Health Insurance Missed Questions
Most insurers issue health insurance policies for delivery in many states. Because each state regulates and mandates the requirement for policies delivered to their residents, instead of having a policy form for each state, the insurer attaches
Conformity with State Statutes provision
The gatekeeper of an HMO helps to
Control specialist costs
Which of the following is INCORRECT concerning taxation of disability income benefits?
If paid by the individual, the premiums are tax deductible
Certain conditions, such as dismemberment or total and permanent blindness, will automatically qualify the insured for full disability benefits. Which disability policy provision does this describe?
Presumptive disability
Which of the following is NOT provided by an HMO?
Reimbursement
Anna loses her left arm in an accident that is covered by her Accidental Death and Dismemberment policy. What kind of benefit will Anna most likely receive from this policy?
The capital amount in a lump sum
Who chooses a primary care physician in HMO?
The individual member
Insured Z's health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true
The insured may carry over the amount of this year's expenses to next year, which will help satisfy next year's deductible
A policy provision conflicts with state statutes. Which of the following will happen?
The provision may be altered to conform to the state statutes if the Conformity with State Statutes provision is included in the policy
An insurance institution or agent may base an adverse underwriting decision
Upon additional personal information obtained from the prospective client as the result of information received from an insurance-support organization
How soon following the occurrence of a covered loss, or after the insurer becomes liable for periodic payments for income benefits, must an insured submit written proof of such loss to the insurance company?
Within 90 days or as soon as reasonably possible but not to exceed one year
The period of time immediately following a disability during which benefits are not payable is
the elimination period
A licensee decides to terminate his residency in this state. Which of the following would be an appropriate action?
Delivering the license to the Commissioner within 30 days
This arrangement specifies who will purchase a disabled partner's interest in the event he or she becomes disabled
Disability buyout
Don has both a basic expense and a major medical policy. He is injured in a car accident, which requires several major surgeries. This quickly exhausts Don's basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?
Pay a special deductible on his major medical policy
Which of the following special policies covers unusual risks that are NOT normally included under Accidental Death and Dismemberment coverage?
Special risk policy
An insured owes his insurer a premium payment. Since then, he incurs medical expenses. The insurer deducts the unpaid premium amount from the claim amount and pays the insured the difference. What is the name of this provision?
Unpaid Premium
