health

monthly

according to the time payment of claims provision, the insurer must pay disability income benefits no less frequently than which of the following?

failing to effectuate prompt, fair, and equitable settlements of a claim

an example of an unfair claims practice would be

gender

an insurance company may not reject a prospective insured's insurance application on the basis of which of the following factors.

licensed producer appointed by the insurer

an insurance company may only pay commissions to a

Proceeds will go to the contingent beneficiary

an insured covered by accidental death and dismemberment (AD&D) insurance has just died. What will happen if the primary beneficiary had already died before the insured and contingent beneficiary

immediately

an insurer receives proof of loss for an acceptable medical expense claim under an individual health insurance policy. Under the time payment of claims provision. the insurer must pay the benefits

an insured must wait at least 60 days after proof of loss has been submitted before a lawsuit can be filed

best describes what the legal actions provision of an accident and health policy requires

Limited Benefit Plans

cancer policies critical illness policies dental policies

rating services

All of these are considered sources of underwriting information about an applicant EXCEPT

is owned exclusively by its shareholder

a stock insurance company

to arrest that statements on the application are accurate to the best of the applicant's knowledge

why is an applicant's signature required on a health insurance application?

File written proof of loss

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?

expense incurred

Long Term Care policies will usually pay for eligible benefits using which of the following methods?

available to those who are enrolled in Medicare part A and Part B

Medicare part C is:

36

S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of many months under COBRA regulations

Time Limit on Certain Defenses

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called

Notice Regarding Replacement

T the producer is replacing a client's insurance policy with a new one. Prior to policy delivery, which form must the client be provided with?

time limit on certain defenses

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is

Irrevocable Beneficiary

What kind of life insurance beneficiary requires his/her consent when a change of beneficiary is made?

waiver of premium rider

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled?

major medical

Which of the following individual health insurance policies will provide the broadest protection?

Major Medical Policy

Which of the following types of health coverage frequently uses a deductible?

10 days

a lapsed health insurance policy has recently been reinstated. How long after reinstatement must an insured wait before coverage for sickness is available?

the maximum amount considered eligible for reimbursement by an insurance company under a health

statement best defines, usual, customary, and reasonable (UCR)charges

the insurer will rescind the policy, deny the claim, and recover all payments made

t was insured under an individual disability income policy and was severely burned in a fire. As a result, T became totally disabled. The insurer began making monthly benefits payments, but later discovered that the fire was set by T in what was described as arson. What actions will the insurer take?

if the employee paid for qualified medical expenses, the reimbursements may be tax-free

true statement about health reimbursement arrangement (HRA)

complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company

what correctly explains the actions and agent should take if a customer wants to apply for an insurance policy?

The ability to periodically increase the amount of coverage without evidence of insurability

what does a guaranteed insurability rider provide a disability income policyowner

time period of disabled person must with before benefits are paid

what is the elimination of period of individual disability policy?

contributory

when an employee is required to pay a portion of the premium for an employer/ employee group health plan, the employee is covered under which of the following plan

cease and desist order

when an unfair trade practice has been discovered, the commissioner of commerce may issue

life insurance policies

which if the following is not a limited benefits plan

HMO

which of the following types of organizations are prepaid group health plans, where members pay in advance of the service of participating physician and hospital that have agreements