Practice exam pt 2
Medicare select plan
Are Medigap policies that offer lower premiums in exchange for limiting the choice of health care providers.
Moral Hazard
Arises when people behave recklessly because they know they will be saved if things go wrong
Under the Age Discrimination in Employment Act, if the obligation of the employer to provide retiree health benefits, what will an individual younger than 65 receive in benefits each year?
At least the value of the Social Security benefits
Which of the following is not an enrollment period for Medicare part a applicants
Automatic enrollment
A policy available to business owners that provides payment for normal business expenses in the event that the owner is disabled is called
Business Overhead Expense
According to the provisions of the Patient Protection and Affordable Care Act, all of the following are required preventive care services EXCEPT
Cervical cancer exams for all women starting at age 40
Which of the following would be considered an illegal inducement to purchase insurance?
Confirming future dividends in a life insurance proposal
According to the fair credit reporting act, all of the following would be considered negative information about a consumer except
Disputes regarding consumer report information
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This would indicate that his policy was written with a 30-day
Elimination period
grievance
complaint
Which of the following losses will be covered by a group medical expense policy?
pre-existing condition
An applicant for health insurance has not had a medical claim in 5 years. He exercises daily and does not smoke or drink. What classification do you assume the applicant would receive from his insurer?
preferred
HMOs operate on what basis
prepaid basis
Department of Insurance
state department charged with controlling insurance matters within the state
Which of the following is not considered a rebate
A favorable payment plan provided to a policyholder
In a group policy, the contract is between
Employer and insurance company
How does reinsurance benefit the insurer?
It helps protect against catastrophic losses
All of the following are unfair claims settlement practices EXCEPT
Suggesting negotiations in settling the claim
Which of the following is an example of a producer being involved in an unfair trade practice of rebating
Telling a client that his first premium will be waived if he purchased the insurance policy today
In comparison to consumer reports, which of the following describes a unique characteristic of investigative consumer reports?
The customer's associates, friends, and neighbors provide the report's data.
Which of the following is true regarding limited health insurance policies
They only cover specific accidents or diseases.
And it sure offers a policy very similar to Medicare. An agent tells an application that the policy is Medicare, since the policies are similar anyway. Which of the following is true
This practice is illegal
promissory warranty
promise to do something or that something will be done in a specific way
In what way can an agent demonstrate a high standard of ethics
Putting the client's best interest before their owner
An agent who offers a cash reward to a prospect for buying a policy is guilty of
Rebating
Pure Risk
a risk that presents the chance of loss but no opportunity for gain
A policy may be issued for a term longer than one year or for an indefinite term as long as there is a clause in the policy providing for cancellation by giving how much notice prior to the anniversary date?
60 days
According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?
60%
If an employer provides long-term group disability insurance for its employees, what percentage of monthly wages are lower paid employees eligible to collect
66 2/3%
According to the fair credit reporting act consumer reports are prohibited from reporting negative information about a customer after how many years
7 years
Speculative Risk
A chance of loss, no loss, or gain.
An applicant is denied insurance because of information found on a consumer report. Which of the following requires that the insurance company supply the applicant with the name and address of the consumer reporting company?
Fair Credit Reporting Act
Which of the following standards is used to determine premium rates under the affordable care act
Family composition
Most LTC plans have which of the following features?
Guaranteed renewability
Which of the following statements is CORRECT concerning the relationship between Medicare and HMOs?
HMOs may pay for services not covered by Medicare.
In insurance transactions, fiduciary responsibility means
Handling insurer funds in a trust capacity
An association could buy group insurance for its members if it meets all of the following requirements EXCEPT
Has at least 50 members
HIPAA
Health Insurance Portability and Accountability Act
Under the Privacy Rule for HIPAA, protected information includes all individually identifiable health information
Held or transmitted in any form
In which of the following locations would skilled care most likely be provided?
In an institutional setting
Where does a domestic insurer have its home office
In this state
Medicaid provides all of the following benefits EXCEPT
Income assistance for work-related injury.
