Insurance Liscence

c. Retirement pension

A group health insurance plan may include all of the following benefits, EXCEPT: Select one: a. Medical expense b. Disability income c. Retirement pension d. Accidental death and dismemberment

A hospital income plan pays a flat payment per day in the hospital, not tied to services provided.

A hospital income plan pays benefits based on which of the following?

All policies must cover newborns from the date of birth.

Mark and Sarah have recently been blessed with a new son, James. James will be covered under Mark's health policy:

A statement of good health is needed when the application does not include the initial premium with the application.

Martin is applying for a life insurance policy. When is a statement of good health required:

This situation will be handled just like there was coverage with two separate insurance companies. The spouse who had the event will be reimbursed from his/her coverage and the other plan will make up the difference up to 100% of the bill. The birth date method of determination deals with which plan will cover children of the marriage.

Sally and James are married and they work for the same employer. Both have family coverage under the employer group plan, since the employer pays the full premium for all employees. What will the reimbursement be in the event that Sally or James has a claim?

age bands

Sam Johnson is looking at possible methods to classify his employees under his group insurance program. He may choose all of the following, EXCEPT: Select one: a. Method of compensation b. Job classification c. Length of service d. Age bands

The producer has the duty to inform the prospective insured that a claim might be rejected later on with possible repercussions. This is a form of fraud, and a claim might be rejected on this basis.

Terry realizes that the client left off information about a prior illness. What should the he do?

Establishing requirements for insurers who market to small employers with 20 employees or less

The Health Insurance Coverage Continuation Act regulates which of the following?

12

The NAIC insurance model includes how many mandatory standard provisions for health insurance contracts?

11

The NAIC insurance model includes how many optional standard provisions for health insurance contracts?

Changing the terms of the contract by referring to documents not included in the policy

The entire contract provision in a health policy prevents the insurance company from:

all of the above

To be eligible to participate in a group medical plan, an employee: Select one: a. Must be full time b. Must have served any required probationary period c. Should enroll during period of eligibility d. All of the above

The main purpose of the MIB (Medical Information Bureau) is to prevent misrepresentation and fraud.

What is the main purpose of the MIB?

Group plans usually have higher income limits and lower premiums.

When comparing individual disability income policies with group disability income policies, group policies are generally:

Disability income contracts provide income for a specified period of time.

Hal has a disability income contract with Gigantic Mutual. If he qualifies for benefits, he should expect to receive: Select one: a. A monthly income for a specified period of time b. Reimbursement for medical expenses related to the disability c. Reimbursement only if he suffers an accident d. Lifetime income regardless of the cause of disability

A per cause deductible will pay for a specific spell of illness. A new sickness will begin a new period of illness with a new deductible.

Harry has a major medical plan that has a new deductible for each illness or accident he incurs. What is the name for this type of deductible?

Health policies may be reimbursement contracts, service basis contracts or indemnity contracts. A valued contract refers to a life contract.

Health polices can be all of the following, EXCEPT: Select one: a. An indemnity contract b. A valued contract c. A reimbursement contract d. A service basis contract

Ancillary charges are the extra charges, other than room and board, and are stated as a multiple of the daily room and board limit. A basic hospital expense plan will have a schedule that is usually based on the room and board rate.

In a basic hospital expense policy, the ancillary hospital charges are usually paid as follows:

The elimination period is the time between a disability and when disability benefits are paid. It's a waiting period.

In a disability income policy, which of the following is considered a time deductible, not dollar deductible, due to benefits not being paid during this period?

90 days

John has been in the hospital for five days. How long does he have to file a claim form and show proof of loss with his insurance company?

In the event the insured is covered by more than one policy, the COB provision defines the method for determining which insurer is the primary insurer and which one is the secondary insurer. The COB provision is also in place to prevent the insured from making a profit from a claim.

Group policies typically contain a coordination of benefits (COB) provision. This provision is in the contract to: Select one: a. Prevent underpayment of claims b. Eliminate arbitration on disputed claims c. Prevent overpayment of a claim when more than one insurance policy is involved d. Provide extra income for the participant

A business overhead expense policy is used to pay business expenses such as rent, utility bills and employee salaries. A business overhead expense policy will never cover the owner's salary.

