KY Health insurance
A second period of disability arises as a result of the same or related cause of prior disability
Recurrent disability
Disability income insurance is
Vital to the financial health of every family that relies on one or more wage earners for income
The amount payable as a death benefit in an accidental death and dismemberment policy is known as the
principal sum
Miss statements in an application can be used to avoid a policy within how many years
2
Which of the following is the usual a grace period for a semi annual policy
31 days
Which of the following is the usual grace period for an Annual premium policy
31 days
I cancellation provision gives an insurer the right to cancel a policy at any time after giving how many days notice to the insured
5
Under the standard cancellation provision, a company has the right to cancel my policy at any time within how many days written notice to the insured
5
Partial disability indemnity is what percent of the monthly or weekly indemnity for total disability
50%
Which provision is designed it to prevent over insurance
6
Supplemental income provides additional income during the first ___ months of long-term disability
6 to 12 months
Most short term disability income policies provide benefits for
6months
Or contributory plans, what percentage of employees must participate
75%
Proof of loss must be furnished within how many days
90
Monthly premium policies require
A 10 day grace period
A health insurance company organized in Illinois with his home office in Philadelphia is license to conduct business in Kentucky. In Kentucky this company would be considered which of the following types of ensures
Foreign
All of the following are primary wrist factors in underwriting individual health insurance policies except
Geographic location
Which kind of health insurance policy assures renewability up to a specific age of the insured, although the company reserves the right to change the premium rate on a class basis?
Guaranteed renewable
A company may change the wording of a uniform policy provision in its health insurance policies only if
The modified provision is not less favorable to the insured
Theodore received a $15,000 cash benefit from his $50,000 accidental death and dismemberment policy for the accidental loss of one eye. The amount he received could be identified as the policies
Capital sum
All of the following are considered service providers except
Commercial insurance companies
Because the obligations of the insurance company hinge on certain acts of the policyholder, the beneficiary, or both, the insurance contract is termed
Conditional
The fact that an insurance contract promises to pay benefits contingent on a future uncertainty makes it what type of contract
Conditional
Which of the following probably would not be considered in underwriting a health insurance risk
Credit rating
What option provides lump sum payments for certain injuries or amputations on a weekly or monthly payment period
Elective benefits or indemnities
Which provision of a health insurance policy stipulates that the endorsements and attached papers constitute the contract for insurance
Entire contract
All of the following groups may contract with PPOs except
Health insurance benefit providers
The Social Security writer will pay benefits
If it turns out the insured is not eligible for benefits from social insurance
Aron submit a claim and proof of loss for medical expenses covered by her major medical policy. According to the time of payment of claims provision, how Soon must accompany pay the claim
Immediately
And insurance contract is prepared by one party, the insurer, rather than by negotiation between the contracting parties. This characteristic means that the insurance contract
Is a contract of adhesion
Which of the following statements about the restoration of plan Benefits is not correct
It is more important than ever to have the restoration of benefits clause because of the low maximums written on major medical policies
Which of the following statements about the ensuring clause in a health insurance policy is not correct
It is one of the 11 NAIC optional provisions
All of the following are basic forms of health insurance coverage except
Limited pay health
Which of the following expenses would not be covered by a business overhead expense policy
Merchandise for a special weekend sale
Any policy that is in conflict with the statutes of the state will be amended to come form to what requirements
Minimum
Which of the following statements pertaining to provisions and health insurance policies is correct
Miss statement of age provision allows the insured to adjust the benefits payable under the policy
Disability income policies must pay such benefits at least
Monthly
Under the timer payment of claims provision, policies that provide for periodic payment of Benefits must pay such benefits at least
Monthly
Compared with a group policy the coverage under an individual policy is generally
More costly and more limited
Which of the following statements about maternity benefits is correct
Most maternity benefits are paid in flat sums for normal childbirth
Which of the following statements regarding health insurance policies is correct
Most medical expense policies are contracts of reimbursement
Which of the following situations is an example of a presumptive disability
Nancy is completely blind and will not recover her site
Maurice has an optional renewable policy. When can the insurance company refuse to renew Maurices policy
Only at premium payment renewable time
Which occupation definition is less restrictive
Own occupation
What is the biggest difference between PPOs and HMOs
PPOs have no separate physical facility
What is coinsurance
Percentage of costs the insurance company and insured each pay (usually 80/20)
Victor changes to a more hazardous job than the one he had when he applied for his disability income policy. According to the policies 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 on the basis of the more hazardous occupation
Who are the owners of a mutual insurance company
Policy holders
Blue Cross/Blue Shield organizations can operate all of the following except
Preferred point plans
What is a Social Security rider
