (BOE) policy can pay the bills for a business while the owner is disabled (employee salaries, rent, utilities, etc.). Think of BOE as a disability income policy for a business.
After Joe suffered a mild heart attack, his doctor put him on a reduced work schedule. Instead of working his normal 40 work week, he is now working and getting paid for only 20 hours each week for the next 90 days. What benefit in Joe's DI plan could make up the difference in lost income?
Residual disability benefit With a residual disability claim, the insured is still actively engaged in their occupation, but because of a sickness or injury is suffering a loss of time and duties, or suffering a loss of income of at least 20%.
Which HMO model is structured so that the physicians are employees of the HMO?
Staff model The staff model is an HMO where the physicians work directly for the HMO as employees.
What provision in a major medical policy requires the insurance company to pay all claims at 100%?
Stop Loss After the insured reaches the maximum out of pocket amount (stop-loss), the insurance company is required to pay all covered losses at 100%.
Individual disability income policy benefits should be paid as a percentage of the insured's pre-disability earnings. What are the tax implications to the insured after receiving disability benefits?
Tax-free if premiums were paid with after-tax dollars
With a disability income policy, the insured must meet a time deductible rather than a dollar deductible as with most other health insurance. What is this time period called?
The elimination period is a period of time the insured is ineligible for benefits.
When an employer sets up a group plan for its employees, the contract of coverage is between who?
The employer and the insurer
For a health policy to be reinstated, what must occur first?
The grace period must end The reinstatement provision outlines the process to be followed after the grace period has ended.
Under the optional illegal occupation provision, which of the following applies if a loss occurs while the insured is participating in a felony or an illegal occupation?
The insurer is not liable for that specific loss. Under the optional "illegal occupation provision," the insurer is not liable for any loss sustained from the insured's commission of a felony or engagement in an illegal occupation.
With all other factors being equal, which of the following policy benefit structure would have the smallest premium?
The longer the elimination period, the less expensive the policy will be. Any occupation definition will cost less than the own occupation definition.
Joe failed to mail the premium for his major medical policy to the insurer for two months and his policy lapsed. He decided to apply for reinstatement that was eventually approved on August 20. Joe accidentally broke his leg on August 21. How will the insurer handle this claim?
The loss will be paid under the terms of the policy Losses resulting from sickness require a 10 day waiting period after the reinstatement. Accidents are covered immediately.
Joe failed to mail the premium for his major medical policy to the insurer for two months and his policy lapsed. He decided to apply for reinstatement that was eventually approved on August 20. Joe had an emergency appendectomy performed on August 29. How will the insurer handle this claim?
The loss will not be paid After policy reinstatement, losses resulting from sickness require a 10-day waiting period after the reinstatement. Accidents are covered immediately.
When a PPO member decides to use a physician that is not in the network, how does the PPO respond?
The member will pay a higher co-payment PPOs will generally only pay full benefits when a preferred provider is used. Reduced benefits are paid for a nonpreferred provider. The only exception is for emergency services, in which full benefits are paid regardless of whether services are rendered by a preferred or non-preferred provider.
Which of the following policies would have the highest premiums?
The own occupation definition of disability is more comprehensive and would cost more than the any occupation definition. The shorter the elimination period, the higher the premium will be.
Joe failed to mail the premium for his major medical policy to the insurer for two months. His policy eventually lapsed. Joe decided to apply for reinstatement and completed all of the necessary requirements on August 1. As of September 10, Joe had not heard from the insurer. What is the status of Joe's policy?
The policy is not reistated The company may require a new application and has the right to decline the application. The policy is reinstated automatically if the insurer does not take action on the application for 45 days.
Joe failed to mail the premium for his major medical policy to the insurer for two months. His policy eventually lapsed. Joe decided to apply for reinstatement and completed all of the necessary requirements on August 1. As of September 15, Joe had not heard from the insurer. What is the status of Joe's policy?
The policy is reinstated To reinstate a lapsed policy, the insured must apply for reinstatement and meet the company's insurability requirements. The company may require a new application and has the right to decline the application. The policy is reinstated automatically if the insurer does not take action on the application for 45 days.
Of the following statements concerning the Coordination of Benefits provision, which one is correct?
The purpose of the Coordination of Benefits provision is to eliminate duplication of benefit payments and overinsurance.
When underwriting group health insurance:
The underwriter generally focuses on the group as a whole, rather than on specific individuals.
You have been covered under your employer's group health plan for 13 months when you are offered a position with another company. Assuming the new employer's group plan covers 2 or more employees, how would the new plan treat preexisting conditions?
There would be no preexisting conditions waiting period in the new plan. If you have been covered for at least 12 months under your current group plan, and then leave your current plan, you will receive a Certificate of Prior Creditable Coverage, and your time in service under the previous plan erases the preexisting conditions limitation of your new employer's plan if you make timely entry into the new plan.