A business overhead expense policy will cover all of the following expenses, EXCEPT:

90 days to 1 yr

A claim has been filed on a timely basis. The insurer has requested further proof of loss. How long does the insured have to furnish the proof?

A disability income plan pays benefits for weekly or monthly income as a result of sickness or accident. It usually pays for non-occupational disabilities.

A disability income plan is designed to pay benefits for which of the following?

A residual disability plan is a form that is written that relies more on loss of earning than inability to perform duties.

A disability plan that pays a benefit based on loss of earnings is considered which of the following?

Disability plans do not have a stop loss and the waiting period does not affect potential benefits once it is satisfied.

A disability policy can be provided on a noncancellable and guaranteed renewable basis because:

31 days

A grace period allows a certain number of days by contract for the insured to submit a premium. Except for weekly and monthly premium contracts, what is the usual grace period?

no premium paid and grace period is over

A policy lapses when:

Non-cancelable Policy

A policy that provides the insured the right to continue coverage by making timely payment of premiums. The insurer cannot make changes to this policy without the consent of the insured. The policy's renewability provision is the same as the guaranteed renewable provision, except that premiums cannot be increased

Disability income pays living benefits, not death benefits.

All of the policies listed below will pay a death benefit, EXCEPT: Select one: a. Ordinary life policy b. Disability income c. Term life policy d. Accidental death and dismemberment

If the age of the insured has been misstated, all amounts payable under the policy will be modified to that which the premiums would have purchased at the correct age.

Amanda noticed that the wrong date of birth was recorded on her application for insurance. Health policies have a provision that addresses this issue. If Amanda has a claim, she can expect which of the following?

Association group health plans may be contributory or noncontributory. An employer may pay premiums for these employees, but is not required to under the association rules.

An association is required to do all of the following to qualify for an association group plan, EXCEPT: Select one: a. The employer must pay all premiums in full for its employees. b. The association must have been in existence for at least two years. c. The association must be a natural group, not formed specifically to provide benefits. d. There must be at least 100 members.

monthly

An insurance company must pay a disability benefit no less frequently than:

Notice of claim provision

An insured has 20 days to notify the insurance company of a loss. This is called:

Caroline would owe $1,800. $7,000 _ $500 = $6,500 x .20 = $1,300 coinsurance + $500 deductible = $1,800

Caroline recently was admitted to the hospital. During this visit, she incurred a $7,000 charge. Her major medical plan has a $500 deductible and pays 80% after the deductible is satisfied. Her plan has a maximum out-of-pocket of $2,500. How much did Caroline owe for her part of the bill?

No legal action may be brought to recover on the policy until 60 days after written proof of loss is provided to the insurer.

Cheryl has filed a claim for a hospital stay with her insurance company. She has complied with all time lines, but the insurance company has been unresponsive to date. Her health care providers are calling her for payment and threatening to turn her account over to a collection agency. How long does Cheryl have to wait until she can take legal action against the insurance company?

Residual disability is when the insured has a total disability, but is allowed to return to work part time.

Frank has been out on disability and receives benefits under his current policy. His health has improved, but not enough for him to return to full time employment. He can work part time. He can continue to receive benefits at a reduced basis if his policy has which of the following provisions? Select one: a. Rehabilitative employment benefit b. Recurrent disability benefit c. Residual disability benefit d. Contingent disability benefit

Cancellable polices allow the insurer to cancel the policy at any time provided the insurer returns all unearned premium.

Fred has purchased a cancellable policy. He should understand that:

Gail will have to pay $1,960. $9,000 _ $200 = $8,800 x .20 = $1,760 coinsurance + $200 deductible = $1,960

Gail has been in the hospital and has a total bill of $9,000. Her insurance policy contains a $200 deductible and a $5,000 maximum out-of-pocket provision. Benefits are paid at 80%/20%. How much will Gail have to pay on this bill?

In all cases where the insured has paid for coverage beyond the cancellation date

Is an insurance company required to return unearned premiums on a policy cancellation?

Unless the company takes action to the contrary, his coverage is deemed to be effective in 45 days.