Guarantee of insurability option in long-term care policies allows the insured to
Increase benefit levels without providing proof of insurability
A life insurance policy has a legal purpose if both of which of the following elements exist?
Insurable interest and consent
Which of the following entities must approve all Medicare supplement advertisements?
Insurance Commissioner or Director
Which of the following is an intermediary who acts on behalf of the insured in insurance transactions
Insurance broker
Corporate Insurance
Insurance sold to businesses.
Private Insurers
Insurance which offers coverage to people through the individual market.
Which of the following is true regarding state regulations for record maintenance?
Insurer's records may be maintained electronically
Who does the Interstate Insurance Product Regulation Compact serve?
Insurers
The type of dental plan which is incorporated into a major medical expense plan is a/an
Integrated dental plan
How is the amount of Social Security disability benefits calculated?
It is based upon the worker's Primary Insurance Amount (PIA), which is calculated from their Average Indexed Monthly Earnings over their highest 35 years.
Concerning Medicare Part B, which statement is INCORRECT?
It is fully funded by Social Security taxes (FICA)
What is franchise insurance?
It is health coverage for small groups whose numbers are too small to qualify for true group insurance
Which of the following statements concerning Medicare Part B is correct?
It pays for physician services, diagnostic tests, and physical therapy.
All of the following would be qualified as a dependent under a Dependent Care Flexible Spending Account, EXCEPT
Jeremy had to have both legs amputated, but has learned how to take care of himself and to get around in a wheelchair
Which of the following insurance principle states that the larger the number of people with similar exposure to loss The more predictable actual license will be
Law of large numbers
When an employee is still employed upon reaching age 65 and eligible for Medicare, which of the following is the employee's option?
Remain on the group health insurance plan and defer eligibility for Medicare until retirement
Prosthodontics
Replacement of natural teeth with artificial teeth or dentures
Do the family emergencies a producer let his license laugh three months ago now he is ready to start transacting insurance again what steps must the producer take to reinstate his license
Retake exam
All group policies that cover inpatient hospital services must provide how much coverage for such services for the treatment of alcoholism, drug abuse, and nervous or mental disorders?
Same
Evaluating information that establishes adverse selection risk is the purpose of which stage of insurance?
Underwriting
bridgework
Unlike dentures, which replace the upper or lower sets of teeth, bridgework is made up of sections of replacement teeth that can be inserted and removed from one's mouth.
Traditional Insurance
Usually has a deductible, co-payment, or coinsurance, Illness/injury only.
Moral Hazard
When the act of insuring an event increases the likelihood that the event will happen
In individual health insurance coverage, the insurer must cover a newborn from the moment of birth, and if additional premium payment is required, how many days should be allowed for payment?
Within 30 days of birth
When can a Long-Term Care policy deny a claim for losses incurred because of a pre-existing condition?
Within 6 months of the effective date of coverage
Consumer Reports
Written and /or oral statements regarding a consumer's credit, character, reputation, or habits collected by a reporting agency from employment records, credit reports, and other public sources.
HMOs
a network of providers for which costs are covered inside but not outside the network
indemmity
a payment for damage or loss
insurable risk
a pure risk that is faced by a large number of people and for which the amount of the loss can be predicted
Welfare benefits include all of the following EXCEPT
workers compensation
A brain surgeon has an accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for all losses?
"Own occupation" - less restrictive than other definitions
An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?
$102
What is the maximum penalty for habitual willful noncompliance with the Fair Credit Reporting Act?
$2,500
The sole proprietor of a business makes a total salary of $50,000 a year. This year, his medical expenses have reached a total of $75,000. What amount may the sole proprietor deduct in regards to his medical expenses?
$50,000
A person who knowingly obtains information on a consumer from a consumer reporting agency under false pretenses may be in prison for up to how many years
2 years
After the original hearing and a final order is issued, an aggrieved person may request a re-hearing within
20 days
What is the minimum length of benefit period that a long-term care policy must provide?
24 monthes
An insured has Medicare Part D coverage. Upon reaching the initial benefit limit, what percentage of the prescription drug cost is the insured responsible for paying?
