Life and Health 3

It's a nonprofit organization that maintains underwriting information on applicants for life and health insurance.

Which of the following best describes MIB

The insured is not required to pay a deductible

Which of the following best describes the "first dollar coverage" principle in basic medical insurance

right of salvage

a provision found in insurance policies which prevents the insured from collecting twice for the same loss is called

care can only be provided in the service area

which of the following is true regarding inpatient hospital care for HMO members?

stop-loss limit

which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses?

a dread disease policy

which of the following would be an example of a limited accident and health insurance policy?

a salaried employee who advertises and solicits insurance

which of the following would be required to be licensed as an insurance producer?

may 1st of this year

A child was adopted on may 1 of this year. when will her health benefits go into effect

Claim is denied if his policy contains the Illegal occupation provision

A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?

Respite care

All of the following long-term care coverages would allow an insured to receive care at home EXCEPT

Death benefits are paid only if death occurs within 24 hours of an accident

All of the following statements concerning Accidental Death and Dismemberment coverage are correct except

Coinsurance

The provision that provides for the sharing of expenses between the insured and the insurance company is

6 months

The relation of earnings to insurance provision allows the insurance company to limit the insureds benefits to his/her average income over the last

policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.

a gauranteed renewable health insurance policy allows the

A benefit for each day the insured is in a hospital.

a hospital indemnity policy will pay

Disability Income

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

anyone who is willing to pay a premium

all of the following qualify for medicare part A except

within 10 days

how long after receiving notice of a claim does the insurer have to furnish proof of loss forms?

Alzheimer's disease

long term care policies must cover

8 hours

once an individual is licensed as an insurance prodcucer for life or accident and health insurance, how many hours of training must the producer complete initially to sell long term care insurance partnership policy ?

Interval expense coverage

the corridor deductible derives its name from the fact that it is applied between the basic coverage and the

Monthly

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

It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason

what statement best describes the free look provision

If it is intentional and material

when would a misrepresentation on the insurance application be considered fraud

insurers executive officer

which of the following entities has the authority to make changes to an insurance policy

The person may not be declined for medical coverage soley based on HIV status

which of the following is true regarding health insurance underwriting for a person with HIV

HMOs do not pay for services covered by medicare

which of the following statements is correct concerning the relationship between medicare and HMOs

payment of premium

with respect to the consideration clause, which of the following would be considered consideration on the part of the applicant for insurance ?

Exchange of unequal values

*Which of the following best describes the aleatory nature of an insurance contract?

Immediately

A health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective?

The benefits will be coordinated

A husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouses coverage. If one of them incurs hospital expenses, how will those expenses likely be paid?

usual, customary, and reasonable

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedurer by a doctor of similar training and experience in that geographic area is known as

Unearned premiums are retained by the insurance company

According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT

The old policy should stay in force until the new policy is issued

An agent is in the process of replacing the insured's current health insurance policy with a new one. which of the following would be a proper action.

consideration clause

An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she is confined to a hospital. This will not be covered by insurance because she has not met the conditions specified in the

10 days

An insured pays a monthly premium of $100 for her health insurance. What would the duration of the grace period under her policy?

The insured is in an accident and incurs a large claim

An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would not be a reason for the insurance company to cancel a policy?

$120 a day

An insured's long term care policy is scheduled to pay a fixed amount of covreage of $120 per day. The long term care facility only charged $100 per day. How much will the insurance company pay?

authorized insurer

An insurer that holds a certificate of authority in the state in which it transacts business is consider a/an

At the date of the final decree of adoption

Coverage for adopted children must be effective at what point?

within 90 days or as soon as reasonably possible, but not to exceed 1 year

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company

adjust the benefit in accordance with the increased risk

If the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following?

Join the group after the effective date

In a group health policy, a probationary period is intended for people who

assets

In a replacement situation, all of the following must be considered EXCEPT

counts toward deductible

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

certificate of authority

In order for an insurer to legally transact insurance, it must obtain which of the following?

Waiver of premium rider

Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums her policy includes

Guaranteed renewability

Most LTC plans have which of the following features?

90 days

Most policies will pay the accident death benefits as long as the death is caused by accident and occurs within

every 24 months

Once an agent has met the requirements to sell long-term care insurance partnership policies, how often must the agent complete the 4 hours of ongoing training courses?

The insured may choose medical providers not found on the preferred list and still retain coverage The insured is allowed to receive care from any provider, but if the insured selects a PPO provider, the insured will realize lower out of pocket costs If a non network provider is used, the insureds out of pocket cost will be higher

Regarding a PPO, which of the following is correct when selecting a primary care physician?

Control specialist costs

The gatekeeper of an HMO helps

a statement that is sufficiently clear to identify the insured and the nature of the claim

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain

90 days of a loss

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within

Neither approved the application nor issued the policy

an applicant for a health insurance policy returns a completed application to her agent, along with a check for the first premium. She receives a conditional receipt two weeks later. which of the following has the insurer done by this point?

time of payment of claims

an insured notifies the insurance company that he has become disabled. what provision states that claims must be paid immediately upon written proof of loss?

The insured was in compliance with the policy requirements regarding claims

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?

