Ch 8-9 Underwriting and Laws

Mary is the sole proprietor of her business and has a family health plan. She would like to deduct the premiums from her taxes. What percentage of her premiums are tax deductible?

100%

What is the minimum number of employees needed for a small employer medical expense plan in Ohio?

2

EXCEPT for fraud, the time after issuance of a policy during which an insurance company may contest a health insurance claim due to the statements on an application is

2 years

Under the Affordable Care Act (ACA), parents can insure their dependent adult children up to their:

26th bday

An Ohio agent's license to sell insurance may be revoked for all of the following reasons EXCEPT

30 days

An individual who declines coverage under a small group accident and health benefit plan and later enrolls is called

A late enrollee

Ohio requires advertisements for accident and health insurance policies covering ONLY a specified illness to prominently display

A statement that the policy is limited

In Ohio, a group accident and health certificate of insurance must contain

A summary of policy features and benefits

An insurance company is normally responsible to its appointed agents for all of the following EXCEPT

Absorbing all of the agent's liability

Which of these is NOT considered a preventative service in a dental plan?

Amalgamated filling

When an accident and health insurance policy provision is in conflict with the statutes of Ohio, it is

Amended to conform to the minimum statutory requirements

Misrepresenting pertinent policy provisions relating to coverage after a loss is

An unfair claims settlement practice

If a group endorses an accident and health insurance product in an advertisement, the public must be made aware of

Any control by the insurer over the group

Under HIPPA rules, a medical plan's pre-existing conditions exclusion may be reduced by

Any period of prior coverage

Which of the following situations would a medical exam NOT be required for an individual health insurance applicant?

Applicant's family members have a history of cancer

Under the Affordable Healthcare Act, which group works with states to establish new Health Insurance Marketplaces?

CCIIO

Long-term care insurance policies may contain exclusions for all of the following EXCEPT

Care for incurable conditions

Which event must an agent report to the Director?

Conducting business under an assumed name

In what situation would disability income insurance premiums be a deductible expense?

Corporation paying for group disability income coverage for its employees

In Ohio, a period of accident and health insurance coverage which may be applied to reduce the length of a pre-existing condition exclusion under a new plan is called

Creditable coverage

All of these are used to prevent adverse selection in a group dental plan EXCEPT

Decreased participation

All of the following are examples of unfair claim settlement practices EXCEPT

Denying unsubstantiated claims on a timely basis

Under which marketing system do insurers solicit customers by mass media advertising and mail without the services of an agent?

Direct response

To which of the following group plans do HIPAA rules NOT apply?

Disability income

In Ohio, continuation of medical plan coverage for a handicapped child beyond the age limit stated in the policy may require proof of the child's

Incapacity and dependency upon reaching the age limit

The type of health insurance in which underwriting procedures are the most restrictive is

Individual

An applicant for accident and health insurance has a risk factor that is similar to a majority of the insurer's other applicants. What will be the likely outcome of this applicant?

Issued with a standard premium rate

In Ohio, viatical settlement brokers are permitted to do all of the following EXCEPT

Make the first transaction up to 30 days before approved for a license

Under the Affordable Care Act (ACA), what is the proportion of premium revenues spent on clinical services and quality improvements?

Medical loss ratio

When advertising a life insurance policy, an agent is required to disclose the

Name of the actual insurer

Which of these plans allow a participant to choose either a network or non-network provider at the time when medical care is needed?

Point-of-service

Which of the following describes the treatment service of a crown?

Prosthodontics

Which of the following is NOT a basic underwriting action for accident and health insurance?

Removing uniform policy provisions

The marketing of Medicare Supplements is regulated to prevent all of the following EXCEPT

Replacement of any existing coverage

Claims settlement practices of insurers are regulated by

State insurance departments

Which of the following is true regarding an agent who is found to have violated a state insurance law by the Superintendent of Insurance in Ohio?

The agent must pay the administrate costs associated with the investigation of such violations

In Ohio, a long-term care policy which lapses may be reinstated within five months if

The covered individual was mentally incapacitated

An applicant for life insurance must be informed that testing for Human Immunodeficiency Virus (HIV) infection is used to help determine

The insurability of the proposed insured

Who reports an agent's termination of appointment to the Director?

The insurer

At the request of a small group medical plan policyholder, the insurer must disclose all of the following EXCEPT

The insurer's expenses

All of the following are causes for termination of an employee's group insurance coverage EXCEPT

The plan's coinsurance limit is reached

Inflation protection must be included in all long-term policies delivered in Ohio UNLESS

The policyholder rejects the coverage in writing

A life insurance illustration showing future premiums being paid out of nonguaranteed values must disclose that

The policyowner may need to resume premium payments depending on actual results

How is a community rating used for underwriting purposes?

The same rates are charged for individual and group plans in the same geographical area

Who does a viatical settlement broker represent?

The viator

Under what circumstances must an agent provide his or her business records to the Director of Insurance?

Upon request of the Director

For long-term care insurance, when does Ohio require provision of a written notice of available insurance counseling programs?

When coverage is solicited

According to the Affordable Care Act (ACA), under what circumstances would lifetime limits and annual limits be permitted on a health plan or insurance policy?

When coverages are not considered essential health benefits

When an HIV test is requested for an individual applying for a health and accident policy, who must sign the consent form?

applicant

What is a prosthodontics dental procedure?

bridgework

Reductions in coverage are one feature of _______ in Health insurance policies.

cost containment

Employer group dental plans may attempt to minimize adverse selection by utilizing all of the following EXCEPT

encouragement of reduction in employee participation

When recommending the replacement of a health and accident policy, all of the following provisions should be carefully reviewed EXCEPT

grace period

Under the Affordable Care Act (ACA), health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition UNLESS it is a

granfathered plan

Splitting the commission with the buyer on a sale of insurance is known as

rebating

Attainment of the limiting age for dependent children will not terminate the coverage of a dependent child if

the child is incapable of self-sustaining employment by reason of physical or mental disability

When a Medicare supplement policy is purchased during the open enrollment period

the policy must be issued regardless of health status

To be covered dependents under an accident and health insurance policy, children of the insured generally must be

unmarried