Jim applies for reinstatement after his health policy lapses. He submits all requirements, including the premiums. He hears nothing further from the company. This policy is in effect:

Immediately for accidents and 10 days for sickness

Joan asked her agent when will she have benefits if she reinstates a lapsed health policy. Her agent would be correct if he told her:

A lower benefit since she had changed to a more hazardous occupation

Julia purchases a disability policy that will provide $500 per month if she becomes disabled. The policy requires her to notify the insurance company if she changes occupations. When the policy was issued, Julia was a bank employee. At the time of disability, she had changed occupations to become a welder. What kind of benefit should she expect?

Partial disability is the inability of an individual to perform duties in his own occupation. This benefit will pay a benefit to bring earnings in line with employment at the time of disability.

Kenneth is injured on the job. He is disabled to the point that he is unable to resume the duties of his job prior to his injury, but he is capable of performing the duties of another occupation. His disability will be classified as:

A major medical policy may have a flat, corridor, or integrated deductible.

Major medical may have any of the following deductibles, EXCEPT: Select one: a. Flat b. Stacked c. Corridor d. Integrated

Experimental drugs are not covered under a major medical plan.

Major medical plans usually allow benefits for all of the following, EXCEPT: Select one: a. Non-occupational accidents b. Diagnostic testing c. Surgical procedures d. Experimental drugs and treatment

Each insurance policy must provide notice that during the free look period, from the date of delivery to the policyowner, such policy may be returned for cancellation to the insurer, the insurer will refund all premiums paid, including any policy fees or other charges, and the policy will be deemed void, as if no policy had been issued.

Martha decides she does not want the new policy she purchased. She is within her free look period, so she returns the policy. She should receive which of the following?

Martin would have to pay $2,100. $8,500 _ $500 = $8,000 x .20 = $1,600 + $500 = $2,100

Martin has gall bladder surgery that requires a 4 day hospital stay. His policy has a $500 deductible and pays 80% with a maximum out-of-pocket of $5,000. The hospital bill is $8,500. What is Martin's part of the bill?

Basic medical plans are generally the only ones without a deductible.

Max has a policy that pays part of his medical bill without any deductible. He most likely has a(n):

The claims form provision of a health contract states that if claims forms are not provided within 15 days, the claimant may submit the claim on any form they choose.

Nathan has advised his insurance company of a loss covered by his major medical policy. Nathan has not received a claim form. After 15 days, Nathan may:

100%

Susan has paid the maximum out-of-pocket required on her major medical plan for the year. Any additional claims will be reimbursed at what level?

The incontestable period for a health insurance contract is called the time limit on certain defenses.

The term used for incontestable period for a health insurance contract is which of the following?

The insurance company would pay $4,800. $6,500 - $500 deductible = $6,000 x .80 = $4,800. The bill would have to exceed $7,500 to trigger the out-of-pocket maximum or stop loss.

Walter has a major medical policy with a $500 deductible, 80/20 coinsurance and a $1,500 maximum out-of-pocket. His hospital bill is $6,500. How much will the insurance company pay?

The only choice is one with all the components of a policy included. These must all be provided to the insured in the form of a policy.

What constitutes the "entire contract" for a health policy? Select one: a. The form the insurance company has on file with the insurance commissioner b. The policy, all riders and amendments, the application and all other papers that are required c. All papers the agent has on file applicable to the policy d. The photocopy on file with the insurance commissioner

36 months

What is the maximum length that COBRA benefits may be extended: Select one: a. 12 months b. 18 months c. 24 months d. 36 months

Time limit for certain defenses

What provision of a health policy may cover pre-existing conditions?

Change a beneficiary

Which of the following is one of the ownership rights of an insurance contract?

Change in Occupation, the rest are required

Which of the following may be an optional provision under the Uniform Provisions Law?

Disability pays in the event of a qualifying disability, not a specific illness or accident. The disability may be caused by sickness or accident, but the insured must also meet the qualification for disability benefits.

Which of the following policies will not reimburse for specified medical expenses? Select one: a. Major medical policies b. Daily hospital indemnity c. Disability income d. HMO plans

100% enrollment is required when the employer pays the premium.

