Illinois health insurance comprehensive EXAM
An insured must notify an insurer of a medical claim within how many days after an accident?
"20". Notice of a claim is typically required within 20 days after the occurrence or a commencement of the loss.
The open Enrollment period for Medicare supplement begins at age
65
Q the producer Gave his client a rebate as an incitement to purchase insurance. Q may be found guilty of a
Class B misdemeanor
Health insurance policy where the insurer has the right to terminate the policy for reasons other than the insurance health is called
Conditional renewability
All of these are characteristics of a major medical expense policy except
Elimination Periods -The elimination period is the period of time between the onset of a disability, and the time you are eligible for benefits. It is typically a characteristic of disability policies, not major medical expense policies.
A 70-year old insured individual has suffered from kidney failure for the past 24 months. She is covered by her spouse's large-group employer plan. How will Medicare be utilized in this situation?
Will be the secondary insurer and pay for claims not fully covered by the group plan If you are eligible for Medicare because of kidney failure and are also covered by a group health plan, your group plan will pay first on your hospital and medical bills for 30 months. During this time, Medicare pays second.
The waiver of premium does not include which provision
All future premiums are waived if the insured recovers from the disability
Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500?
$700 In this situation, the insured will pay $500 deductible plus $200 coinsurance = $700.
All of the following statements correctly describe the purpose of Social Security
1. It provides retirement in survivor benefits to a worker and the workers family 2. augments a sound personal insurance plan 3. provides basic protection against financial problems accompanying death, disability, and retirement
Which of the following actions may an insurance company do in a health policy that contains a guaranteed renewable premium benefit
1. Stop renewing policy when the insured reaches a specified age 2. Increase the premiums on the basis of an entire classification 3. cancel policy if premiums are not pay
Preexisting conditions may be excluded on a Medicare supplement policy for up to
6 months
Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home options would best serve him?
Assisted living An assisted living facility would best suit an individual who needs some nursing care and supervision but not full-time care.
An attending physicians statement would be appropriate for which health insurance purpose
At the request of the insurer to assist in the underwriting decision
According to Illinois law, when must an agent deliver the outline of coverage to a Medicare supplement applicant
At the time of Application
Which of the following actions may an insurance company not do in a health policy that contains a guaranteed renewable premium benefit
Increase the premiums on an individual basis
Maria is a Preferred Provider Organization (PPO) subscriber and received care from an out-of-network provider. Which of the following is the likely result?
care is covered but at a lower percentage compared to treatment from an in-network provider
______ is NOT an element of a valid contract
countersignature
Key Person Disability Insurance pays benefits to the
employer
A common exclusion with Vision plans is
lasik surgery
The Notice of Claims provision requires a policyowner to
notify an insurer of a claim within a specified time
What is considered to be a characteristic of a conditionally renewable health insurance policy
Premiums may increase at time of renewal
Health Maintenance Organization (HMO)
Provides prepaid health care
Premium mode is a term used to describe the
frequency of the premium payment
Which of the following services are covered under a limited health service organization
1. Ambulance care services 2. pharmaceutical services 3. dental care services
What are the following is not a requirement provision in an accident and health insurance policy
1. Change of occupation
All of these are characteristics of a major medical expense policy
1. Coinsurance 2. Deductible 3. Large benefit maximums
What are the following are requirement provisions in an accident and health insurance policy
1. Grace period 2. Legal actions 3. Reinstatement
The waiver of premium includes which provisions
1. If the insured qualifies, the premiums are waived retroactively to the beginning of the disability 2. the insured must be disabled for a set period of time before benefits begin 3. the waiver of premium generally does not extend past the insured age 60 or 65
The deeds and actions of a producer indicates what kind of authority
Apparent Apparent authority is the appearance of assumption of authority based on the actions, words, or deeds of the producer
A health insurance claim may be settled using which of the following payment methods
Fee-for-service
What is the required renewability status of all Medicare supplement policies
Guaranteed renewable
Which of the following services is not covered under a limited health service organization
Home health care services
An insurance company normally Has two years the contact information provided on an accident and health application. This to your period begins on the date that the
Insurer dates the policy
All of the following statements correctly describe the purpose of Social Security except
It provides a source of income for a meaningful standard of living during retirement
The open enrollment period for Medicare part B is
January 1 through March 31
Donna and Mary were racing bicycles in a store parking lot while being cheered on by fellow employees. Mary ran into John, another employee, who happened to be taking out the garbage. Both Mary and John are injured. Who would most likely be covered under Workers' Compensation?
John Misconduct on the job or injury occurs wouldn't be covered. However Jon was an innocent bystander just doing his job
How does one become eligible for part D prescription drug coverage
Must have Medicare coverage
In Illinois long term care insurance
Must offer inflation protection to applicants
When an insured has a major Medical plan with the first dollar coverage, how does this impact the benefit paid
No deductible payment is required a health insurance plan with first dollar coverage means no deductible payment is required before expenses are reimbursed
If a Medicare supplement policy involves replacement, it must be verified on a question located
On the application
An individual covered under a blue cross blue shield plan is called an
Subscriber
Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?
Taxable income Disability insurance benefits from a group policy paid for by an employer is considered taxable income.
Bill the producer is collecting the initial premium on a health policy. Which of the following statements is true?
The contract is not in force without the initial premium being paid
Backdating an insurance policy occurs when
The policy's effective date is earlier than the present
Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation?
Unpaid premium If there is an unpaid premium at the time a claim becomes payable, the amount of the premium is to be deducted from the sum payable to the insured or beneficiary.
An individual can enroll in a Part C Medicare Advantage Plan at what time?
When becoming eligible for Medicare
When does a health insurance policy typically become effective
When initial premium is collected and policy is issued
Premiums paid that exceed 7 1/2% of an insured's Adjusted Gross Income (AGI) are tax-deductible when paid for which of the following plans?
Qualified Long-Term Care plan
