Health 3 (Chapters 21, 22, & 23)
In a health insurance policy, the length of the grace period can be determined by which of the following?1. the mode of premium payment2. the length of the benefit period3. the length of the elimination period
1 only
Incurred medical expenses that are not reimbursed may be deducted only to the extent that they exceed:
10% of A.G.I.
Under the Claims Forms Provision, it is the company's responsibility to supply claim forms to an insured within how many days after receiving notice of a claim?
15
All of the following unreimbursed medical expenses may be considered and lumped together to determine their deductibility except:I. Prescription drugsII. Contributions to group disabilityIII. Contributions to group AD&DIV. Contributions to a group medical plan
2 & 3
Which of the following statements concerning a noncancellable policy is/are true?1. The premiums can not be raised except by class.2. The premiums can not be raised.3. The benefits may changed only by class.4. The benefits can not be changed.
2 & 4
Which of the following are requirements for long-term care benefits to become payable?1. prior hospitalization2. being certified as unable to perform at least two activities of daily living
2 only
Under the Notice of Claim provision in a Health policy, the insured must give notice to the insurance company within a maximum of how many days after incurring a covered loss?
20
An individual has how many days in which to notify the company of a claim?
20 days
Under the "relation of earnings to insurance" provision, the insurance company may take into account the insured's average monthly earnings for the past_____ months.
24
A Medicare supplement has _______ free look.
30 days
Medicare supplement policies must contain a minimum free look period of how long?
30 days
John has disability income insurance through the group plan his employer offers. The premium is $50 a month - the employer pays $40 and John pays the other $10. Should John become disabled, what percentage of the benefit is taxable income to him?
80%
Under a health policy, an insured is required to provide written Proof of Loss to the insurance company within a maximum of how many days after a loss?
90
With the exception of instances of legal incapacity, Proof of Loss for surgical expense benefits must be furnished to the insurance company within:
90 days
Which of the following policies can be written on a non-cancelable and guaranteed renewable basis?
A Disability Income Policy
Which of the following statements are true?
A chronic illness can not be cured, but managed
Which of the following statements concerning reinstatement of a health insurance policy is true?
Accidents are covered immediately
An illness from which the body can fully recover with proper medical attention is called:
An acute illness
Which of the following would probably NOT be considered in underwriting a health insurance risk?
An individual's marital status
Under the NAIC Uniform Provisions Law, which of the following is optional for a health policy?
Change of Occupation
Which of the following is not a mandatory health insurance provision?
Coinsurance provision
Which of the following types of care in a Long Term Care Policy is not provided under direct supervision of a doctor?
Custodial Care
Medicare supplement policies do not provide coverage for which of the following?
Drugs
Benjamin is totally disabled under his own occupation disability policy. He has been receiving monthly payments for two years. How often must Benjamin submit proof of loss?
Every six months
Which of the following limits coverage under an insurance contract?
Exclusions
Which of the following policy provisions defines a specific period in which an insured who has not paid the premium due remains covered by the policy?
Grace Period
Which of the following are considered required provisions for an individual health insurance policy?I. Proof of lossII. Payment of claimIII. Illegal OccupationIV. Conformity with state statutes
I & II
A Guaranteed Renewable health insurance policy allows the insurer to:I. change premium rates for all insureds in the same classII. renew, even though the insured is seriously ill and is preparing to file a claimIII. change the policy provisions during the time the policy is in forceIV. renew the policy if the insured shows a required evidence of insurability
I and II only
The Time Limit on Certain Defenses Provision in a health policy refers to:
Incontestability
Golan Hites purchases a health insurance policy and is told that the insurance company cannot raise the premium or terminate the coverage. Which of the following types of renewability clauses does this policy contain?
Non-cancelable
A person purchased a health policy that's not guaranteed renewable, and after two years they filed a claim. During the claims process fraud and misrepresentation was discovered. What is the company's obligation to pay?
Nothing
Which of the following is not an approach MCOs use for medical cost management
Optional Second Opinions
What will the insurer do if its Disability Income policy contains a Change of Occupation provision and the insured changes to a more hazardous job and then is subsequently injured?
Policy benefits will be reduced to an amount the premium would have purchased originally, based on the more hazardous occupation.
Which of the following is designed to provide a short rest period for a family care giver?
Respite care
Which of the following is not true when an agent is soliciting Medicare Supplemental insurance?
The agent can not sell an additional policy if replacing an existing one
When group disability benefits are paid directly to the individual employees who qualify, a tax question arises. Which of the following would be the most appropriate response?
The premiums are tax deductible by the employer, the benefits are taxable to the employees.
Which of the following statements is/are true about a Medicare Supplement policy?
These policies are designed to cover the deductibles and coinsurance that Medicare patients have to pay
An insured submits a valid documented claim for medical expenses covered by his Major Medical policy. According to the Time of Payment of Claims Provision, how soon must the company pay the claim?
Within 45 days
All Medicare supplement (or Medigap) policies must:
all of the above
Thug Life advised her insurance company of a loss covered by her Major Medical policy. If the insurance company does not provide her with proper claim forms within 15 days, she has which of the following rights?
the right to submit a description of the loss, in her own words, as proof of loss
There are how many standard Medicare supplement policies?
8
The minimum grace period in a health insurance policy paid on a quarterly basis is:
31 days
When a health insurance policy premium is paid quarterly how long is the grace period?