Wildlife Manufacturing Company has a non-contributory health plan. How many employees must participate to meet enrollment requirements?

business buy/sell

A business can deduct premiums in all of the following EXCEPT: Select one: a. Business Buy/Sell b. Group disability c. Business Overhead Expense (BOE) d. Workers compensation

Business Overhead Expense (BOE)

A business cannot deduct premiums in all of the following EXCEPT: Select one: a. Business Buy/Sell b. Key person disability c. Business Overhead Expense (BOE) d. None of the Abov

key person disability

A business cannot deduct premiums in what type policy? Select one: a. Key person disability b. Group disability c. Individual disability d. Workers compensation

An indication that coverage will begin as of the application date if the policy is issued without modification

A conditional receipt issued by the agent at the time of application provides which of the following?

delivery

Charlie is purchasing a life insurance policy. The policy summary is usually given to the purchaser at the time of:

Larger groups are generally rated by the claims experience generated by that particular group. The size of a group that will determine experience will vary from company to company, but 1,000 is usually the size where all companies use experience rating to determine rates. Companies may use a mixture of community rating and experience rating on groups between 100 and 999.

A large group of 2,000 employees has renewed for another year. The premiums have increased by 12% over the previous year. The new rates were most likely a result of:

Major medical is designed to have substantial lifetime maximums to provide protection for the much larger medical bills.

A major medical expense plan: Select one: a. Is provided only through a group plan b. Supplements Medicare c. Has large lifetime benefit maximums d. Never has a deductible

Explain the issue and collect an additional premium.

A producer submitted an application with a premium. After underwriting, the insurer sent back the policy, rated, with an impairment rider. What should the producer do now?

a. Coinsurance provision

All of the following provisions are mandatory in health policies, EXCEPT: Select one: a. Coinsurance provision b. Grace period c. Payment of claims provision d. Reinstatement provision

The insurer will reinstate the policy upon the 45th day after all past due premiums are paid, unless the application is denied. The law assumes that the company has approved the reinstatement if they do not take action to the contrary.

An application for reinstatement of a health insurance policy was submitted with all the proper requirements. The company makes no response. Will the policy automatically reinstate without further company action?

This new employee will be allowed to enroll as soon as any probationary or eligibility period has expired. If an employee has 12 months or more coverage under a previous employer, that will eliminate any pre-existing condition clause that may be applied.

An employee changes employers and has diabetes. He has worked for his previous employer for 4 years and is covered by a HIPAA eligible group. When will he have full coverage under the new employer?

The entire contract provision prohibits any changes in the policy unilaterally.

An insurance company may not modify the policy agreement (contract) without the insured's written permission. The part of the policy that addresses this is called which of the following?

The agent should return to the prospective insureds home and ask the questions in person. Then he or she should have the client initialize the changes on the application.

Ashley, the producer, notices that she forgot to ask a few questions on the application after leaving the clients home. She is in a hurry to submit the application, what should she do?

Make the insured responsible for some of the charges to hold down claims payments

Co-insurance is designed to control which of the following situations?

$500

George has a hospital indemnity plan that pays $100 per day while he is an inpatient. He was admitted to the hospital for five days. What benefit should he expect?

A waiting or probationary period before disabilities related to his pre-existing condition are covered

Edward has been treated for kidney stones in the past. He is applying for disability benefits. His agent should explain to him that he might have which of the following added to his policy:

The employer pays 100% of the cost.

For a benefit plan to be considered non-contributory:

A certificate of coverage is what is issued for a group policy. A health insurance policy may also include a summary of benefits and directions on how to file claims, etc.

George has enrolled in his company's group insurance plan. As proof of his participation, George will receive which of the following? Select one: a. A certificate of coverage b. A copy of the master contract outlining benefits c. An individual insurance contract that he can keep if he leaves the group d. Claim forms

At the time of hire or other annual open enrollments

Guaranteed issue is a process by which eligible employees may enroll in the company's group plan without restriction. Guaranteed issue is usually available on what basis?

63 days

HIPAA recognizes time served under group plans to determine pre-existing condition restrictions. If a person is not covered, what is the maximum period they are allowed to go without coverage before the HIPAA requirements become void?

Individual underwriting is always more restrictive than group underwriting.

How does the pre-existing condition vary from individual to group policies?

18 months

How long do COBRA benefits remain from the date employment is terminated?

Benefits are tax-free, and premiums are not deductible.

In a key person disability policy, which of the following is TRUE? Select one: a. Premiums are deductible, and benefits are tax-free. b. Benefits are tax-free, and premiums are not deductible. c. Benefits are not tax-free, and premiums are deductible. d. Premiums are not deductible, and the benefits are not tax-free.

