health567

Pre-hospitalization authorization is considered an example of: managed care PPO care Medicaid Major Medical insurance

managed care

Periodic health claim payments MUST be made at least:

monthly

Which of these is considered a mandatory provision? Payment of Claims Insurance with Other Insurers Misstatement of Age Change of Occupation

Payment of Claims considered a mandatory provision and directs where the claim benefits will go. The others are considered optional provisions.

Which of the following BEST describes how pre-admission certifications are used? sed to assist in underwriting Used to prevent nonessential medical costs Used to minimize hospital lawsuits Used to help process claims

Pre-admission certification is used to prevent unnecessary medical costs.

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called:

noncancellable

What must the policyowner provide to the insurer for validation that a loss has occurred?

proof of loss

The Legal Actions provision of an insurance contract is designed to do all of the following, EXCEPT:

protect the producer

P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax?

$0- Disability income benefits that derive from an individual policy which was paid entirely by the policyowner is not subject to federal income tax.

Which of the following are NOT managed care organizations? Point-of-Service plan (POS) Preferred Provider Organization (PPO) Medical Information Bureau (MIB) Health Maintenance Organization (HMO)

----Medical Information Bureau (MIB)

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?

Change of occupation provision

A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim?

Claim will be paid and coverage will remain in force

Which of the following correctly explains the actions an agent should take if a customer wants to apply for an insurance policy?

Complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?

File written proof of loss

The purpose of the Grace Period is to give the policyowner additional time to pay overdue premiums.

Gives the policyowner additional time to pay overdue premiums

Which of the following provisions specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due?

Grace Period

The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the:

Insuring clause

Which of the following actions will an insurance company most likely NOT take if an applicant, who has diabetes, applies for a Disability Income policy? Issue the policy with a diabetes exclusion Issue the policy with an altered Time of Payment of Claims provision Issue the policy with a rating Decline the applicant

Issue the policy with an altered Time of Payment of Claims

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?

Monthly

What type of renewability guarantees premium rates and renewability?

Noncancellable

Which of the following BEST describes a short-term medical expense policy?

Nonrenewable

S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning:

November 1

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

Payment of Claims

A prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take?

Send a notice to the MIB that the applicant was declined

Which type of plan normally includes hospice benefits?

Short-term disability plans Group life plans Workers' Compensation ----Managed care plans

An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to: issue the policy only when the initial premium check has cleared determine if the applicant is insurable by investigating family health history issue the policy on a standard basis determine if the applicant is an acceptable risk by completing standard underwriting procedures

determine if the applicant is an acceptable risk by completing standard underwriting procedures

The sections of an insurance contract which limit coverage are called:

exclusions

K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered:

guaranteed renewable

Which of the following statements about the classification of applicants is INCORRECT? Substandard applicants are never declined by underwriters Substandard applicants are occasionally declined by underwriters Preferred risk applicants typically have better premium rates than standard risk applicants An applicant can be classified as substandard risk because of a hazardous job

substandard risk is below the insurer's average risk guidelines. An individual can be rated substandard for a number of reasons and can even be rejected outright.

According to the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, nonfraudulent misstatements first become incontestable:

years from the date of the policy was issued