DE Accident & Health Insurance March 2020 Quizlet

A nonresident agent would not apply for a temporary license in Delaware, but for a

nonresident agent's license

Group plans are not tailored to

the individual

Petra is self-employed and pays $5000 a year in premiums for health insurance covering her family. If her spouse also works and is covered by an employer-sponsored health plan, what is the maximum income tax deduction Petra can take for her health insurance coverage?

$0 . THE DEDUCTION IS NOT AVAILABLE TO THOSE WHO COULD BE COVERED BY THEIR SPOUSES GROUP POLICY.

Commissioner charges how much for nonwillful violations and how much for willful violations?

$1000 per violation up to $10,000 for nonwillful violations $5000 fine for willful violations, up to a total of $50,000 in any 6-month period.

Suppose an insurer has knowingly accepted insurance business from an individual who is not licensed. He can be fined up to:

$20,000.00

What is the maximum amount in life insurance benefits covered by the Delaware Life and Health Insurance Guaranty Association?

$300,000

What is the maximum number of days of skilled nursing facility care for which Medicare will pay benefits?

100 days

According to the disability insurance time limit on certain defenses provision, how long after the date of a policy's issue can innocent misstatements on an application be used to void a claim? For the life of the policy 5 years 2 years 1 year

2 years

Benefit periods for long-term disability income policies typically range from:

2 years or longer

Identify the number of days the insured or insurer must do the following in this order: Notice of Claim, Claims Forms, Proof of Loss, Waiting Period for Sickness Claims upon Reinstatement

20, 15, 90, 10

How many continuing education credits must Delaware resident producer licensees earn every two years?

24 credits (12 per year)

A license is being used for controlled business if more than

25% of the agent's total commission is earned from controlled business

The free look provision in a long term care policy allows for how many days for a full refund?

30 days

To be considered currently insured, and therefore eligible for disability benefits under Social Security, a worker must have earned a minimum of

6 credits in the last 13 quarters

To be eligible for disability benefits under Social Security, a worker must have earned a minimum of

6 credits in the last 13 quarters

Benefit periods for short-term disability income policies typically range from:

6 months to 2 years

After an individual has received the eligibility notice for COBRA continuation from the employer, the option to elect coverage expires

60 days from the date of receipt

What is the definition of pre-existing condition in a long-term care policy?

A condition for which advice or treatment was received within 6 months before the effective date of coverage

A group of employers from a similar industry assembled to qualify for group health insurance is

A multiple employer trust

Guaranteed renewable health insurance policies ensure renewability up to

A specific age of the insured

METs can provide benefits on a self-funded basis, or they can

Add benefits through a contract issued by an insurance company.

Medicare—Part D Prescription Drug Coverage is available to

Anyone enrolled in Medicare Part A

Disability benefit payments funded fully by employer

Are taxable

Bob is severely injured after falling off of his roof while cleaning the gutters. If he is unable to provide proof of loss within 90 days, it may

Be filed up to one year after the date of loss

To be eligible for Social Security disability benefits, one of the requirements is that the person

Be totally and permanently disabled for at least 5 months

A POS plan allows a subscriber to access care

Both in-network and out-of-network

Under many dental expense plans, diagnostic care is

Covered

Medicare supplement policies (Medigap) pay for medical costs arising from extended ___________

Custodial (nursing home) care

Medicare Part A covers 80% of the cost of

Durable medical equipment

Injuries covered by workers compensation are technically _______ under health insurance

Excluded. Workers comp is a separate thing.

Major medical policies may include which types of deductibles?

Flat, corridor, per cause

Presumptive Disability provision will provide benefits

For very severe conditions that raise the presumption of total disablement

Who sets the requirements that must be met for LTC policies to be considered qualified

HIPAA 1996

Dentists that are on a specified list, and whom are paid on a flat per capita basis, characterizes an

HMO

An employer funded account that pays employees for qualified medical expenses they incur

Health Reimbursement Account

Most long term care policies provide coverage for ____________ care

Home health care

How long must replaxing and existing insurers maintain a replacement register and copies of all written communications regarding replacement?

Three years

Changes made to a health policy in Delaware must be approved ......

In writing by an executive officer of the insurance company

Major medical policies may include any of the following types of deductibles

Integrated/per-cause, corridor, or flat

Because of Pearson's financial situation, he must rely on Medicaid to pay the cost of long-term care. Pearson is not a good candidate for

LTC

Three distinct categories of basic health coverage exist:

Medical expense, disability income, and accident-only

Coverage for the reasonable cost of the first 3 pints of blood must be included in all _______________

Medicare Supplement Policies. All CORE benefits must be included

Qualifying events under COBRA include

Medicare eligibility, reduction in work hours, termination of a child's dependent status and divorce

Benefits received from a tax-qualified, long-term care insurance plan for employees are

NOT subject to income tax

Is illegal occupation a mandatory provision?

No , it is optional, because in some cases it is not needed

Disability benefit payments with employee contributions are

Not taxable

A nonforfeiture benefit is an ____________ benefit to a long-term care insurance policy?

Optional

Loss-of-time benefit adjustment - optional or required?

Optional , because in some cases it is not needed.

ERISA requires certain information concerning group insurance plans be made available to

Plan participants and their beneficiaries The IRS The Department of Labor

Change of occupation provision states that a change in occupation from a more dangerous to less dangerous occupation specifies that

Premiums will be reduced and the insurer will return the excess pro-rata unearned premium to her

Medicare Part A specifically excludes

Private duty nursing, non-medical services, intermediate care, custodial care, and the first three pints of blood

Change of beneficiary - optional or required?

Required!

What type of plan integrates its coverage with basic medical expense coverage, providing benefits in excess of those specified in the basic plan

Supplementary Major Medical

The commissioner is elected by

The citizens

Utilization review is a set of techniques to evaluate

The clinical necessity of health care services `

The Medical Reimbursement benefit available in some individual disability income policies is a percentage of

The monthly income benefit

Union workers as a class may be excluded since

Their compensation and benefits are covered by a collective bargaining agreement

Which of the following statements regarding persons participating in an HMO is correct? They negotiate health care service fees with contracted HMO providers They pay for health care services are they incurred They pay a fixed periodic fee whether or not health care services are used They pay for health care services as they are incurred, at a rate discounted for the HMO

They pay a fixed periodic fee whether or not health care services are used

A managed health care system that finances and delivers health care services through contract providers is called

a Health Maintenance Organization (HMO)