Provides for a monthly payment amount that might be received from Social Security for a total disability
Which of the following statements pertaining to recurrent disabilities for disability insurance is not correct
Recurrent disability policy provisions have no effect on the payment of benefits
Insurers will use all of the following techniques when issuing health insurance policies to substandard risk except
Requiring additional collateral to pay for extraordinary claims
A percentage of the total disability benefit for periods of partial disability is defined as
Residual disability benefit
Which of the following statements about health insurance premiums is not true
The agent six of the insured are considered primary factors that affect health insurance premium rates
The shorter the waiting period or Elimination period means
The higher the premium payment
The longer the waiting period or elimination period means
The lower the premium payment
An entire contract is
The policy, endorsements, and attachments
All of the following statements about deductible provisions in medical insurance policies are correct except
They are most common and basic medical expense policies
All of the following statements regarding Blue Cross/Blue Shield are correct except
They offer health care coverage on both an individual and group basis
The purpose of business overhead expense policies are
To keep the business running due to the owner becoming disabled
All of the following are responsibilities to the master policy holder except
Underwriting individual risks
What are statements that are guaranteed to be true
Warranties
Wednesday policy is reinstated, how many days is the waiting period for accident coverages coverages
0
All other policies require
31 day grace period
HMOs require members to have what
A primary care physician
Partial disability applies largely to
Accidental disability or severe illnesses, such as heart attacks
Most Long term policies provide benefits to
Age 65 or two years
Which of the following statements pertaining to health maintenance organization's is correct
And insurance company that markets group health insurance is also known as an HMO
If the coinsurance feature in a major medical insurance policy is 75 to 25 with $100 deductible how much of the $210 bill would the insured pay
$600
Once a policy is reinstated, how Long is the waiting period for sickness coverage
10 days
For non-contributory plans, what percent of employees must be included
100%
Group policies are required by law to provide maternity benefits with how many employees
15
When an insurer received a notice of a claim, it should furnish the insured with forms to provide proof of loss within how many days
15
Which of the following statements about emergency first aid coverage is correct
A physician who provides life-saving treatment at the scene of an accident might receive payment through the injured persons emergency first aid coverage
What are PPOs
A selected group of independent hospital and medical practitioners that provide a range of services at a prearranged cost
Weekly premium requires
A seven day grace period
Under the mat statement of age provision in a health insurance policy, what can a company do if it discovers that and insured gave a wrong age at the time of application
Adjust the benefits
What is an open panel
All providers who want to provide services for the HMO may do so as long as they agree to the HMOs requirements
A person who makes a representation on a health insurance application
Believes it to be true
Which of the following statements about elimination periods in a disability income policy is not correct
Benefits are not payable during an illumination period, but are paid retroactively to the beginning of the period if the insured remains disabled throughout the period
All of the following are required uniform provisions in an individual health insurance policy except
Change of occupation
A situation where the individual is not disabled immediately but as time passes the person becomes totally disabled
Delayed disability
And insurance company organized in a headquartered in Kentucky can be described as what type of company when transacting insurance business in Kentucky
Domestic
An accidental death and dismemberment policy paying twice the principal some is known as
Double indemnity
Which section of a health insurance policy specifies the conditions, times, and circumstances under which the insured is not covered by the policy
Exclusions
Which of the following is not a basis for occupational sustainability when determining total disability
Job interest
All of the following factors would affect your health insurance policies premium rate except
Location of the insured's residence
Type of data reflects the average number of disabilities due to sickness or accidents at various ages
Morbidity
Common exclusions include
Pre-existing conditions, self-inflicted injuries, suicide, injury while committing a felony, and cosmetic surgery
HMOs are not required to provide
Prescription drugs, vision care, dental care, home health
Vicks policy stipulates that no benefits will be paid for any illness that occurs during the first 30 days after the policies effective date. What period is this?
Probationary period
A less hazardous occupation does what to the premium rate
Reduces
If the total monthly benefits are more than the insured's monthly income, each company will do what
Refund a share of the excess premium
The purpose of disability income insurance is to
Replace income when disability prevents an individual from working to earn a living
All of the following expenses would be covered under a major medical policy except
Replacement of an artificial limb
What are statements the applicant makes that he or she represents to be true to the best of their knowledge
Representation
Which of the following expenses would not be covered as a hospital benefit
Some types of surgery
The type of HMO that employees its own physicians and requires its members to use these physicians is known as
Staff model HMO
If discovered, and intentional or fraudulent misrepresentation can cause the insurer to
Void the policy provided the material
Any standard health insurance policy provision that is in conflict with a state statute
is automatically amended to conform to the state statute.