TN Health and Accident

The difference between group insurance and blanket health policies is

Blanket health policies do not issue certificates

Generally, how long is a benefit period for a major medical expense plan?

One year

P is an employee who quits her job and wants to convert her group health coverage to an individual policy. After the expiration of COBRA laws, which of the following statements is TRUE?

She DOES need to provide evidence of insurability

Group/voluntary long-term care policy premiums are typically deducted from the employee's income and

are less costly as compared to individual long term care coverage

Which of the following involves analyzing a case before admission to determine what type of treatment is necessary?

Prospective Review

Medicare Part C is:

available to those who are enrolled in Medicare Part A and Part B

The reason for a business having a Business Overhead Expense Disability Plan is to cover:

fixed business expenses

Medicare Part B does NOT cover

inpatient hospital services

The Coordination of Benefits provision:

prevents an insured covered by two health plans from making a profit on a covered loss

An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.

15

An inured must notify an insurer of a medical claim within ____ days after an accident.

20

Which of the following costs would a Basic Hospital/Surgical policy likely cover?

Surgically removing a facial birthmark

In order to establish a Health Reimbursement Arrangement (HRA), it MUST

be established by the employer

Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party?

subrogation

A Business Disability Buyout plan policy is designed

to pay benefits to the corporation or other shareholders

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?

Monthly

Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)

More physicians to choose from

An individual health insurance policy is required to contain a(n)

Payment of claims provision

Which Long Term Care insurance statement is true?

Pre-existing conditions must be covered after the coverage has been in force for six months

Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business?

Business owner becoming disabled

P loses an arm in a farm accident and is paid $10,000 from his Accidental Death and Dismemberment policy. This benefit is known as the

Capital Sum

For a change to a health policy to be valid, what is required?

Changes in the policy must be approved by an executive officer of the insurer

When does the free-look provision for health insurance begin?

Date the policy is delivered to the insured

a characteristic of a preferred provider organization (PPO) would be:

Discounted fees for the patient

M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?

Earned, but unpaid benefits

Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class?

Guaranteed renewability

The first portion of a covered Major medical insurance expense that the insured is required to pay is called the:

Initial deductible

Information obtained from a phone conversation to the proposed insured can be found in which of these reports?

Inspection report

What is being delivered during a policy delivery?

Insurance contract to the proposed insured

When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called which of the following?

Residual disability

Which of the following statements is true about most Blue Cross/Blue Shield organizations?

They are nonprofit organizations

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called

Time Limit on certain Defenses

A business Overhead Expense policy

covers business expenses such as rent and utilities