To have a lower premium for the 75/25 plan

Jason is comparing plans for medical insurance. His employer offers two plans. One has an 80/20 coinsurance provision and the alternate plan has a 75/25 coinsurance provision. Jason should expect which of the following?

Joe will have to satisfy a new elimination period. If Joe had gone out as a result of the same accident, his coverage would have continued without interruption. Since this is an unrelated disability, it will be subject to a new elimination period.

Joe is qualified for disability benefits as a result of an off the job accident. He returns to work after 9 months. Unfortunately, Joe has a heart attack and must go out on disability again. Which of the following is true?

In the event that an individual is covered both under an employer group health plan and Medicare, the employer group plan will be the primary insurer, while Medicare will be the secondary insurer.

John is over 65 and has been enrolled in Medicare Part A. He remains enrolled on his employer's group plan. If he has a claim, how is payment determined?

20 days

Mary has been admitted to the hospital for testing. How long does she have to give notice of claim to the insurance company?

reimbursement

Medical expense plans are what type of contracts?

probationary period

Seth must work for 90 days before his insurance is effective. These 90 days are called the:

A Multiple Employer Trust (MET) is an arrangement where small employers can join and receive more benefits than if they bought insurance separately.

Several small businesses join together to form a large group for the purpose of buying group health insurance. This type of arrangement is called which of the following?

The health plan is noncontributory because the employer pays for the full amount of the premiums. In a group health policy, premiums are deductible for the employer, and benefits are tax-free to the employee. Benefits are not taxable because they are covering a loss; note the difference between group disability plans where benefits are taxable to the employee.

Surin Global has a group health policy and a group disability policy for its employees. They pay 75% of the premium for the disability policy, and they pay 100% of the premium for the health plan; which of the following statements is CORRECT? Select one: a. The health plan is noncontributory, and twenty-five percent of the benefits are not taxable in the disability plan. b. The premiums are tax deductible for the employer in the health plan, but not tax deductible for disability policy. c. The disability policys benefits are not taxable on seventy-five percent. d. Seventy-five percent of the benefits from the disability policy are taxable, and the health plan is contributory.

application

Susan is buying a life insurance policy. The buyer's guide is usually given to the purchaser at the time of: Select one: a. Application b. Delivery c. Point of sale d. Underwriting

12 months

The longest pre-existing period for conditions that occurred prior to employment under HIPAA is:

The producer should note how many children the applicant has in the house.

The producer is responsible for field underwriting. Field underwriting is done when the producer is in front of the applicant. Which of the following is not expected from a producer as part of the field underwriting?

LTC policy premiums are deductible over 7.5%.

The statement about policy premiums is TRUE for, which of the following? Select one: a. LTC policy premiums are deductible over 7.5%. b. Individual disability premiums are deductible. c. Key employee premiums are deductible. d. Individual medical policy premiums are always deductible.

facility of payment provision

states benefits are payable to an individual who is related to the deceased insured by blood or marriage. The limit in this amount is usually less than $3,000.

31 days

the conversion period for an employee to convert their group policy to an individual policy is: Select one: a. 7 days b. 15 days c. 31 days d. 45 days

Change the insuring clause

A company may use a rider or an endorsement to do any of the following, EXCEPT: Select one: a. Add benefits b. Change the insuring clause c. Increase premiums d. Restrict benefits

Change of occupation is an optional provision. This provision is in place to protect the company, not the policyholder.

All of the following are required provisions in a health policy, EXCEPT: Select one: a. Grace period b. Notice of claim c. Entire contract d. Change of occupation

Not all states require the employer to have Workers' Compensation insurance, but they all have laws concerning Workers' Compensation. Not having Workers' Compensation insurance does not relieve the employer of liability for on the job injuries.

All of the following are true concerning Workers' Compensation laws, EXCEPT: Select one: a. All states require employers to have Workers' Compensation Insurance. b. Workers' Compensation provides benefits for employees who have been injured, become ill or died as a result of workplace issues. c. Many states have pools from which employers can purchase coverage. d. Premiums for Workers' Compensation vary by industry classification and actual employer experience.

Sickness while traveling abroad is not a policy exclusion. The exception to this is Medicare, which does not cover treatment out of the country.

