Heath insurance
If an insured pays a health insurance premium each month how long would the grace period be under the policy
10 days
The policy holder return the policy to be insure a week after it's delivered how much of the premium will be returning to the applicant
100%
To qualify for disability income benefits under Social Security and individuals disability must be expected to result in death or less for at least
12 months
Cours benefits are included in all Medicare supplement policy is what percentage of part B call insurance is required
20%
The affordable care act mandate that ensures provide coverage for adult children of the insured up to the age
26
A Medicare supplement policy must have a free look period of at least
30 days
To be acceptable to insurance companies what percentage of eligible employees must be in rolled under a contributory group health insurance plan
75%
According to the meadow level classification of health plans what percentage of healthcare cost will be covered under a gold plan
80%
Flexible Spending Account (FSA)
A form of cafeteria plan benefit funded by salary reduction and employer contributions employee is allowed to deposit a certain amount of their paycheck into the account before paying income taxes FSA benefits are subject to annual maximum and user lose rule/ Maybe use to pay medical and dental for employee
Benefits of group disability plans are based on
A percentage of the workers income
An individual is approaching a retirement age and he's concerned about having proper coverage should he have to be placed on a long-term care bacillary his agent told him that LTC policies will provide necessary coverage at all of the following levels except
Acute
usual, customary, and reasonable (UCR)
Amount paid for procedure based upon the average charge for that procedure in that specific geographic area
Which of the following writers paid a beneficiary the death benefit that is double or triple the face amount if the insurance death was caused by an accident as defined in the policy
An accidental death writer
Which action by and ensure or it's representatives is not considered an unfair Claims violation
An agent in size is a claimant to obtain the services of an attorney
All of the following could qualify as a group for the purpose of purchasing group health insurance except
And Association of 35 people
An underwriter is reviewing an application with an extensive medical history which of the following we get the underwriter a better understanding of how the applicant has been treated for various illnesses
Attending physician statement
Accidental death and dismemberment
Can be written as a writer or as a separate policy the (principal sum) is paid for accidental death in case of loss of sight or accidental dismemberment a percentage will be paid by (capital some). The policy will usually pay the full principle of loss in sight in both eyes or two limbs however it only pays 50% of the loss of one hand or foot meaning the policy will pay twice or three times the face amount in the event of accidental death/ 90 days
Conrad receives 50,000 from 800,000 accidental death and dismemberment policy as a result of the loss of his left arm in an accident Conrad has received the
Capital amount
Which of the following elements of an insurance contract requires payment premium
Consideration
What is the purpose of the gate keeper in an HMO
Control and cost
HMO members pay a small fee when they see their primary care physician the fee is called a
Copay
When filling out an application for insurance the applicant makes a mistake if a fresh application were not available what could the application due to park with the correct
Cross the incorrect answer out right the correct one beside it and initial the answer
Which of the following meets the insurance personal needs and is provided by non-medical personnel
Custodial care
Which of the following losses would likely be covered under the accidental death writer
Death caused by a head on collision
Which of the following is provided by skilled medical personnel to those who need occasional medical assistance for rehabilitative care
Intermediate care
Which underwriting information includes information on and applicants character general reputation personal habits and motive living
Investigative consumer report
Point of Service (POS)
Is a combination of HMO and PPO plans
How does insurance distribute the financial consequences of individual losses
It transfers the risk to all persons insured
Which of the following time. Is the general enrollment period for Medicare part B
January 1 through March 31 each year
