Chapter 10: Laws and Rules Pertinent to Insurance
What is not an example of advertisement for accident and health insurance?
a company's financial rating
What begins the free look period?
a delivered receipt
When purchasing a medicare supplement policy, a producer must provide an applicant with?
a suitability form
Home Health care must be formulated and supervised by who?
an insured's physician
What does the RI life and health insurance guaranty association apply to?
annuity contract
When must the outline of coverage be presented to the applicant?
at the time of the initial solicitation
A health policy must provide essential benefits without annual and lifetime limits when purchased
individually - or with a group through a federal market place
a small employer is defined as one the employs how many employees?
up to 50 employees
How long is the free look period in a long term care policy?
30 days
A long term care policy may exclude pre-existing conditions for a maximum of how many months? From when?
- 6 months - after the effective date of coverage
HMO's must provide newly enrolled subscribers the following disclosures:
- HMO's most recent financial statement - a description of the organizational structure and options of HMO - a description of where and how to obtain and secure services - NOT a list of current shareholders of the organization
The outline of coverage includes?
- a description of features of the policy - a statement of the principal exclusions, reductions, and limitations of the policy - a statement that the outline of coverage is not an insurance contract - does not include a separate schedule of premiums
All RI health plans must cover services of licensed midwives if services? Not required to provide coverage for?
- are within the midwives' area of professional competence - are currently reimbursed when rendered by any other licensed health care provider - Home birthing services
The coordination of benefits
- reduces duplication of benefits - establishes an order of benefit determination
When does new born coverage begin? How long does it last?
- the moment of birth - 31 days
Long term care is designed to provide coverage for a minimum of?
12 consecutive months
An insurer may exclude coverage for a pre-existing condition in a medicare supplement policy up to?
6 months
A renewability provision in a long term care policy must state?
that coverage is guaranteed renewable
Prepaid legal insurance requires?
the attorney be licensed in RI or any other state where the attorney provides basic legal services
stop loss insurance advertisements must disclose?
the elements of coverage including the amount of stop loss insurance in effect