What is the greatest concern of underwriters in issuing group insurance?
adverse selection.
The insurer under a health policy is liable for which of the following losses?
Those sustained while under the influence of a prescribed medication Under a health insurance policy, the insurer is not liable for any loss attributable to the insured while under the influence of intoxicants, drugs or narcotics (unless such drugs were administered on the advice of a physician), or sustained while committing a felony.
Which of the following statements pertaining to the grace period and reinstatement provisions in health insurance policies is NOT correct?
Under a health policy's reinstatement terms, insured losses from accidental injuries and sicknesses are covered immediately after reinstatement. Under a health insurance policy's reinstatement terms, insured losses from sickness will not be covered unless they occur at least 10 days after reinstatement. This is to prevent adverse selection against the insurer. Accidental injuries, however, are covered immediately.
Creditable coverage means coverage of the person provided under any of the following except:
Workers'' Compensation.
You've been covered for 6 months under a group health policy covering 10 employees. You then decide to take a job with a larger company with a group health plan. How long must you wait to be covered under the new employer group plan?
You will have immediate coverage. In this situation, HIPPA provides that if you go to work for an employer with a group plan covering 2 or more employees, you would be covered immediately.
Disability income policies are designed to help replace income if the insured becomes disabled. The definition of disability that requires that the insured is unable to perform the duties of an occupation for which he or she is reasonably qualified by education, training, or experience is called:
any occupation. The "any occupation" definition of a disability requires that the insured cannot perform any occupation for which he or she is reasonably qualified by education, training, or experience. This is a more restrictive definition than the "own occupation" definition.
All of the following are optional provisions in a health insurance policy EXCEPT: misstatement of age. (X)change of beneficiary. unpaid premium. illegal occupation.
change of beneficiary. All health insurance policies must contain a change of beneficiary provision, which gives the insured the right to change the beneficiary unless the insured makes an irrevocable beneficiary designation. Optional provisions include a misstatement of age provision, which provides that if the insured's age was misstated, the amount payable will be equal to what the premium paid would have purchased at the correct age. An unpaid premium provision is also optional, and allows the insurer to deduct the amount of any unpaid premium or any note or order written against the policy. An illegal occupation provision, which states that the insurer is not liable for losses occurring while the insured committed a felony or engaged in an illegal occupation, is also optional.
Medical expense policies can be written as a part of a managed care plan. True or False
false Medical expense policies can be written as individual or group plans. However, they are not written as a managed care plan such as an HMO or PPO.
In underwriting group insurance, companies use all of the following underwriting guides to guard against adverse risk EXCEPT: (X)medical examinations. minimum participation rules. benefits determined by formula. careful group selection.
medical examinations. Medical examinations are not typically required for during the initial enrollment period for group plans.
According to the optional misstatement of age provision, all of the following statements are correct EXCEPT: if the insured actually was younger at the time of application than shown in the policy, benefits would be increased. if the insured actually was older at the time of application than shown in the policy, benefits would be reduced. if the insured actually was older at the time of application than shown in the policy, the excess premiums paid would be refunded. if the age of the insured is misstated at the time of application, all amounts payable under the policy would be what the premiums paid would have purchased at the correct age.
if the insured actually was older at the time of application than shown in the policy, the excess premiums paid would be refunded. According to the optional misstatement of age provision, if the insured was actually older at the time of application than shown in the policy, benefits would be reduced accordingly.
With health insurance contracts, the majority of claims are from:
illness or sickness. Illness (sickness) claims comprise better than 96% of all health insurance losses.
With most health insurance contracts, pregnancy qualifies as a(n):
illness.
Any standard health insurance policy provision that is in conflict with a state statute:
is automatically amended to conform to the state statute. In accordance with the Conformity with State Statutes provision, any health insurance policy provision that conflicts with state law is automatically amended to conform to the statute.
All of the following statements pertaining to waiver of premium in disability income policies are correct except: it exempts an insured from paying premiums during periods of permanent and total disability. it may be applied retroactively, after the insured has been disabled for a specified period. it applies only to a specified age, such as 60 or 65. (X)it exempts an insured from paying premiums during periods of partial and total disability.
it exempts an insured from paying premiums during periods of partial and total disability. The waiver of premium provision applies to premiums during periods of permanent and total disability, not during periods of partial and total disability . It may be applied retroactively, after the insured has been disabled for a specified period and it applies only to a specified age, such as 60 or 65.
The optional provision, other insurance with this insurer, is specifically designed to:
limit the risk with any one individual insured by the company. The optional provision, "other insurance in this insurer," is an overinsurance provision. It is designed to limit the company's risk with any one individual insured. An important consideration in health insurance underwriting is avoiding issuing a policy that provides too high a benefit, which would be a disincentive to return to work. Therefore, this provision sets a limit on the total indemnity for a particular type of coverage.