25%
A consumer would like to get more information on their investigative consumer report. How many days does the insurer have to comply
3 days
If group coverage ends, coverage may be continued or converted into an individual policy if a person has been insured under that contract for at least
3 months
When agents are acting within the scope of their contract, their actions will be assumed to be the acts of the
insurer
Which of the following is NOT a metal level of coverage offered under the Patient Protection and Affordable Care Act?
iron
Who is the beneficiary in a credit disability income policy
lending institution
In order to reduce the premium to the lowest monthly amount on his disability income policy, the insured could choose
longer elimination period, shorter benefit
When compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is
lower
If a dental plan is integrated, it is combined with what type of plan?
medical
Which of the following information regarding an insured is NOT included in an Investigative Consumer Report, which is requested by an underwriter?
medical history
The Interstate Insurance Product Regulation Compact is a contract between
member states
All of the following are essential elements of a contract except
monetary consideration
Which of the following factors is considered more important to the underwriting decision for disability coverage than for most of the other forms of insurance?
occupation
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
Which type of dental care would cover operative treatment of the mouth
oral surgery
What is the major difference between a stock company and a mutual company
ownership
hospital indemnity policy
pays stipulated daily, weekly, or monthly cash benefits during hospital confinement
Which of the following occupations would have the lowest disability insurance premiums
personal trainer
An intermediary must maintain records for how long?
3 years
How long must an insurer retain an advertisement for its long term care policies
3 years
Intermediaries Are required to maintain records related to insurance transactions for what period of time
3 years
If a new individual long-term care policyholder is not satisfied with a new policy, within how many days can the insured return the policy for a full premium refund?
30
A Medicare supplement must have a free-look provision of at least
30 days
The commissioner issues an order without having conducted a hearing. Within how many days of receiving the order can the person aggrieved by the order request a trial?
30 days
To comply with the timely payment of claims provision, insurers must pay a claim within how many days of receiving proof of loss?
30 days
Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months?
30 months
What is the number of credits required for fully insured status for Social Security disability benefits?
40
What is the total amount of insurance risks an agent can place with a single insurer in one calendar year if the agent Is not listed with that insurer
5
What is the elimination period for Social Security disability benefits?
5 months
What is the maximum number of employees that a small employer can have?
50
If the insurer failed to pay premium within the required period of time, all overdue payments will be charged an annual interest of
7.5%
An insurer plans to discontinue a specific type of group health insurance coverage. How much prior notice must the insurer give each employer and plan participant?
90 days
Morale Hazard
A condition of carelessness or indifference that increases the frequency or severity of loss.
Underwriting for disability insurance is unique due to the type of risk involved. Which of the following situations illustrates this?
A construction worker pays a higher premium and receives a poorer classification of disability.
All of the following statements about medicare part B are correct except
It is a compulsory program.
Which of the following is excluded in a dental insurance plan?
Lost dentures
If a person is compensated for a testimonial in an advertisement, which of the following statements should be included in the advertisement?
Paid endorsement
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?
Parts A and B of Medicare
HMOs operate on what basis?
prepaid basis
affirmative warranty
statement of fact (basically representation)
Which of the following are responsible for making premium payments in an HMO plan
subscribers
All of the following coverages are usually included under a dental insurance plan EXCEPT
teeth whitening
Which of the following does NOT have to be disclosed in a long-term care (LTC) policy?
The aggregate amount of premiums due
Apparent Authority
The appearance or the assumption of authority based on the actions, words, or deeds of the principal or because of circumstances the principal created.
If a licensee wants to transact insurance under a different name than that listed on his or her producer's license, which of the following must occur?
The change must be filed with the Department
In a group policy, who is issued a certificate of insurance
The individual insured
HMO (Health Maintenance Organization)
A managed care organization that provides comprehensive medical services for a predetermined annual fee per enrollee.
Which of the following would best describe total disability?
A person's ability to work is significantly reduced or eliminated for the rest of his/her life.
