AR Health Guaranteed Exam Missed

The "stop-loss" feature on a major medical policy is intended to

establish a maximum amount of out-of-pocket expense that an insured will have to pay for medical expense in the calendar year

A husband and wife both incur expenses that are attributed to a single major medical insurance deductible. Which type of policy do they have?

family

In order for an alumni association to be eligible to purchase group health insurance for its members, all of these statements must be true EXCEPT when the asscociation

has been active for five years minimum *2 years *100 members *constitution, bylaws, meetings *organized for reasons other than insurance

Ed is covered under a health plan provided by his employer. HE was told that his insurance would pay the majority of the covered expenses if he would choose to see a provider in his plan's list. If Ed chose to be treated by a provider who was not on the list, his portion of the bill would be greater. Ed is covered under a/an

preferred provider plan

An insured is anxious to get treatment for a health condition, and is convinced that a specialists is needed to cure the condition. If the insured has a PPO plan,

the insured can select any specialist, but non-network specialists will have higher out of pocket costs

Which of the following statements is incorrect?

the insurer does not have the right to conduct an autopsy

If an applicant submits the initial premium with an application, which action constitutes acceptance?

the underwriters approve the application

An agent tells an insured that if he replaces his current insurance policy with a newer one, his dividends will behiher and his premium will be slightly lower. The policy however, would not offer either one of these things. What type of misrepresentation is being committed?

twisting

An agent who knowingly misrepresents material information for the purpose of inducing an insurance to lapse, forfeit, change, or surrender a life insurance policy or annuity has committed an illegal practice known as

twisting

Under the mandatory uniform provision Notice of Claim, written notice of claim must be submitted to the insurer within what time parameter?

w/in 20 days

An employee is insured by a group major medical plan that is provided through her employer. The employer contributes 75% of the premium and the employee contributes the remaining 25%. If the insured received a benefit from this policy in the amount of $1,000, how much of this benefit would be taxed as income?

$0

An employee has a Flexible Spending Account (FSA) with a $5,000 annual benefit. This year the employee used $3,000. What is available next year?

$5,000 "use-or-lose" rule

How many members must a group have to be eligible for blanket coverage?

100

What is the minimum length of coverage required for long-term care policies?

12 month

Within what number of days can a new HMO enrollee expect to recieve evidence of coverage?

30 days from effective date of coverage

What is the maximum age that a disabled insured workers mwy recieve Social Security disability benefits?

65

Under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss?

90 days

Which of the following statements is NOT true regarding health insurance policy provisions?

All additional provisions written by insurers are cataloged by their respective states

An applicant gives her agent a completed application and the initial premium. What can the agent issue her that acknowledges the initial premium payment?

Conditional Receipt

The Uniform Provision Law that prevents an insurance company from altering its agreement with a policyholder by referring to documents or other items not contained in the policy is called the

Entire Contract Provision

A portion of a patient's open-heart surgery costs is paid by the organization that provides the surgery and post-operative care. Which type of organizaton is this?

HMO

Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care?

Intermediate care

When may HIV-related results be provided to the MIB?

Only if the individual is not identified

A core Medicare supplement policy (plan A) will cover all of the following EXCEPT

Plan A deductable

Which of the following is NOT mandatory under the Uniform Provisions Law as applied to accident and health policies?

Probationary Period

HMOs are known as what type of plans?

Service

An insured was diagnosed 2 years ago w/ kidney canceer. She was treated w/ surgeries and chemotheraphy and is now in remission. She also has a 30-year smoking history. The insured is now healthy enough to work and has just started a full time job.

She would be covered under her employer's group health insurance plna, without higher premiums

Insureds have the right to do which of the following if they have NOT received the proper claim forms within 15 days of their notice to the insurer of a covered loss under a major medical policy?

Submit the description in their own words on a plain sheet of paper

If a basic medical insurance plan's benefits are exhausted, what type of plan will then begin covering those losses?

Supplementary major medical

Jane was granted a temporary license for her deceased's husband's agency on MArch 1st. On May 1st she processed an application for the life insurance on a aplicant.

The application was processes w/o a valid license

Which statement is an accurate description of life insurance policy dividend?

They are not taxable and are not guranteed

Does NOT allow the insurer to deny a claim due to a misstatement on the application after the policy has been in force for a number of years

Time Limit on Certain Defenses

Under a group health insurance plan, benefits may be extended to all of the following dependents EXCEPT

a 27-year old married daughter who is attending college and lives with her parents

All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT

an association of 35 people

A Major Medical Expense policy would exclude coverage for all of the follow treatments EXCEPT:

drug addiction

guranteed purchase option

future increase option

All of the following are features of catastrophic plans EXCEPT

high premiums

principle

insurer issuing a policy

All of the following are excluded from coverage in an individual health insurance policy EXCEPT

mental illness

Guranteeing future dividends is considered to be an unfair or deceptive act known as

misrepresentation

Entire Contract Clause in Health Insurance

only an executive officer of the company can make changes

On the Accident Death and Dismemberment (AD&D) policy, the death benefit payable is known as the

principal sum

Disability income insurance

residual benefit