Chapter 8

What is the maximum number of employees allowed in order for a group to qualify for a guaranteed-issue group plan

50

to qualify as an eligible insured under HIPPA, a person must not have has a gap in coverage lasting more than how many days?

63 days

Types of disability income insurance

Business overhead, disability buyout, key person. EXCEPT builder's risk disability

In group insurance, the underwriter will examine a group's experience rating, which is associated most closely with the groups

Claims experience

Money that an individual pays for health care services after a deductible has been paid is called

Coinsurance

Which of the following types of groups are formed when several similar or related small companies join forces to create a large pool of people that the insurer will accept as a group?

Multiple-employer trusts

In long-term care insurance, what is maximum daily benefit?

The maximum amount the insurer will pay per day for care

which of the following is true of noncontributory life insurance?

The plan is completely paid for by the employer

In group insurance, the underwriter will examine a groups experience rating, which is associated most closely with the groups

claims experience

An insured has a major medical policy that calls for a $1,000 deductible and 80/20 participation. If this insured incurs covered medical; expenses of $5,000, the insured would pay

$1,800

How much of the premium is paid by employees participating in a non-contributory plan?

0%

An insured has a major medical policy that class for a $1,000 deductible and 80/20 participation. If this insured incurs cover medical expenses of $5,000, the insured would pay

1,800

An insurer may used MIB reports for

Logging codes after underwriting is complete, investigating an applicant's medical history, examining an applicant's moral history. EXCEPT justifying denial of a policy

Which of the following statements is true regarding group health insurance underwriting?

Medical insurance underwriting is typically not necessary for large groups but may be required for small groups

Mandatory provision in health insurance policies

Notice of claim, Grace period, Entire Contract. EXCEPT illegal occupation

An individual just lost his job. Under COBRA, for how many months is this individual entitled to keep his health insurance coverage?

18 months

A stop-loss limit provision puts a cap on which of the following?

Coinsurance a policyholder must pay

What is an outcome of the consolidated omnibus reconciliation act?

Individuals who leave their jobs may temporarily keep their existing health coverage

Which of the following provisions states that it is the insureds responsibility to notify the insurer of a loss within a specified number of days?

Notice of claim

If an insured employee selects COBRA coverage after the employment is terminated, how much premium will the insured have to pay?

100% of the premium paid by the employer and 2% processing fees

how many consecutive months of coverage must LTC insurance provide in this state?

12 months

Which of the following is a specified dollar amount that the insured must pay before the policy benefits begin?

Deductible

In disability income insurance, a deductible stated in days instead of dollars is known as

Elimination period

The time between the date a disability commences and the beginning of the benefit payment period is called the

Elimination period

Benefits of cafeteria plans

Employees converting taxable income to nontaxable income, employers forgoing FICA taxes on employee contributions, choosing between benefit plans. EXCEPT carrying money from one year to the next.

which of the following provisions states what must be included for an insurance contract to be considered complete?

Entire contract

Qualifying events for COBRA

Reduction of work hours to part-time status, a divorce form the insured employee, coverage for dependents due to the employee's death. EXCEPT termination of employment for gross misconduct

which of the following types of long term care services provides temporary relief from caregiving to a member of the insured's immediate family?

Respite care

An insured has a cavity filled. His insurer covers his claim up to a predetermined amount, which is indicated by a fee schedule. Which type of dental plan does the insured have?

Scheduled