Health Insurance- Extra questions

Which of the following is NOT among the goals of a Medicare supplement application? A.Advising applicants regarding the availability of counseling services B.Presuming the applicant is eligible for Medicaid, based on the nature of the policy C.Determining whether or not an applicant has an existing Medicare supplement policy D.Determining whether or not the policy will replace another accident and health policy

B.

What process will the insurance company use to monitor the insured's hospital stay to make sure that everything is proceeding according to schedule?

Concurrent review

What report will provide the underwriter with the information about an insurance applicant's credit?

Consumer report

In a group prescription drug plan, the insured typically pays what amount of the drug cost?

Copayment

What term is for the specific dollar amount that must be paid by an HMO member for a service?

Copayment

An insurance company assures its new policyholders that their premium costs will not increase for a period of at least five years. However, due to increasing financial strain, they plan to raise premium costs for all insureds by 10% over the next two years. What term best describes this act?

Fraud

In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?

Insurer to the insured

What is the benefit of experience rating?

It allows employers with low claims experience to get lower premiums.

Which of the following is true regarding a term health policy?

It is nonrenewable.

Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date?

Optionally renewable

Regarding the taxation of Business Overhead policies,

Premiums are ducuctible and benefits are taxed

What is the taxation of individual disability income insurance premiums and benefits?

Premiums are not deductible, and benefits are not taxable

Which of the following is correct regarding the taxation of group medical expense premiums and benefits?

Premiums are tax deductible and benefits are not taxed.

After the elimination period, totally disabled insured qualified and started receiving benefits from his disability income policy that has a waiver of premium rider. What will most likely happen to the premium paid into the policy during the elimination period?

Premiums will be refunded

What is accurate comparison between private and government insurers?

Private insurers may be authorized to transact insurance by state insurance dpartments

The Federal Fair Credit Reporting Act

Regulates consumer reports

Disability Income policies can provide coverage for a loss of income when returning to work only part time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?

Residual disability

Which of the following best describes the "first-dollar coverage" principle in basic medical insurance?

The insured is not required to pay a deductible.

Insured Z's health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true?

The insured may carry over the amount of this year's expenses to next year, which will help satisfy next year's deductible.

Which of the following statements is true regarding coinsurance?

The larger the percentage that is paid by the insured, the lower the required premium will be.

Who is the beneficiary in a credit health policy?

The lending institution

An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a preexisting condition. What is true?

The pre existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one picking up where the old left off

An HSA holder who is 65 years old decides to use the money in the account for a nonhealth expense. Which of the following is true?

There will be a tax. -An HSA holder who uses the money for a nonhealth expenditure pays tax on it, plus a 20% penalty. After age 65, a withdrawal used for a nonhealth purpose will be taxed, but not penalized.

What is true regarding fraud?

a person who knowingly defrauds an insurer is committing a felony

A business entity may be licensed as an insurance producer if

an employee who holds a producer license is designated as a compliance officer

What term is used to describe when the medical caregiver provides services to only members or subscribers of a health organization, and contractually is not allowed to treat other patients?

close panel

The provision that states that both the printed contract and a copy of the application form the contract between the policy owner and the insurer is called the q]

entire contract

What term is used to describe when a medical caregiver contracts with a health organization to provide services to its members or subscribers, but retains the right to treat patients who are not members or subscribers?

open panel

Once a complaint has been filed with the commissioner regarding an unfair claims practice, the commissioner

within 10 business days will send a copy of the complaint to the company involved

What is the maximum civil penalty for willfully and knowingly violating a cease and desist order?

$50,000 per violation

A disability income policy is written with a 10 month benefit period, a 30 day elimination period, and a 30 day probationary period. If the insured becomes disables due to illness 9 days after the effective date, the policy will pay benefits for a maximum of

10 months

Any licensed person whose activities affect interstate commerce and who knowingly makes false material statements related to the business of insurance may be imprisoned for up to

10 years

To be eligible under the HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?

18 months

The relation of earnings to insurance provision allows the insurance company to limit the insured's benefits to his/her average income over the last

24 months

If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?

5 days

What is the elimination period for Social Security disability benefits?

5 months

Insurance companies may be classified according to the legal form of their ownership. The type of company organized to return any surplus money to their policyholders is

A mutual insurer

What type of information is NOT included in a certificate of insurance? A.The cost the company is paying for monthly premiums B.The policy benefits and exclusions C.The procedures for filing a claim D.The length of coverage

A.

Which of the following is NOT correct regarding examination of companies? A.The Commissioner must examine all alien companies. B.The Commissioner may examine a company doing business in this state at any time. C.The Commissioner may waive examination of foreign companies under certain circumstances. D.All domestic companies are subject to fiscal examination.

A.

If an insurance company makes a statement that its policies are guaranteed by the existence of the Insurance Guaranty Association that would be considered

An unfair trade practice.

If an insurance company wishes to order a consumer report on an applicant to assist in the underwriting process, and if a notice of insurance information practices has been provided, the report may contain all of the following information EXCEPT the applicant's

Ancestry