Health practice final

A physician opens up a new practice and qualifies for a $7000/month disability income policy. What rider would the physician add if he wants the ability to increase his policy benefits as his practice and income grow?

Guaranteed insurability option rider

PPO's

are a considered to be a managed health care system

In order to establish a health reimbursement arrangement (HRA), it must:

be established by the employer

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n):

closed panel

M completes an application for life insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect EXCEPT

free-look period has expired

The health insurance portability and accountability Act (HIPAA) gives privacy protection for:

health information

With a Basic Medical Expense policy, what does the hospitalization expense cover?

hospital room & board

An insurer receives proof of loss for an acceptable medical expense claim under an Individual Health Insurance Policy. Under the Time of Payment of Claims provision, the insurer MUST pay the benefits

immediately

the first portion of a covered major medical insurance expense that insured is required to pay is called the?

initial deductible

Medicare Part B does NOT cover

inpatient hospital services

Information obtained from a phone conversation to the proposed insured can be found in which of these reports?

inspection report

Which health policy clause specifies the amount of benefits to be paid?

insuring

the clause identifying which losses resulting from an accident or sickness are insured by the policy bis the called the:

insuring clause

which of the following claims are typically excluded from medical expense policies?

intentionally self-inflicted injuries

Which type of plan normally includes hospice benefits?

managed care plans

what is not a managed care organization?

medical information bureau

The document that describes policy features, benefits, exclusions and riders in a long term care policy is known as?

outline of coverage

Deductibles are used in health policies to lower

overuse of medical services

Deductibles are used in health policies to lower?"

overuse of medical services

Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?

preferred provider organization (PPO)

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

10 days

coverage for sickness is available how many days after reinstatement?

10 days

An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.

15 days

An insurer must send notice of appointment how many days?

15 days

According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?

31 days

An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?

31 days

new born additional premium

31 days

Under which of the following circumstances will the benefits under COBRA continuations coverage end?

All group health plans are terminated by the employer

what does a medicare supplement policy cover?

Allowable amounts under medicare Part B

All of the following statements regarding group health insurance is true, EXCEPT?

An individual policy is given to each member

When is a Group Health policy required to provide coverage for a newborn child?

At the moment of birth

When does a Probationary Period provision become effective in a health insurance contract?

At the policy's inception

G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern is

Business overhead expense

organization that would make reimbursement payments directly to the insured?

Commercial insurer

what best describes a hospital indemnity policy?

Coverage that pays a stated amount per day of a covered hospitalization

K completes an application for a disability policy but does not pay the initial premium. The company approves the policy standard and the agent delivers the policy. K then pays her initial premium 3 days later. At what point does K's policy take effect?

Date the initial premium is collected

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?

Determined by the terms of the policy

Characteristic of preferred provider organizations (PPO's) would be:

Discounted fees for the patient

which of the following statements BEST describes the intent of a coinsurance clause in a major medical policy?

Discourages over-utilization of the insurance coverage

M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?

Earned, but unpaid benefits

From what authority derives the requirement that an insurance application contains a disclosure stating that an investigative consumer report may be obtained on an applicant?

Fair credit reporting act

When determining the monthly benefit amount for a disability income policy, the factor that limits the amount a prospective insured may purchase is?

Income

The health insurance program which is administered by each state and funded by both the federal law and state government is called:

Medicaid

The provision that defines to whom the insurer will pay benefits to is called?

Payment of claims

The insuring clause

States the scope and limits of the coverage

Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party?

Subrogation

an assignment of benefits of a health policy:

Transfers payments to someone other than the policyownwer

describe how pre-admission certifications are used?

Used to prevent nonessential medical costs

A foreign insurance company?

a company formed under the laws of another state

Social Securtiy does NOT provide benefits for?

dismemberment

Benefits NOT covered due to an act of war are:

excluded by the insurer in the contract provision

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

file written proof of loss

A major medical policy typically?

provides benefits for reasonable and necessary medical expenses, subject to policy limits

percentage of PIA determines?

social security disability income

Insured losses are covered immediately after a health policy is reinstated when:

the losses result from accidental injuries

A disability period is best described as a:

time deductible

elimination period?

time period a disabled person must wait before benefits are paid

Disability policies do NOT normally pay for disabilities arising from which of the following?

war