Hi

Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months

30 months

To keep cobra coverage, how soon after termination of employment must an employee excervise benefits

60 days

Amount of physician or supplier bills for particular service or supply

Actual charge

What documentation, grants, espresso authority to an agent

Agents contract with the principal

Which of the following hospice events would not be covered in a cost containment setting?

Antibiotics

Which of the following describes taxation of an individual, disability, income, insurance, premiums and benefits

Are not tax deductible and benefits are not taxable

I bought an individual health insurance policy for himself which of the following roles does he now have legally

Both subscriber and insured

An insurance producer who buy contract is bound to write insurance, for only one company is classified as

Captive agent

Most scheduled plans provide first dollar benefits without

Coinsurance and deductibles

Splitting cost of premium with employer is called

Contributory plan

Gatekeeper of an HMO helps

Control specialist costs

the amount that an insured must pay on a claim before the insure will pay

Deductible

Which agreement specifies how a business will transfer when one of the owners dies or is disabled

Disability buy sell

Which of the following are not covered by health maintenance organizations HMO's

Elective services

Provision, stating both printed contract and application form between the policyholder and the insurer is called

Entire contract

The provision in a policy that ensures that the insured can't refer to any document that isn't contained in the contract is the

Entire contract clause

Denture replacement is covered how often

Every five years

What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?

Experience rating

What is the main eligibility factor for the mass health program?

Family income

How many pints of blood will be paid for by Medicare supplement core benefits

First 3 pints

In disability income insurance, the occupation, definition of disability applies

For the first two years of disability

New employee who meets HIPPA eligibility must be issued health coverage on what basis

Guaranteed

Which of the following statements is correct considering the relationship between Medicare and HMO's

HMO's may pay for services that aren't covered by Medicare

The benefits received by the business, and a disability by sell policy are

Income tax-free

Which of the following entities must approve all Medicare supplement advertisements

Insurance Commissioner or Director

The section of a policy stating causes of eligible loss, where an insured is assumed to be disabled is the

Insuring clause

All of the following statements about Medicare part B are correct except

It is a compulsory program.

Which of the following is true about PPO?

It's goal is to channel patients to providers that discount services

All of the following characteristics of a major medical expense policy, except

Low maximum limits

If an insurance company offers, Medicare policies, it must offer which plan

Part A

All of the following examples of risk retention, except

Premiums

Which disability covers conditions, such as dismemberment or total blindness

Presumptive disability

The commissioner can delay, the date of an insurance rate plan, which has been filed less than 30 additional days in order to

Properly, examine the filing and supporting info, filed as a requested or to permit a related hearing

The risk of loss may be classified as

Pure risk and speculative risk

Protection against catastrophic losses is called

Reinsurance

All of the following are ways in which a major medical policy premium is determined, except

The average age of the group

When employees are actively at work on the date coverage can be transferred to another insurance carrier what happens to coinsurance and deductibles

They carry over from the old plan to the new plan

Which of the following is not the purpose of hipaa

To provide immediate coverage to new employees who had been previously covered for 18 months

Pro rata benefit reduction

ensures that insureds or beneficiaries do not profit from losses

For the purpose of insurance risk means

the uncertainty or chance of loss

What is the license renewal period for a portable electronics insurance license?

2 years

The commissioner must examine each domestic and foreign company in order to determine its financial condition, ability to fulfill its obligations complains with insurance laws and dealing with its policy holders at least once every

5 years

Difference between group, underwriting, and individual underwriting is that there is little or no medical information required, regarding regarding plan, participants in groups of

50 or more

Unreimbursed medical expenses paid for the insured may claimed as deductions in the expenses exceeding what percentage of adjusted gross income

7.5%

How many eligible employees must be included in a contributory plan?

75%

how is eligibility of members for group health insurance determined

By conditions of employment

What process will the insurance company use to monitor the insurance hospital stay to make sure that everything is proceeding according to schedule.

Concurrent review

All of the following are true about group, disability, income insurance, except

Coverage applies both on and off the job

Which of the following healthcare plans would most likely provide the insured/subscriber with comprehensive healthcare coverage?

Health maintenance organization plan

Units with the same or similar exposure to loss are

Homogenous

Rose has three policies from same insure, and her benefits have exceeded the maximum allowed what will happen

Pro rata benefit reduction

A doctor submits claimants information to patients and insurance before performing the procedure. She's doing this to check for procedure coverage. This is an example of.

Prospective review

What type of review process doing employers and insurers used to evaluate utilization review process and effectiveness of professionals involved in large insurance claims

Retrospective review

An applicant with the history of of heart disease in his family wants to buy health insurance that strictly covers heart disease what is this policy called

Specified coverage

a person has both the chance of winning or losing our classified as

Speculative risk