exam study
20 hours
Required prelicensing education
Health Savings Account (HSA)
Tax-sheltered savings account similar to an IRA but created primarily to pay for medical expenses. Individual covered by HDH) not eligible for medicare. Must be covered by an HDHP for this plan and individual or employer contribute. Annually specified limit, Funds do carry over.
Master Policy
The policy contract issued to the employer under a Group insurance plan. Remember, the employees covered by a group plan are considered to be insureds, but they only receive certificates.
cost of living cola
The rider that may be added to a Disability Income policy that allows for an increase in the benefit amount under certain conditions is called
15 days
To notify agent of termination of appointment
PPO
Under which of the following organizations are the practicing providers compensated on a fee for service basis
legal action
What health policy provision prevents the insured from bringing a lawsuit against the insurance company for at least 60 days after proof of loss is provided
application and policy issued
What is the entire contract in health insurance underwriting?
50
What is the max number of employees that a small employer can have
Point of service plan (POS)
a network of selected contracted, participating providers; also called an HMO-PPO hybrid or open-ended HMO. Higher coinsurance
10 days
advance notice to the policyholder for midterm policy cancellation
30 days
after notice unpaid claims considered overdue
1 year
after time required by policy for insured to send proof of loss
Flexible spending account (FSA)
all employees eligible except self employed, do not have to be covered by a health plan, both employer and employee and contribute, no statutory limits, and does not carry over funds
Health Reimbursement Account (HRA)
all employees eligible, do not have to be covered by a health plan, employer contributes, no statutory limits, and funds can be carried over
scheduled plan
also known as basic; pays benefits from a list of procedures up to the amount shown in the schedule. no coinsurance or deductibiles
100000
amount of bond that may be required for surplus lines agents and brokers
7.5%
annual interest rate on overdue claims payments
Commissioner
appointed by he governer
15 days
appointments are effective prior to being entered in the licensing system
5 years
before person with revoked license can reapply
medicare
being 65 or having been entitled to to social security disability income benefits for 2 years or having kidney failure qualifies you for what
35
biennial regulation fee for resident producers
special enrollment
can enroll anytime of the year if the individuals spouse is still employed and covered under a group health plan
precertification
clause that allows both insured and dentist to know in advance what benefits will be paid
36 months
cobra covers dependents after events such as death of the employee, divorce, or legal separation for how long
24 hours
continuing education required every 2 years
exclusions
cosmetic procedures, denture replacement or duplicates, and oral hygiene instructions
Individual Catastrophic Plans
cover essential benefits and are available for adults under 30 and individuals who cannot obtain affordable coverage. Low monthly premiums but high deductibles
5 years
examine domestic insurers and licensed rate service organizations
20 days
for an aggrieved person to request a rehearing
30 days
for comissioner to act on rehearing petition before it is considered denied
part A
hospital insurance (financed through payroll tax)
agent
if an applicant does not receive is or her insurance policy who is responsible
Part A
inpatient hospital care is covered by
general enrollment
jan 1st-march 31st
5000
max amount of compulsive forfeiture for noncompliance with an order
1000
max fine for a firm whose agent has committed a violation
1000
max fine per day for violation of an order
3 and a half years
max imprisonment for person violating insurance code
1 year
max period for a temporary license
10000
max total penalty for a person violating insurance statutes
indemnity
means insured cannot recover more than their loss. and is a provision in an insurance policy that states that in the event of loss an insured is permitted to collect only to the extent of the financial loss
part B
medical insurance (financed through insureds and general revenues)
part C
medicare advantage which allows receipt of health care services through available provider organizations
25
minimum placed risks with all insurers in 1 year to be considered more than an occasional exchange of business
5
minimum placed risks with one insurer in 1 year to be considered more than an occasional exchange of business
3 years
minimum time to keep records
12 months
no prelicensing education required if license held in another state for the same line of authority
60 days
notice to insured when cancelling a policy in effect for more than one year
Major service
orthodontic work under a nonscheduled plan
Part B
outpatient hospital care
prepaid plans
payments are made continuously, regardless of services provided
