Incorrectly Answered Life

Which of the following is defined as the demographic characteristics that carriers consider when determining premium rates for individuals and small employers?

Case characteristics

A carrier that fails to pay, deny, or settle a claim within the allotted time periods will be liable for the covered benefits and, in addition, will pay to the insured

Interest at the rate of 20% annually

A Medicare supplement policy may exclude coverage based on

Pre-existing condition.

An insurer who willfully violates a single provision of an unfair trade practice regulation may be fined

$30,000

An insurer misses the deadline to respond to an Examination Request from the Division of Insurance. If this is the company's first violation, it can face a penalty of

$500

How many consecutive months of coverage (other than in an acute care unit of a hospital) must LTC insurance provide in this state?

12

At what age may an individual make withdrawals from an HSA for nonhealth purposes without being penalized?

65

What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?

As long as the policy is in force

When must an insurer offer a long-term care insurance policyholder the option of purchasing inflation protection?

At the time of purchase

What document describes an insured's medical history, including diagnoses and treatments?

Attending Physician's Statement

In a relative value system of determining coverage for a given procedure, what term describes the total amount payable per point?

Conversion factor

A waiver of premium provision may be included with which kind of health insurance policy?

Disability income

In a disability policy, the probationary period refers to the time

During which illness-related disabilities are excluded from coverage

An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This would indicate that his policy was written with a 30-day

Elimination period

No individual or group policy of sickness and accident insurance issued by an insurer, nor a plan which provides hospital, surgical, or major medical coverage on an expense incurred basis will be sold in Colorado unless a policyholder under the policy or plan is offered the opportunity to purchase coverage for

Home health services and hospice care which have been recommended by a physician as medically necessary.

Which of the following riders would NOT increase the premium for a policyowner?

Impairment rider, The impairment rider excludes a specified condition from coverage, therefore, reducing benefits. An insurance company will not charge extra for a rider that reduces benefits.

Long-term care policies sold in Colorado must offer which of the following?

Inflation protection

In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary and reasonable, the extra cost

Is not covered.

If a dental plan is integrated, it is combined with what type of plan?

Medical

Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is

Monthly.

Under Colorado's Unfair Claims Practices regulations, when denying a claim an insurer must do all of the following EXCEPT

Pay a claim that occurs after the grace period has ended.

Long-term care insurance will not exclude coverage for a loss or confinement that is the result of a pre-existing condition beginning within 6 months following the effective date of coverage. However, the Commissioner may extend the 6 month limitation period to

Specific age groups.

The transfer of an insured's right to seek damages from a negligent party to the insurer is found in which of the following clauses?

Subrogation

Which of the following entities is appointed to oversee the business of insurance and to ensure that the insurance laws of Colorado are enforced?

The Commissioner of Insurance

Which statement regarding qualifications for Social Security disability benefits is NOT true?

The individual must be at least 65 years old.

An insured submitted a notice of claim to the insurer, but never received claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insurer. Which of the following would be true?

The insured was in compliance with the policy requirements regarding claims.

Which of the following statements is true regarding deductibles and coinsurance for treatment of mental illness?

They may not differ from those established for other conditions.

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of Payment of Claims