Health insurance exam
Short-term disability plans are not
RENEWABLE. both group and individual plans are not renewable
a hospital indemnity will pay
a benefit for each day the insured is in a hospital
because an insurance policy is a legal contract, it must conform to the state laws governing contracts wich require all of the following elements EXCEPT.
Conditions, legal purpose, offer n acceptance EXCEPT consideration
In disability policy, the probationary period refers to the time...
During wich illness-related disabilities are excluded coverage
If the insured pays a monthly premium for health insurance, how long would the grace period be on the policy?
10 days
under the mandatory uniform provision notice of claim, the first notice of injury or sickness covered under an accident and health policy must contain...
A statement that is sufficiently clear to identify the insured and the nature of the claim.
Insurance policies are not drawn up through negotiations, and an insured has little to say about its provisions. what contract characteristics does this describe?
Adhesion: a contract of adhesion is prepared by only the insurer, the insureds only option is to accept or reject
The premium charged for exercising the guaranteed insurability rider is based upon the insured's...
Attained age: the premium charged for the increase will be based upon the attained age of insured.
What type of hospital policy pays fixed amount each day that the insured is in a hospital?
Indemnity: A hospital indemnity policy pays fixed amount each day the insured is hospitalized, unrelated to medical expenses.
A life insurance policy has a legal purpose if both of wich of the following elements exist?
Insurable interest and consent
Regarding the taxation of Business Overhead policies.
Premiums are deductible, and benefit are taxed. ( premiums paid for BOE insurance are tax deductible to the business expense. benefits received are taxable to the business as received)
What is a conditional contract?
The contract is formed on the basis that certain conditions are met by both parties.
First-dollar coverage best description
The insured is not required to pay a deductible
Wich of the following is a statement that is guaranteed to be true, and if untrue, may breach an insurance contract?
a Warranty: in insurance is a statement guaranteed to be true.
How is part B medicare funded?
by monthly premium and from the general revenues of the federal goverment.
if more than one family member covered under the same major medical policy is injured in the same accident, the family only has to pay one deductible. this is due to
common accident provision
Representations are written oral statements made by the applicant that are...
considered true to the best of the applicant's knowledge
The legal process that gives the insurer, after a payment of loss, the right to seek recovery from a third party that was responsible for the loss is know as
subrogation
All of the following statements about medicare supplement insurance policies EXCEPT
they cover medicare deductibles and copayments, they supplement medicare benefits, they are issued by private insurance EXCEPT they cover the cost of extended nursing home care
Conversion from group to individual
31 days
if a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply.
5 days
A feature of disability buyout plan?
A lump-sum benefit payment option
Wich of the following medical professional will NOT be covered under LTC' home health care.
Licensed practical nurse, community-based organization professionals, registered nurses NOT attending physician
a health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as
Major medical, AD&D, medical expense or critical illness. ANSWER critical illness
In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary and reasonable, the extra cost
Must be covered by the insurer, counts toward deductible, counts toward coinsurance, is not covered. ANSWER is not covered
Long-term care coverage may be available as any of the following options EXCEPT
group long-term care, individual long-term care, endorsement of a life policy EXCEPT endorsement to a health policy.
an insured is involved in a car accident. in addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive presumptive disability benefits?
no benefit, partial benefit, complete benefit. ANSWER no benefit
Insurance contract must contain all of the following EXCEPT
offer n acceptance, consideration, competent parties and legal purpose EXCEPT Beneficiary's consent
Prior to purchasing a medigap policy, a person must be enrolled in what?
parts A and B of medicare
an insured has endured multiple surgeries and hospitalizations for an illness during the last few months. Her insurer no longer bills her for medical expenses. Wich of the following allows that?
waiver of premium, maximum loss, stop-loss limits, grace period. ANSWER stop-loss limits
Free-look provision
a mandatory provision found in health insurance policies that allows the applicant to examine the policy and if dissatisfied for any reason, return the policy for a full refund.
Difference between copay and coinsurance?
copay is a set dollar amount and coinsurance is a percentage of the expenses.
in a basic expense policy, after the limits of the basic policy are exhausted, the insured must pay what kind of deductible?
corridor, full, half, none ANSWER corridor
what is the definition of unilateral contract?
one-sided: only one party makes an enforceable promise
An agents appointments has been denied. Wich of the following is true?
States taxes may be refunded upon written request.
What benefit is based on primary insurance amount?
Social Securitybdisability