All of the following may be exclusions from coverage in a health policy, EXCEPT: Select one: a. Injury while committing a felony b. Sickness while traveling abroad c. Treatment for drug and alcohol abuse d. Self-inflicted injury

Coinsurance refers to the mechanics of how the policy pays benefits, not to provide insurance for multiple individuals.

Coinsurance may do any of the following, EXCEPT: Select one: a. Provide insurance for multiple individuals b. Provide a cost sharing between the individual and the insurance company c. Mitigate risk d. Define which party will pay what portion of a medical bill

The waiting (probationary) period is different for sickness and accidents.

Arthur has been issued a health policy with a probationary period. He should understand which of the following? Select one: a. The waiting period for accidents may be different than for sickness. b. The probationary period is one of the 12 mandatory rules. c. A sickness before the probationary period has been served will void the policy. d. Accidents must involve dismemberment to be covered.

The basic surgical expense plan contains a list of covered surgical procedures and the dollar limit for each procedure. This list of surgical procedures is referred to as a schedule. The most complex procedures are assigned the highest dollar benefit, while the least complex have the lowest.

Barney has a surgical expense policy listed as a "$1,000 Basic Surgical Expense Policy". This means which of the following?

To qualify for Social Security disability, Bernie must have total and permanent disability and not be able to work. He must also earn the necessary number of quarters of coverage, and the disability must be expected to last 12 months or more. The waiting period for Social Security disability benefits is 5 months, or 150 days.

Bernie is disabled and wants to apply for disability under Social Security. In order to qualify, he must meet all of the following requirements, EXCEPT: Select one: a. Total and permanent disability and he must not be able to work b. He must have earned the necessary number of quarters of coverage. c. There is a 6 month waiting period. d. The disability is expected to last 12 months or more, or result in death.

BOE plans will pay for most expenses to operate the insured's business, except his salary and other expenses not related to running the business.

Bill is a small business owner. He is considering the purchase of a Business Overhead Expense (BOE) plan. He can expect the policy to pay which of the following in the event he is disabled?

A noncancellable policy guarantees the rate and the renewal from change or cancellation.

Bruce has a noncancellable health policy. The company may do any of the following, EXCEPT: Select one: a. Pay the benefits when they are due b. Cancel the policy or raise premiums c. Offer different premium modes d. Pay the listed beneficiary any death benefit due

Social Security disability benefits are paid after a five-month waiting period. The disability must be total and expect to last twelve months. Being eligible for Medicare is not one of the criteria. In fact, Social Security disability benefits become retirement benefits when a person reaches age 65.

Carl is unable to work due to a medical condition. He has been confined to his home for four months and wants to begin the process for filing a disability claim with Social Security. All of the following are true, EXCEPT: Select one: a. He should wait until he has completed 5 months of waiting. b. He should be eligible for Medicare before he applies. c. His disability should prevent him from working at all. d. He should expect to be disabled for 12 months or more.

A Disability Buy-Sell Policy is used to establish how ownership in a business is transferred upon an owner's disability. In this case, Larry, Moe and Curly should buy three Disability Buy-Sell policies of $167,000.

Larry, Moe and Curly are equal partners in a business that has been valued at $500,000 by their accountant. None of the three want to be in business with their partners' families in the event one is disabled. The business entity should purchase which of the following? Select one: a. Three disability buy-sell policies for $100,000 each b. Six disability buy-sell policies for $100,000 each c. Life insurance will cover this need d. Three disability buy-sell policies of $167,000 each

90 days

Marjorie has notified her insurance company that she has been in the hospital. The insurance company has furnished the form to file a claim. How long does Marjorie have to file proof of her loss?

15 days

Marjorie has notified the insurance company of a claim. How long does the insurance company have to furnish a claim form?

The insured is not of legal capacity.

Normally, proof of loss for a medical claim must be submitted to the insurance company for consideration within 90 days, UNLESS:

This is the way a guaranteed renewable contract works. This is generally the type of contract for medical benefits, since the claims will be subject to inflation.

Old Reliable issues a policy that may not be cancelled by the insurance company, except for non-payment of premium. The company does have the right to adjust premiums for an entire class of business. This type of policy is called which of the following?

the insurer always pays the cost of autopsy

Physical Examination and Autopsy provision

The accident occurred prior to the application for the policy

Pre-existing Condition

The correct answer is $500. The usual benefit for partial disability is 50% of the full disability benefit.