HMO
preventive care prepaid basis limited to service area
comprehensive care
provide coverage for most types of medical expenses
COBRA
qualifying events for this are voluntary termination of employment, termination for reasons other than gross misconduct, employment status change from full time to part time
Part A
skilled nursing facility care is covered by
benefit schedule
specifically states exactly what is covered in the plan and for how much
representations
statements that are believed to be true
benefit amount will be adjusted to the insureds correct age
the insured on a health policy misstated his age on the application. If this misrepresentation is discovered what will happen to the policy
Medicare carve out or supplements
they pay deductibles that are not paid by medicare
2 weeks
to comply with an order before a penalty is issued
30 days
to notify commissioner of a change of address
30 days
to notify commissioner of termination of appointment
30 days
to report felony or misdemeanor conviction
30 days
to request a hearing after an order is issued without one
integrated expense plan
type of dental plan which is incorporated into a major medical expense plan
group
what disability income plan would benefits be subject to income tax
a percentage of the principal sum
what is the capital sum in accidental death and dismemberment coverage
lower
when compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is
when premium was paid upon policy delivery and not at time of application
when should an gent obtain a statement of good health from insured
Insurer
who pays the expense for an autopsy
The SIS payment will be reduced dollar-for-dollar by the Social Security benefit payment.
your client has a social insurance supplement rider on his disability policy. After he becomes disabled he receives payments from the company. Shortly therafter he also begins receiving social security benefit payments, What will happen.
discretionary group
- A group that can apply for group health insurance according to a decision made by the head of the Department of Insurance
10-60 days
- For Commissioner to give hearing after a request
Bronze
60%
Silver
70%
Gold
80%
Platinum
90%
Reinsurance
A contract under which one insurance company (the reinsurer) indemnifies another insurance company for part or all of its liabilities.
risk retention group
A liability insurance company owned by its members, which are exposed to similar liability risks by virtue of being in the same business or industry.
15 working days
After receipt of request, for insurer to supply insured with a copy of the application
captive agent
An insurance producer who by contract is bound to write insurance for only one company is classified as a/an
3 hours
CE credits in ethics
20 employees
COBRA applies to employers with at least
18 months
Cobra covers you for how long after a qualifying event
Specified Coverage
Coverage under medical expense insurance that is limited to one specific form of care, such as vision-only, dental-only, etc
Field Underwriting
During this process, the producer determines which risks are desirable and submits those to the underwriting department for approval. The producer provides any required disclosure of information practices to an applicant, such as a notice regarding replacement, a buyer's guide, an outline of coverage, or a policy summary.
ERISA (Employee Retirement Income Security Act)
Ensures employees receive pension and other benefits promised by their employers
2 plans
Every small employer carrier must actively offer to small employers at least how many health benefit plans?
major medical insurance (indemnity plans)
High maximum limits Blanket coverage Deductibles paid up front Cost shared after meeting deductible
75%
How many eligible employees must be included in a contributory plan
Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation
How will changing ones occupation to be more hazardous affect the health insurance policy in force?
10 days
If the insured pays a monthly premium for health insurance, how long would the grace period be on the policy?
Affordable Care Act
Mandates preventative, educational, and community based health care. Premiums based on geographical rating, family composition, ae, and tobacco use. Children covered till 26. Coverage for preexisting conditions. Enrollment nov 1-Jan 31. Metal level plans.
90 days
Most health policies will pay the accidental death benefits if the death is caused by an accident and occurs within how many days?
nonscheduled plan
Pays on the basis of what is considered usual, customary, and reasonable (UCR) in a certain geographic area and based on amount physicians in area usually charge for same or similar procedures.
Hospital Indemnity
Pays you a fixed amount for each day you are hospitalized Does not cover medical costs Supplement to the other plans
PPO
Preferred provider organization. A prepaid health insurance plan in which providers agree to deliver services for discount fees; patients can go to any provider, but using nonparticipating providers results in higher costs to the patient
part D
Prescription drug coverage