If an insurance company issued a policy even though some questions on the application where I answered when can we ensure I get the answers to those questions
Never the insurer has Waze it's right answers by issuing the policy by excepting the application with unanswered questions
Hi deductible health plan in savings account
Often in coordination with medical savings account health savings account or health reimbursement account the high deductible health plan features higher in your deductibles and out-of-pocket limit than traditional plans giving lower premiums the deductible of HDHP may be paid with funds from coordinating account plan
In network provider equals less out-of-pocket cost
Out of network provider equals higher out-of-pocket cost
PPO
PPL is a group of physicians in hospitals that contract with employers insurers and third-party organizations to provide medical care services at a reduced fee
HMO Prepaid Basis - member selects pcp, pcp gives referral
PPO fee for service basis - no pcp or referrals/ in network out network provider
The insured purchased a health insurance policy with a renewability clause that states in the policy is guaranteed renewable this means that as long as they require premiums are paid the policy will continue until the insured
Reach his age 65
Health insurance rates may be based upon all of the following except
Religion
Which of the following is a daily nursing and rehabilitation of care that can only be provided by medical personnel and do the direction of a physician
Skilled care
To limit to the amount an employee and employer cannot contribute to MSA
The annual deductible limit: 65% and the annual income limit: 75%
Once the initial benefit limit in Medicare part D is reach how isThe beneficiary affected
The beneficiary is then responsible for a portion of the prescription drug costs
benefit schedule
specifically states exactly what is covered in the plan and for how much
Medicare is health insurance program for all of the following individuals except
those with low income and low assets
Health insurance must offer pediatric dental coverage for children 18 or younger as an essential health benefit
under a health plan or a standalone dental plan
Health Savings Account (HSA)
Designed to help individuals safe for qualified health expenses that they their spouse or their dependence in Kerr individual who is covered by a high deductible health plan can make a tax deductible contribution to an HSA and use it to pay for out-of-pocket medical expenses contributions by an employer are included in the individual taxable income a person may obtain coverage under a qualified health insurance plan with establish minimum deductible of 1400 for singles 2800 for families/ an HSA holder who uses the money for A non-health expert denture pays tax on it plus a 20% penalty after age 65 a withdrawal use for non-health purposes will be taxed but not penalized
What is the purpose of the agents report in the application process
Do you provide additional information about the applicant to the underwriter
All of the following are features of health insurance plan purchased on the health insurance marketplace except
Dollar limit on essential benefits
All of the following are ways to handle wrist except
Elimination
Which of the following is not a hazard
Exposure
The illumination. In a disability income policy is better known as
The period of time and insured most weight after the onset of illness or injury for the benefits begin
Which of the following is required in order for a plan to be qualified?
The plan must be formally written and communicated to the employees
HRA characteristics /all size
They are contribution healthcare plans not defined benefit plan, not a taxable employee benefit, employers contribution or tax deductible, employees can( roll over and his balances at the end of the year), employers do not need to advance claims payments to employees or healthcare providers during the months of the plan year, provided with employer dollars not employee salary reductions, permit the employer to reduce health plan caused by coupling the HRA with a high deductible health plan and balancing the group purchasing power
What is the purpose of a disability Byselle agreement
To allow the business buy out in case the owners disability
And employee is covered under cobraHis previous premium payment was 100 per month his employer now collect 102 per month why does the employer collect an extra two dollars
To cover the employers administration cost
Health Reimbursement Account (HRA)
Employer-funded plan that reimburses employees only for eligible and substantiated health-care expenses.