31 days
If an application is filed for the reinstatement of a Health Insurance policy but the company takes no action on such reinstatement, the policy is automatically reinstated after how many days?
45
A cancellable policy may be cancelled by the insurance company for any reason with-in how many days?
45 days
The maximum pre-existing condition waiting period on a Medicare Supplement (which is not being replaced) is:
6 months
After filing Proof of Loss an insured must wait how many days before filing suit for payment against an insurance company?
60
The Legal Action provision states that a policyowner must wait a minimum of how many days after submitting Proof of Loss to an insurance company before making a lawsuit against the company?
60
Which of the following concerning group disability insurance is/are true?I. Premiums are tax deductible by the employer, and benefits are taxable to the employee.II. Premiums are not tax deductible by the employer, and the benefits are taxable to the employees.III. Any amount contributed by the employee toward the premium makes the entire benefit tax free.IV. The percentage contributed to the premium by the employee makes the same percentage deductible by the employer.
I
Riders or endorsements may do which of the following to a health insurance policy?I. add benefitsII. restrict benefitsIII. limit coverageIV. increase premiums
I, II, III and IV
The "Time Limit on Certain Defenses" provision refers to which of the following:
It refers to the period of time, after a policy is issued, that an insurance company may deny the payment of a claim and void the policy because of a material misrepresentation.
What is considered a Moral hazard?
Lifestyle
In which case are long term care benefits taxable?
Long term care benefits are only taxable to the insured to the extent that they exceed an annual amount established by the IRS.
Disability payments must be paid at least:
Monthly
All of the following are considered to be the three primary premiums factors to health insurance except:
Morality
Which of the following is not considered a primary risk factor in health insurance?
Morbidity statistics
Which of the following is NOT correct concerning Medicare Supplemental Insurance?
Must cover the Part B copayment up to a maximum of $10000
Which of the following statements concerning Long Term Care policies is correct?
The benefits are tax-free if the policy is " qualified"
Luke has had a disability income policy for 7 years in which the premium is paid semi-annually. He forgot to pay the premium that was due on July 1, 2014. On July 31, 2014 he became totally disabled and notified the insurance company immediately. How will the insurance company respond?
The company will pay the benefit, less the premium owed.
John bought his individual disability income insurance a few years ago when he was a firefighter. Recently, John changed jobs and began selling insurance, but has not updated his disability income insurance policy to reflect the change. If John becomes disabled in a car accident today, how will the insurance company respond?
The company will pay the stated benefit and refund the excess premium paid from the date he changed occupations.
Larry was a chainsaw juggler who had purchased a $5000 per month disability benefit back in his chainsaw juggling days. He was issued a standard policy for which he had been paying premiums for five years. In the evenings he finished medical school and has since been practicing medicine as a surgeon. Having sliced off his hand with a scalpel he submits a claim. Which course of action would the company most likely follow?
The company would pay the $5000 and refund any premium.
Which of the following statements most accurately describes a Guaranteed Renewable policy?
The insurance company may not refuse to renew the policy before a specified age, but may increase the premiums on all policies in the same class.
What must the insured do if the insurance company does not send a claim form within the appropriate time frame?
The insured should present proof of the loss in any written manner showing the nature of the loss, extent of loss and other information.
Under the optional Illegal Occupation Provision, which of the following applies if a loss occurs while the insured is participating in a felony or an illegal occupation?
The insurer is not liable for the loss.
All of the following statements about noncancellable policies are true EXCEPT:
The insurer may increase the premium rate after the policy is in effect, provided it does so by class of insureds.
Select the correct statement about long-term care policies:
They are guaranteed renewable
Optional Provisions 1 and 2, addressing changes of occupation and misstatement of age, permit the insurer to do which of the following?
They permit the insurer to pay indemnities equal to benefits that would have been purchased at the premium paid had the insurer known the facts when the premium was established.
Optional Provisions 1 and 2, addressing changes of occupation and misstatement of age, permit the insurer to do which of the following?
adjust the benefits that correspond to the premiums that have been paid
Which of the following is/are usually eligible for coverage under a family health policy?
all the above
Which of the following statements regarding health insurance underwriting is correct?
all the above are true
Beautimus names her husband as the beneficiary of the accidental death benefit in her health policy. She has relinquished her right to change the beneficiary designation. According to Required Provision 12, Beautimus' husband is:
an irrevocable beneficiary
The factor in premium computation that has to do with the record-keeping and statistical analysis insurance companies perform is:
claims experience
Faye is hospitalized for a serious illness. After being dismissed she submits a claim to:1. the agent2. the company
either
Which of the following is NOT an objective of the State Partnership program for long term care?
eliminating the need for Medicaid
When receiving disability income payments for longer than two years, the insured must submit proof of loss how often?
every six months
All of the following are primary risk factors in underwriting individual health insurance policies, EXCEPT:
geographical location
An insurance application submitted to the insurance company without the initial premium provides coverage beginning when the:
insured is accepted by the insurance company, the premium is paid, and a continued good health statement is signed
Which premium factor is not common to both life and health insurance?
morbidity
Required Provision 7 indicates that, except in the absence of the insured's legal capacity, if it was not reasonably possible for the insured to provide proof of loss as required in a policy, the latest time the proof of loss may be furnished is:
one year from the time proof is otherwise required
All of the following are common exclusions in a long-term insurance policy except:
organic mental conditions
When an insured returns a policy to the insurance company within the Free Look Period, the Insurance company must do which of the following?
refund all premiums paid
