Accident and Health Laws, Rules and Regulations

What are some examples of words/phrases that producers are prohibited to use?

"Tax free" "Extra cash" "Extra income" Claim settlements can not be described as "generous"

What is the Health Insurance Exchange?

An online market to secure health coverage that fall into four qualified health plans

Newborn and Adopted Child Coverage

Covers newborns/adopted children from the moment of birth/placement for a maximum of 60 days includes treatment of medically diagnosed care Dependent care will continue if notification is provided to the insurance company within the 60 days

How long of a Free Look Provision is included in a Long Term Care policy?

It has a 30 day free look

What is the Patient Protection and Affordable Care Act (Health Reform Law)?

It mandates 5 qualified health plans that much include certain Essential Health Benefits (EHB)

What are some examples of Essential Health Benefits?

-Ambulatory services -Emergency services -Prescription drugs -Lab services -Preventative services

What are the requirements to have coverage under the ICHA?

-Be a resident of Iowa for at least 60 days -Been denied health insurance due to a preexisting condition

What does Long Term Care (LTC) provide coverage for?

1. Loss of functional capacity 2. Cognitive impairment (Alzheimer's Dementia)

What steps must an insurer take if they withdraw a health plan?

1. Provide a nonrenewal notification at least 90 days in advance of renewal 2. Offer an alternative health plan

What is the Grace Period for a monthly premium policy?

10 days

What is the Grace Period for all other policies?

31 days

How long does someone have to request a reinstatement for their Long Term Care policy?

5 months after termination

What is the Grace Period for a weekly premium policy?

7 days

What is the Healthy and Well Kids in Iowa Program (HAWK-I)?

A joint federal-state funded program that provides health insurance to certain children

How long must an LTC policy provide coverage?

A minimum of 12 consecutive months somewhere other than an acute care facility (hospital)

What is the Iowa Comprehensive Health Association (ICHA or HIPIOWA)?

A non-profit corporation created by the Iowa State Legislature to provide health insurance to Iowa residents who have been denied coverage

Incontestability Clause

A policy that prohibits the insurance company from denying a claim for any reason other than nonpayment of the premium AND fraudulent misstatements after the policy has been in effect for two years

The purpose of the replacement regulation is to: A. Minimize the sale of a new policy that is detrimental to the applicant B. Promote the sale of new health insurance C. Ensure that new health insurance is competitive D. Promote the conversation of existing health insurance

A. Minimize the sale of a new policy that is detrimental to the applicant

A health policy that covers a specific illness: A. Must indicate: This is a limited policy B. Must indicate: This is critical insurance coverage C. Is prohibited in Iowa D. Is permitted in Iowa

A. Must indicate: This is a limited policy

Individuals may represent themselves as financial planners: A. If they are licensed B. If they have credentials from a national designation program C. Ensure that new health insurance is competitive D. Promote the conversation of existing health insurance

B. If they have credentials from a national designation program

Group health insurance premiums that are paid 100% by the employer are: A. Contributory B. Noncontributory C. Mandatory D. Taxable

B. Noncontributory

During a replacement transaction, the producer must: A. Advise the applicant of the financial rating of the new insurer B. Advise the insurance division of the replacement C. Complete a replacement form D. Present the applicant with a policy illustration

C. Complete a replacement form

In a sale of insurance, suitability refers to the: A. Insurer's underwriting guidelines in accepting new business B. Insurer's financial guidelines in accepting new business C. Insurance division's requirement that insurance is in applicant's best interest D. Producer's guidelines in writing new business

C. Insurance division's requirement that insurance is in applicant's best interest

The insurance division prohibits which of the following activities during the sale of insurance: A. Promoting the AM Best financial rating of the insurer B. Promoting the educational background of the producer C. Promoting the existence of the Iowa Guaranty Association D. Promoting the services provided by the producer or insurer

C. Promoting the existence of the Iowa Guaranty Association

Individual health plans are: A. Noncancelable B. Renewable at the option of the insurer C. Renewable at the option of the insured D. Renewal indefinitely

C. Renewable at the option of the insured

Which of the following is NOT a feature of group health insurance? A. Premiums are determined by age, sex and occupation as a group B. Policy amounts must be issued according to non-discriminatory test C. Statements made by the policyholder are considered representations D. Coverage is only applicable to employees

D. Coverage is only applicable to employees

When selling a new health insurance policy, a producer must: A. Make sure that the policy duplicates a current policy in force B. Use undue pressure to secure coverage C. Complete a replacement form D. Present an outline of coverage

D. Present an outline of coverage

What are the Iowa Mandated Coverages?

Diabetic coverages Mammography coverage Prescriptive contraceptive coverage Newborn and adopted child coverage Complications from pregnancy

What is the Silver plan?

Has a lower premium, higher out of pocket expense (70/30% coinsurance)

What is a Bronze plan?

Has the lowest premium, highest out of poked expense (60/40% coinsurance)

What is the Gold plan?

Higher premium, lower out of pocket expense (80/20% coinsurance)

What is the Platinum plan?

Highest premium, lowest out of pocked expense (90/10% coinsurance)

Diabetic Coverage

Provides benefits for the costs associated with equipment, supplies, and education for the treatment of diabetes

What is Medicare Supplement Insurance (Medigap)?

Refers to policies that are marketed to individuals that are 65 or older and pays for some of the deductibles and copayments found in Medicare

What is the Notice of Claim Provision?

Requires that written notice of a claim must be given to the insurance company within 20 days after the occurence

What is the Proof of Loss Provision?

Requires that written proof of loss be given to the insurer within 90 days after the termination of the period for which the insurer is liable

What is the Claims Forms Provision?

Requires the insurance company to furnish claims forms within 15 days after being given notice of a claim