Robert has been notified that he does not qualify for full disability benefits, but his policy does contain a provision for partial disability that he does qualify for. His current policy pays $1,000 per month in the event of a full disability. What benefit should he expect for a partial disability?

In this case, Rudy most likely did not meet the threshold to qualify for disability. He may have been injured, but not to the extent that his policy defines a disability.

Rudy suffered an injury in an automobile accident. His policy covers disabilities as a result of an accident. In this case, he did not qualify for disability benefits. His injury most likely:

He must wait 60 days.

Rupert has filed a claim to be reimbursed for a recent hospital stay. He feels the company is either ignoring his claim or is attempting to deny coverage. How long must he wait to initiate legal action?

A corridor deductible is the type of deductible used when a basic plan is involved. Some benefits will be paid with no deductible and major medical will cover those not fully covered by the basic plan, but there is a deductible called a corridor. The corridor is between the basic and the major medical.

Samantha has a basic plan with a supplemental major medical through her employer. The deductible that will be applied when she is eligible for major medical benefits is called which of the following?

Samantha will be subject to an elimination period as outlined in the policy.

Samantha has qualified for a disability benefit under her current plan. Samantha can expect to begin receiving benefits at the end of: Select one: a. The disability period b. The probationary period c. The benefit period d. The elimination period elected under the policy

The Insurance company will exclude the benefit entirely. Voluntary cosmetic surgery is not covered.

Sarah wants to have her face lifted to look better. There is no medical necessity for this procedure. The insurance company will:

Disability rates are calculated using morbidity tables which predict the frequency and length of claims.

The factor that affects rates and benefits for a disability policy primarily is:

The insurer, upon receipt of the notice, must furnish the forms for filing proof of loss. If the forms are not provided within 15 days, the claimant will be deemed to have complied with the policy's requirements for proof of loss upon submitting written proof of the occurrence, as well as the character and the extent of the loss for which claim is made.

Seth has notified his insurance company that he has a claim. The insurance company must furnish a claim form within how many days to comply with the governing provisions?

The principal sum is the face amount of the coverage and is paid out if the insured dies or loses two limbs, two hands, two feet, or vision in both eyes as a result of an accident.

The death benefit for an accidental death and dismemberment policy is referred to as which of the following? Select one: a. Maximum benefit b. Principal sum c. Capital sum d. Residual sum

There are two definitions used to define an accidental injury: the accidental means definition and the accidental bodily injury definition. With the accidental means definition, the reason for the accident must be unintentional and unexpected. In other words, the insured must be unaware that the risk would create a loss, and be unaware that the events leading up to the risk have the potential for loss. Under the accidental bodily injury definition, an accident is any event that causes loss, in which the results of the loss were unforeseen.

The definition of accident is determined by which of the following theories? Select one: a. Accidental means and accidental bodily injury b. Accidental means only c. Accidental bodily injury only d. None of the above

Frequency in premium payment

The grace period for a health insurance policy may vary according to which of the following?

The grace period on a health policy is based on the mode of premiums. The grace period can vary from 7-31 days depending on the mode of premium.

The grace period on a health policy is based on:

The owner should consider a key person disability plan. A company may generally buy individual policies on the employees they want to cover without covering the entire staff.

The owner of CEO, Inc. is concerned about his key employees becoming disabled. He should consider a(n): Select one: a. Key person disability plan b. Business overhead expense policy c. Individual medical plan for the key employees d. Entity buy out plan

Medicaid

To protect against a disabled person receiving more income by being disabled than they can earn by working, most group disability plans will offset policy benefits with any of the following benefits, EXCEPT:

18 months

Under HIPAA an insurance company may look back how far on pre-existing conditions for a late enrollee?

Frequency of premium payments

Unless the company takes action to the contrary, his coverage is deemed to be effective in 45 days.

nothing when related to alch

Zack and his friends were celebrating his promotion to manager at a local pub after work. Zack was "over served" at the party and on the way home, Zack was involved in a serious accident that required him to be hospitalized. His blood alcohol level was well above the allowable limit. Zack's insurance policy will most likely pay his benefit at what level?