Which of the following is an example of a producers fiduciary responsibilities
A producer promptly forwarding premiums to the insurance company
What is a material misrepresentation?
A statement by the applicant that, upon discovery, would affect the underwriting decision of the insurance company
When the policy premium wasn't submitted with the application, what should the agent obtain from the insured upon policy delivery?
A statement of good health
Group Insurance
A type of health insurance in which all those insured have the same coverage and pay a set premium
Group Insurance
A type of health insurance in which all those insured have the same coverage and pay a set premium. Covers eligible group members. Underwriting process is designed to avoid adverse selection: insurance incidental to the group, turnover and persistency, group size and composition, groups prior claims experience
Agent's Report
A written report from the agent submitted to the insurer along with the application disclosing what the agent knows, observed, or learned about the proposed insured's risks.
Fair Credit Reporting Act
Act that protects privacy of background information and ensures that information supplied is accurate.
Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis?
Adult day care
What documentation grants express authority to an agent?
Agent's contract with the principal
Which of the following statements is NOT correct regarding medicare
Medicare Advantage must be provided through HMOs
In cases where a covered employee is eligible for Medicare benefits to treat end-stage renal disease (ESRD) with dialysis or kidney transplant, which of the following is correct?
Medicare is the secondary payer during the first 30 months of treatment
Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?
Metal level classification
Under which of the following would the commissioner grant a requested re-hearing?
New evidence is discovered
Which of the following is true about Medicaid
Not all low-income individuals will qualify for Medicaid.
restorative care
Nursing care that is planned to promote residents health and regain as much of their independence as possible
When health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost, it is called
Preferred Provider Organization (PPO)
Who can provide skilled nursing care?
doctor
Which of the following is NOT the purpose of HIPAA?
To provide immediate coverage to new employees who had been previously covered for 18 months
OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage?
end stage renal failure
What is the difference between the Medicare approved amount for a service or supply and the actual charge
excess charge
Under a typical health insurance policy, claims that result from injuries while the insured was intoxicated or under the influence of drugs are generally
excluded
The authority granted to an agent through the agent's contract is referred to as
express authority
Medicaid is funded by
federal and state governments
Which of the following would be considered a peril?
fire
The benefits for individual disability plans are based on
flat amount
Which provision allows a person to return a medicare supplement policy within 30 days for a full premium refund
free look
A new employee who meets HIPAA eligibility requirements must be issued health coverage on what basis?
guaranteed
HMO
health maintenance organization
Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage
health maintenance organization plan
In long-term care (LTC) policies, as the benefit period lengthens, the premium
increases
What is the purpose of requiring licenses for persons who transact insurance
protect the general public
Which of the following is the most common way to transfer risk?
purchase insurance
A situation in which a person can only lose or have no change represents
pure risk
Which of the following insurance options would be considered a risk sharing arrangement
reciprocal
Credit Disability Insurance
repays the outstanding loan balance if the borrower becomes disabled
Which of the following is not covered under a dental insurance plan?
respite care
In dental insurance, what type of care will cover crowns?
restorative
Contributory Plan
retirement plan funded by contributions from the employer and employee
noncontributory plan
retirement plan funded entirely by contributions from the employer
Consideration
something of value exchanged for something else of value
Express Authority
the authority of an agent, stated in the document or agreement creating the agency
An applicant is considered to be high-risk, but not so much that the insurer wants to deny coverage. Which of the following is NOT true?
the insurer will issue a conditional coverage
Which of the following statements about qualified long-term care policies is FALSE?
the policy may duplicate medicare benefits
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
they cover the cost of extended nursing home care
When an individual purchases insurance, what risk management Technique is he or she practicing?
to transfer
Own Occupation
total disability that requires that in order to receive disability income benefits the insured must be unable to work at the insured's own occupation.