A statement that the insured does not automatically qualify for medicare part A

insurers or agents soliciting partnership policies must provide each prospective applicant with all of the following EXCEPT

surgical expenses of persons eligible for medicare

medicare supplements specifically exclude all of the following except

The insured

the annual contribution limit of a dependent care flexible spending account is set by

capital sum

under the accidental death and dismemberment (AD&D) coverage , what type of benefit will be paid to the beneficiary in the event of the insured's accidental death?

Termination of employement due to downsizing

which of the following would be a qualifying event as it relates to COBRA

Free look period

which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it?

indemnity

which type of hospital policy pays a fixed amount each day that the insured is in a hosptial ?

an independent examination as often as reasonably required

while a claim is pending, an insurance company may require

a doctor

who can provide skilled nursing care?

An agent misrepresents policy benefits to convince a policyowner to replace policies

Rebating is an unfair trade practice and is regulated by law. All of the following would be considered to be rebating EXCEPT

The policy will not lapse since payment to the agent is the same as a payment to the insurer.

if an insurance premium is paid by the policyowner to the agent, and the agent fails to remit that premium to the insurer, which of the following statements is true?

a right to return the policy for a full premium refund

the free look provision allows for which of the following?

the insurer may terminate the contract only at renewal for certain conditions. The insurance company cannot cancel a noncancellable policy, nor can the premium be increased beyond what is stated in the policy. The insured has the right to renew the policy for the life of the contract; however, the guarantee to renew coverage usually only applies until the insured reaches age 65.

which of the following is NOT a feature of a noncancellable policy?

adult day care

which of the following long term care benefits would provide coverage for care for functionally impaired adults on a less than 24 hour basis?

monthly

which of the following premium modes would result in the highest annual cost for an insurance policy

consumer report

which of the following reports will provide the underwriter with the information about an insurance applicants credit

Any benefits received are taxable to the business

which of the following statements regarding business overhead expense policies is NOT true

The applicant has a prior felony conviction

which of the following would qualify as a competent party in an insurance contract

Promising to pay in accordance with the contract terms

In respect to the consideration clause, which of the following is consideration on the part of the insurer

in an institutional setting

In which of the following locations would skilled care most likely be provided?

To provide an incentive for the insured to return to work

Insurers usually do not reimburse claimants for 100% of income lost due to disability. What is the reason for insurer limitations on coverage amounts?

Attending physican's statement

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

Diagnostic and preventative care

What is an important feature of a dental expense insurance plan that is NOT typically found in a medical expense insurance plan?

to help the insurance company to prevent over utilization of the policy

What is the purpose of coinsurance provisions?

The insurer is considered to be notified since the notification to the agent equals notification to the insurer.

When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her agent did not notify the insurance company until 60 days after the loss. Which of the following statements correctly explains how this claim would be handled?

To renew the policy until the insured has reached age 65

When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees

conditional The contract is formed on the basis that certain conditions are met .

When both parties to a contract must perform certain duties and follow rules of conduct to make the contract enforceable, the contract is

Agents report

Which of the following includes information regarding a person's credit, character, reputation, and habits

It pays for physician services, diagnostic tests, and physical therapy

Which of the following statements concenring medicare part B is correct

The larger the percentage that is paid by the insured, the lower the required premium will be .

Which of the following statements is true regarding coinsurance

the medical information bureau

Which of the following would provide an underwriter with information concerning an applicant's health history?

the wife (contingent beneficiary)

a policyowner names his 5 children as primary beneficiaries and his wife as a contingent beneficiary. if the policyowner and one of his children die, who would receive policy benefits

The medicare part A deductible Medicare supplement plan A provides the core, or basic, benefits established by law. All of the above are part of the basic benefits, except for the medicare part A deductible, which is a benefit offered through nine other plans.

which of the following is NOT covered under plan A in medigap insurance

special risk policy The special risk policy will cover unusual types of risks that are not normally covered under AD&D policies. It covers only the specific hazard or risk identified in the policy, such as a racecar driver test-driving a new car.

which of the following special policies covers unusual risks that are NOT normally included under Accidental Death and Dismemberment coverage

It consists of 3 parts: Part A: hospitalization, Part B: Doctor's services, part C: disability income medicaid is a state program funded by state and federal taxes that provide medical care for the needy. Parts A-C are part of medicare.

which of the following statements is NOT true concerning medicaid?

Both individual and group accident and sickness

An employee becomes insured under a PPO plan provider by his employer. if the insured decides to go to a physican who is not a PPO provider, which of the following wil

The PPO will not pay any benefits at all

An employee becomes insured under a PPO plan provided by his employer. If the insured decides to go to a physican who is not a PPO provider which of the following will happen

workers compensation

An employee is injured in a construction accident, rendering him unable to work for a year. Which of the following plans would provide him with medical expense coverage and income assistance

Beneficiarys consent

An insurance contract must contain all of the following to be considered legally binding except

Aleatory

An insurance contract requires that both the insured and the insurer meet certain conditions in order for the contract to be enforcable. what contract characteristic does this describe.

$0

An insured is covered under 2 group health plans - under his own and his spouse's. he has suffered a loss of $2000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1500 of medical expenses. what amount, if any, would be paid by the secondary insurer?

Insurance companies from adverse selection by high risk persons

The medical information Bureau was created to protect

insuring clause

The section of a health policy that states the causes of eligble loss under which an insured is assumed to be disabled is the