All of the following statements about agents are true except
Exclusive agents work for themselves
FSA exemption
Exempt to federal income taxes Social Security FICA taxes and in most cases state income taxes saving 1/3 or more on taxes
Which of the following statements is not true regarding HICAP
Exist to assist seniors who are not qualified to receive Social Security or Medicare
And insurance agents have authorization to represent the company and may exercise this relationship to
Express authority implied authority and apparent authority
The family deductible is written so there any claims filed by the family within a year apply to the deductible for the entire family
Family deductible's are usually written with a common accident provision
Principle Sum
Full face amount 100%
A 25 year old full-time student is living off a trust fun why would he not qualify for an IRA
He doesn't have earned income
There are two types of flexible spending accounts
Healthcare account for out-of-pocket healthcare expenses and a dependent care account to help pay for dependence care expenses
In an HMO a gatekeeper helps to control the cost of
Healthcare, by only making the necessary referrals
All of the following are features of the catastrophic plan except
Hi premiums
consumer-driven health plan (CDHP)
High deductible plans or patient directive plans or healthcare plans that are controlled by employer employer determines eligibility contribution the girls percent and exit rules funds are allowed to roll over from here to here at the discretion of the employer
Dependent care account
IRS women's annual contribution to a specified amount they get suggested angela The for Coast And leaving this is a family limit meaning that even if both parents have access to flexible care accounts their combined contributions cannot exceed the amount
Qualifying life event changes/only time you can make changes outside of open enrollment
Marital status, number of dependence, one of dependence become eligible for or no longer satisfies the coverage requirements under the medical reimbursement plan for unmarried dependence due to attained age student status for similar circumstances, family medical leave, change independent care provider, the insureds spouses or qualified dependent employment status that affects eligibility under the plan
Which of the following used to be called Medicare choice plans
Medicare advantage plans
Non-help with drawls before age 65 equals 20% penalty
Non-health withdrawal after age 65 equals no penalty
What does basic medical if expense cover
Non-surgical services a physician provides
Only the agent is involved in completing the agents report the agent statement is
Not included in the entire contract
PPOs versus HMOs
PPOs allow more flexibility between in networking out network providers in exchange for a higher premium
Which of the following Medicare parts provides prescription drug benefits
Part d
Who makes up the medical information Bureau
Insurers / Insurance company
Medical Savings Account (MSA)
Is an employer funded account linked to a high deductible medical insurance plan the employer raises the medical plan deductible and returns all or part of the previous savings to the employees to contribute to the MSA, if a distribution is made for a reason other than to pay for qualified expenses the amount withdrawn will be subject to an income tax and an additional 20% tax
Darryl is involved in an automobile accident with another motor is Darryl was at fault Darryl was injured and hospitalized For two months the other motor is suffered 15,000 of medical expenses as a result of the accident Deorro's disability income policy will pay
Darryl's loss of income
A representation in an insurance contract qualifies as an
Implied warranty
A qualifying retire he has access to all parts of the Social Security Medicare program which of these parts requires a monthly payment from the insured
Part b
Which of the following is consideration on the part of the insurer
Paying a claim
Policies written on a third-party ownership bases are usually written to cover which of the following
Policy owner is minor children are business associates
The frequency amount of the premium payment is known as what
Premium mode
In group insurance the primary purpose of the coordination of benefits provision is to
Prevent over insurance
The main Focus for an HMO is
Preventative care
On an accident death and dismemberment policy the death benefit payable is known as the
Principal some
Self-insured association plans are
Prohibited by the CIC
the purpose of the Fair Credit Reporting Act is to
Protect consumers against the circulation of inaccurate or obsolete personal or financial information
And insured was diagnosed two years ago with kidney cancer she was treated with surgeries and chemotherapy and is now in remission she also has a 30 year smoking history the insured is not healthy enough to work and has just started a full-time job which describes the health insurance that she will most likely receive
She would be covered under her employer's group health insurance plan without higher premiums
Under the family medical leave act what happened to an employee's insurance benefits while he or she is on leave
The benefits earned remain in effect for the duration of the employees leave
Which of the following reasons me a great coverage not be discontinued
The company stock value lowers
And insured is anxious to get treated for a health condition and he's convinced that a specialist is needed to cure the condition is the insured has a PPO plan which of the following issue
The insured can select any specialist but not in network specialist will have a how your out-of-pocket cost
When a health plan has both the aggregate deductible and embedded deductibles the annual contribution limit for an HSA is the lesser of
The maximum annual contribution limit, the aggregate deductible, or the embedded deductible multiplied by the number of family matters
Close Panel HMO
The medical caregiver provide services to only members or subscribers of the health organization and contractually is not allowed to treat every patient
What is the purpose of a benefit schedule
To state what and how much is covered in the plan
Insurance provides a means to
Transfer loss
Which of the following services will not be provided by an HMO
Unlimited coverage for a treatment for a drug rehabilitation
Open-panel HMO
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
A limited health insurance policy that will pay a lump sum to an insured diagnosed with a heart attack stroke or renal Failure is known as
critical illness insurance
Which of the following is an example of a physical hazard
diabetes
Medicare part B covers all of the following except
long term care services
Under the affordable care act when would pregnancy be considered a pre-existing condition
never