If only one party to an insurance contract has made a legally enforceable promise, what kind of contract is it?
unilateral
In insurance policies, The insured is not legally bound to any particular action in the insurance contract, but the insurer is legally obligated to pay losses covered by the policy. What contract element does this describe?
unilateral
An insurance company receives an application with some information missing and issues the policy anyway. What is this called?
waiver
Own Occupation
A definition of total disability. The insured must be unable to work at her own occupation. It is easier for the insured to receive benefits under policies using this definition.
Which of the following is NOT considered a rebate?
A favorable payment plan provided to a policyholder
Medicaid
A federal and state assistance program that pays for health care services for people who cannot afford them.
Medicare
A federal program of health insurance for persons 65 years of age and older
Workers Compensation
A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment.
Which of the following groups seeking group health insurance would represent a bad risk for underwriters?
A group that changes insurance annually
What is the shortest possible elimination period for group short-term disability benefits provided by an employer?
0 days
An insured's disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payment from the insurer before Social Security benefits begin?
1 year
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
According to OBRA, what is the minimum number of employees required to constitute a large group?
100
S is a sole business proprietor who owns a medical expense plan. What percentage of the cost of the plan may he deduct?
100%
An intermediary has just placed insurance on himself. He can receive compensation for this transaction only if he has placed insurance on other individuals with the same insurer within the last
12 months
If reasonably possible, a notice of proof of loss claim must be provided to the insurer within what period of time after the time required by the policy?
12 months
In order to collect Social Security disability benefits, the claimant must be able to demonstrate that the disability will last at least
12 months
Coverage for diagnostic procedures and medically necessary non-surgical treatment for the correction of TMJ disorders may be limited to an annual amount of
1250
Applicants must complete a Crime Information Bureau form within how many days before taking their state exam?
180 days
HIPAA applies to groups of
2 or more
Buy-Sell Agreement
A legal contract that determines what will be done with a business in the event that an owner dies or becomes disabled.
Over several years, a policy owner paid $10,000 in premiums for his insurance policy. When he suffered a loss, the insurance company paid out $50,000 in benefits. What characteristics of an insurance contract does this describe
Aleatory
Producers license
All persons or business that sell, solicit, or negotiate insurance are required to be licensed as an insurance producer
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?
All providers will have the same coverage options and conditions for each plan
All of the following apply to short-term disability plans EXCEPT
Both group and individual plans are renewable
Which of the following includes information regarding a person's credit, character, reputation, and habits?
Consumer report
Individual Insurance
Covers applicant, spouse, and family. Underwriting and risk classifications are: age, Tobacco use, geographic area, single or family enrollment
Endodontics
Dental specialty that diagnoses and treats diseases of the pulp
And dental care which of the following would be considered prosthodontics
Dentures
Concerning group Medical and Dental insurance, which of the following statements is INCORRECT?
Employee benefits are tax deductible the year in which they were received.
defined contribution plan
Employees and employer pay a specific amount into the plan for each participant. Employer contribution often are based upon a percentage of salary or a percentage of profits.
Which type of dental treatment involves the dental pulp within the teeth?
Endodontics
Which types of insurance companies marketing long-term care insurance coverage must establish procedures to assure that any comparison of policies by its agents will be fair and accurate?
Every company is required to establish marketing procedures.
An insurance organization that does not issue insurance policies but provides a meeting place for underwriters to conduct business is known as a
Lloyd's Association
Medicaid eligibility
Low income + no insurance
All of the following statements describe a MEWA EXCEPT
MEWAs are groups of at least 3 employers.
All of the following statements concerning Medicaid are correct EXCEPT
Medicaid is a state funded program that provides health care to persons over age 65, only.
Which of the following describes taxation of individual disability income insurance premiums and benefits?
Premiums are not tax deductible, and benefits are not taxable.
Which of the following is NOT among the goals of a Medicare supplement application?
Presuming the applicant is eligible for Medicaid, based on the nature of the policy
What Medicare advantage plan is offered through private insurance companies
Private fee for service
Medicare supplement plan
Private insurance plans specifically designed to provide coverage for some of the services that Medicare does not pay, such as Medicare's deductible and coinsurance amounts and for certain services not allowed by Medicare.
