Health

Within how many days of the termination of the insured's group coverage must the insured notify the insurer of the decision to convert to individual policy

30 days

within how many days of the termination of the insured's group coverage must the insured notify the insurer of the decision to convert to individual coverage?

30 days

A newborn infant must be covered under a policy for routine nursery care and pediatric costs until either the mother is discharged from the hospital or a period of

5 days

partial disability usually pays what percent of the total disability benefit

50%

under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss?

90 days

Which rider, when added to disability policy, pays income during the six-month waiting period before Social Security benefits can begin?

Additional Monthly Benefit

what advantage does the "recurrent disability" provision provide in the insure under a disability income policy?

it eliminates the imposition of a second elimination period for the same disability

An insured purchased a health insurance policy with a renewability clause that states the policy is "Guaranteed Renewable." This means that as long as the required premiums are paid, the policy will continue until the insured

reaches age 65

which of the following is NOT a characteristic of a managed care plan

risk retention

An insured's health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. That means the policy provides benefits on what basis?

scheduled

If the insurance premiums were not tax deductible, what other taxation will this affect?

taxation of benefits

an applicant completes an application for a disability policy and pays the initial premium. The producer gives the applicant a conditional receipt. insurance coverage for the applicant will become effective when

the Insurance company accepts the risk

whose responsibility is it to ensure that the application for health insurance is complete and accurate?

the agents

in health insurance, what is coinsurance

the amount an insured pays for treatment

which entity has the option of including optional provisions in a health insurance policy

the insurer

if an applicant submits the initial premium with an application, which action constitutes acceptance

the underwriters approve the application

A producer represents

their appointing insurer

an employee is covered under COBRA. His previous premium payment was $100 per month. His employee now collects $102 each month. Why?

to cover the employer's administration costs

what is the purpose of the impairment rider in a health insurance policy

to exclude coverage for a specific impairment

what is the purpose of the impairment rider in a health insurance policy?

to exclude coverage for a specific impairment

An agent who knowingly misrepresents material information for the purpose of inducing an insured to lapse, forfeit, change or surrender a life insurance policy or annuity has committed an illegal practice known as

twisting

An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under CObRA

within 60 days

if an individual willfully violates provisions of the Fair Credit Reporting Act, what is the maximum civil penalty>

$2500

How much are health policies required to provide for substance abuse?

$6,000 each 24 month period

in some cases, in order for an insurer to legally disclose priveleged information to appropriate sources, the insured must sign an authorized form. what is the maximum amount of time that can legally pass between the completion of the form and the disclosure of information?

1 year

When a hearing regarding an insurance matter is requested, all parties affected must be notified within what time period of the hearing?

10 days

when must a producer notify the Commissioner of Insurance of a change of business address?

10 days

To qualify for disability income benefits under Social Security, an individual's disability must be expected to result in death or last for at least

12 months

What is the minimum length or coverage required for long-term care policies?

12 months

How many days does an insured have to return a Medicare supplemental insurance policy after policy delivery for a full refund of premium?

30 days

An underwriter is reviewing an applicant with ar extensive medical history. Which of the following would give the underwriter a better understanding of how the applicant has been treated for various illnesses?

Attending Physicain's Statement

A portion of a patient's open-heart urgery costs is paid by the organization that provided the surgery and post-operative care. Which type of organization is this?

HMO

Which of the following time periods is the general enrollment period for Medicare Part B?

January Through March 31 each year

which of the following Medicare parts provides perception drugs benefit?

Part D

When acting as a field underwriter, a producer is

Seeking credible information about an applicant for health insurance

Which of the following describes the relationship between the principal sum and a capital sum?

a capital sum is a percentage of the principal sum

Which of the following statements is NOT true regarding health insurance policy provisions?

all additional provisions written by insurers are cataloged by their respective states

the benefits from a business overhead expense insurance policy

are limited to covered expenses and are taxable to the business

if a person qualifies for SS disability benefits after the 5 month period, when will benefits begin?

benefits begin at the beginning of the 6 month and are not retroactive to the beginning of the disability

An applicant misstates his age on his application for a health insurance policy. He states that he is 39, but his actual age is 49. When he files a claim, what will most likely happen?

benefits paid will be those that would have been purchased at the correct age

an insured recently received his major medical insurance policy. only 20 days after the policy issue, while recreational rock climbing, the insured suffered a fall that required hospitalization, surgery and physical therapy to repair his broken leg, which of the following is true

both a deductible and coinsurance payments will be required

Conrad receives $50,000 from a $100,000 Accidental Death and Dismemberment policy as a result of the loss of his left arm in an accident. Conrad has received the

capital amount

An employee dies having 6 quarters of coverage during the previous 13-quarter period. What status of coverage does the employee have under Social Security?

currently insured

which of the following is an example of a physical hazard?

diabetes

The "stop-loss" feature on a major medical policy is intended to

establish a maximum amount of out-of-pocket expense that an insured will have to pay for medical expense in a calendar year

The presumptive disability provision assumes that the insured is totally disabled upon loss of all of the following EXCEPT

feeling

An insured has an individual disability income policy with a 30-day elimination period. He becomes disabled on June 1st for 15 days. When will he collect on his disability income payments?

he won't collect anything

All of the following are reatures of catastrophic plans EXCEPT

high premiums

Regarding major medical plans

higher stop-loss means lower premium

right after the insured reinstated his major medical policy, he was involved in an accident that required hospitalization. when would this accident be covered upon

immediately

According to the time of payment of claims provision, how soon must a claim be paid?

immediately upon proof of loss

according to the time of payment of claims provision, how soon must a claim be paid?

immediately upon proof of loss

restoring an insured financially after a clean is known as

indemnity

which of the following is NOT true regarding a noncancellable policy

insurer can increase the premium above wha is stated in the policy if claims experience is greater than expected

All of the following are excluded from coverage in an individual health insurance policy EXCEPT

mental illness

Under the Affordable Care Act, when would pregnancy be considered a pre-existing condition?

never

Only the agent is involved in completing the agents report. The agent's statement is

not included in the "entire contract"

Which of the following best describes a presumptive disability?

one that is severe enough that the insured automatically qualifies for full disability benefits

An insured purchased a core policy (Plan A) to supplement his Medicare coverage. Following a stay in the hospital, the insured found that the supplemental coverage paid for all of the following EXCEPT

part A deductible

All Of the following statements about mutual insurance companies are correct EXCEPT

policy dividends issued by mutual companies are guaranteed and not taxable

Utilization management consists of an evaluation of the appropr lateness, necessity and quality of health care, and may include

prospective and concurrent review

If a producers license has been terminated, what is the producer required to do?

return the license to the Commissioner immediately

what is the purpose of the impairment rider in a health Insurance policy

the exile coverage for a specific impairment

an applicant completes an application for a disability policy and pays the initial premium. the producer gives the applicant a conditional receipt. Insurance coverage for the applicant will become effective when

the insurance company accepts the risk

Under the mandatory uniform provision "Notice of Claim", written notice of a claim must be submitted to the insurer within what time parameters?

within 20 days

a subscriber has been treated for a medical condition by his primary care physician for 3 months with experimental remedies without a significant health improvement before being referred to a specialist. which of the following types of plans does the subscriber have?

a gatekeeper HMO plan to control the costs

In health insurance, what is coinsurance?

a percentage of the cost of service that the insured and the insurer share

Which of the following is NOT true of Long-term care for employer group health insurance?

any premium paid by the employer, if not used, can be pocketed at the end of the year as gross income by the employee