NC Accidental & Health Agent Prep

Medicaid

The health insurance program which is administered by each state and funded by both the Federal and state gov. is called:

Prospective Review

Which of the following involves analyzing a case before admission to determine what type of treatment is necessary?

$0

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?

Insured must be under a physician's care

What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision?

Waiver of Premium Rider

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled? a) waiver of premium rider b) Disability Income rider

Residual Disability

When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called which of the following?

Income

When determining the monthly benefit amount for a Disability Income policy, the factor that limits the amount a prospective insured may purchase is:

Time Limit on Certain Defenses

Which accident and health policy provision addresses preexisting conditions?

Disability Buy-Sell

Which contract permits the remaining partners to buy-out the interest of a disabled business partner?

Insuring

Which health policy clause specifies the amount of benefits to be paid?

Single Premium

Which mode of payment is NOT used by health insurance policies?

Used to prevent nonessential medical costs

Which of the following BEST describes how pre-admission certifications are used?

Medical Information Bureau (MIB)

Which of the following are NOT managed care organizations?

Insurance Regulators

Which of the following is not regulated by the insurance information and privacy protection act?

Applicants monthly income

Which of the following is the MOST important factor when deciding how much disability income coverage an applicant should purchase?

Commercial Insurer

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?

Commercial Insurers

Which of the following reimburses its Insureds for covered medical expenses ?

Services are reimbursed after the insurer receives the invoice

Which of the following statements BEST describes dental care indemnity coverage?

They are nonprofit organizations

Which of the following statements is true abut most Blue Cross/Blue Shield organizations?

Business Owner becomes disabled

Which of these circumstances is a business disability Buy-Sell policy designed to help in the sale of a business?

Marital Status

Which of these factors do NOT play a role in the underwriting of a health insurance policy?

Employee Funds the HRA entirely

Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?

Managed care plans

Which type of plan normally includes hospice benefits?

Business Overhead Expense

Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident and out of work for 6 weeks?

Health Maintenance Organization (HMO)

Which type of provider is known for stressing preventative medical care?

Insured

Who does an insurance broker in NC represent?

From member companies

How is Life and Health Insurance Guaranty Associated funded?

The insured's contingent beneficiary

If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the Uniform Simultaneous Death Act?

Limits an insured's out-of-pocket medical expenses

In Major Medical Expense policies, what is the intent of a Stop loss provision?

The Dept. of NC

In NC a Dept. is:

31 Days

In NC, a health policy that is paid on a quarterly basis requires a grace period of

Commissioner of Insurance

In NC, an agent obtains his/her license from the

Less than $5000 per month benefit regardless of the cause

T has a disability Income policy that pays a monthly benefit of $5000. If T becomes partially disabled, what can he likely expect?

Request of the change will be refused

T is covered by an Accidental Death and Dismemberment (AD&D) policy that has an irrevocable beneficiary. What action will the insurance company take if T requests a change of beneficiary?

Conditional

K applies for a health insurance policy on herself and submits the initial premium with the application. She is given a receipt by the producer stating that coverage begins immediately if the application is approved. What kind of receipt was used?

Disability Income

K becomes ill after traveling overseas and is unable to work for 3 months. What kind of Policy would cover her loss of income?

Date the initial premium is collected

K completes an application for a disability policy does not pay the initial premium. The company approves the policy standard and the agent delivers the policy. K then pays her initial premium 3 days later. At what point does K's policy take effect?

Guaranteed Renewable

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

Business Overhead Expense

Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is:

Those enrolled as a full-time student

Medicare is intended for all of the following groups, EXCEPT

Major Medical with Basic Hospital/Surgical Coverage

Comprehensive Major Medical policies usually combine:

Her Group Health Plan

A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?

Recurrent Disability Provision

A disability income policyowner suffers a disability which was due to the same cause as a previous disability. Both disabilities occurred within a five-month period. The insurer may cover the second disability without a new elimination period under the:

Provides benefits for reasonable and necessary medical expenses, subject to policy limits

A major medical policy typically:

Health Maintenance Organization (HMO)

A medical care provider which typically delivers health services at its own local medical facility is known as a:

Twenty

A person insured under a health policy is required to give the insurance company a Notice of Claim within hoe many days after a covered loss?

Irrevocable

A policyowner wold like to change the beneficiary on an accidental death and dismemberment (AD&D) insurance policy and make the change payment. Which type of designation would fulfill this need?

irrevocable

A policyowner's rights are limited under which beneficiary designation?

Age

According to the Affordable Care Act (ACA), a dependent child's eligibility status is determined by

File written proof of loss

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss

Twisting

An agent inducing an insured to lapse, forfeit, or surrender insurance through misrepresentation is committing illegal act of

Transfers payments to someone other than the policyowner

An assignment of benefits of a Health Policy:

90

An eligible employee has a MAX of ____ days after their first day of employment to be added to group health coverage.

Domestic Company

An insurance company formed under NC laws is referred to as a(n);

$1,250

An insured owns an individual disability income policy with a 30-day Elimination Period for sickness and accidents and a monthy indemnity benefit of $500. if the insured is disabled for 3 1/2 months, what is the MAX amount he would receive for an approved claim?

31

An insured pays a premium on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?

immediately

An insurer receives proof of loss for an acceptable medical expense claim under an individual health insurance policy. Under the Time of Payment of Claims provision, the insurer MUST pay benefits:

$16,000

Chemical dependency treatment under a Group Health policy MUST include (over the life of the contract) a minimum benefit of

Overuse of medical Services

Deductibles are used in heath policies to lower:

War

Disability policies do NOT normally pay for disabilities arising from which of the following

States the scope and limits of the coverage

The Insuring clause

Notify an insurer of a claim within a specified time

The Notice of Claims provision requires a policyowner to:

Defamation

The circulation of written literature that maliciously critical of an insurers financial condition is called an:

not issue the form in connection with any new application

The commissioner of Insurance has notified an insurer that an individual health policy form does not comply with NC laws. The insurer may

Blanket health policies do not issue certificates

The difference between group insurance and blanket health policies is:

Internal Limit

The phrase "This policy will only pay for a semi-private room" is an example of a(n):

Payment of Claims

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

Closed Panel

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n):

Certificate

What is issued to each employee of an employer health plans?