A man's physician submits claim information to his insurer before she actually performs a medical procedure on him. She is doing this to see if the procedure is covered under the patient's insurance plan and for how much. This is an example of
Prospective review
Which type of dental treatment involves the replacement of natural teeth with artificial devices
Prosthodontics
Department of Insurance
Protects the general public, control and supervise all insurance business in the state, and issue licenses and certificates of authority
Medicare Part A (aka Hospital Insurance or HI)
Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible & co-pay.
In what way can an agent demonstrate a high standard of ethics?
Putting the client's best interest before their own
Any inducement offered to the insured in the sale of an insurance policy that is not specified in the policy is an unlawful practice known as
Rebating
What type of care is Respite care?
Relief for a major care giver
Which of the following is monitored by ERISA?
Stock profit-sharing plans
Which of the following is an example of a producer being involved in an unfair trade practice of rebating?
Telling a client that his first premium will be waived if he purchased the insurance policy today
Which of the following statements concerning group health insurance is CORRECT?
The employer is the policyholder.
Government Insurers
The federal government provides life and health insurance through various sources. The federal government has offered a variety of military life insurance plans including United States Government Life Insurance, national Service Life Insurance, and Serviceman's Group Life Insurance. Because private insurance policies exclude catastrophic risks, the federal government has stepped in to provide them. At the state level, government are involved in providing unemployment insurance, workers compensation programs and secondary-injury funds, and state-run medical-expense insurance plans. Federal, state and local governments provide social insurance to a segment of the population who would otherwise be without disability income, retirement income, or medical care, such as Medicaid.
Who chooses a primary care physician in an HMO plan?
The individual member
Which insurance principle states that if a policy allows for greater compensation than the financial loss incurred, the insured may only receive benefits for the amount lost?
indemnity
Retained Risk
The potential loss that exceeds the amount covered by insurance.
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 pre-existing condition. Which of the following 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 one left off.
If a policy is rated-up, which of the following is true?
The premium increases
Which state has jurisdiction over a group policy that covers individuals that reside in more than one state?
The state in which the policy was delivered
Which of the following is true regarding METs
They allow several small employers purchase less expensive insurance together.
Which of the following statements is most correct concerning the changing of an irrevocable beneficiary?
They can be changed only with the written consent of that beneficiary.
What is the purpose of Medigap policies?
To cover expenses for Medicare deductibles and coinsurance
What is the purpose of coinsurance provisions?
To help the insurance company to prevent overutilization of the policy
Self-insurance
a special form of planned retention by which part or all of a given loss exposure is retained by the firm
orthodontist
a specialist who corrects irregularly positioned teeth
orthodontics
alignment or straightening of the teeth
Implied Authority
an agent's authority to do things not specifically authorized in order to carry out express authority
capitated plan
an insurance plan in which prepayments made to a physician cover the physician's services to a plan member for a specified period of time
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
Which of the following hospice expenses would NOT be covered in a cost-containment setting?
antibiotics
Medicaid is sponsored by what kind of sources?
both state and federal
periodontics
branch of dentistry dealing with diseases of the bone and gum tissues supporting the teeth
Morale Hazard
carelessness or indifference to a loss because of the existence of insurance
peril
cause of loss
In a group prescription drug plan, the insured typically pays what amount of the drug cost?
co-payment
A producer who fails to separate premium Monies from his own personal funds is guilty of
commingling
Insurers must report or list all appointments and all terminations of appointments to what authority?
commissioner
In any case where there is a controversy or dispute between the insurance company and the insured, the soliciting agent is the agent of the
company
A health insurance plan that covers all accidents and sicknesses that are not specifically excluded from the policy is referred to as a
comprehensive plan
When both parties to a contract must perform certain duties and follow rules of conduct to make the contract enforceable, the contract is
conditional
An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles has the insurer violated
consideration
Which provision allows the policyowner to change a term life policy to a permanent one without providing proof of good health?
conversion
Which of the following is the term for the specific dollar amount that must be paid by an HMO member for a service?
copayment
An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement?
cost containment