#8 Laws and Rules Pertinent to Insurance

No long-term care policy May exclude pre-existing conditions for a period of more than_____?

6 months

In Pennsylvania, HIPAA laws require that an individual's prior credible coverage may reduce the maximum pre-existing condition exclusion period that a new group health plan can apply. This rule is applicable as long as there has been no gap in credible coverage for a period greater than_______?

63 days.

What is the difference between a long-term care partnership plan and a non partnership plan?

Asset Protection

Viatical Settlement Brokers send packets of information which normally include:

Existing policy terms, payout, premium payments requirements, prognosis of viator (policyowner), chances of viator living longer than expected, and any special payout terms.

An Accelerated Death Benefit in Pennsylvania must be at least what percentage of the total death benefit?

In Pennsylvania, payment on an Accelerated Death Benefit may not be less than 25% of the total benefit.

In Pennsylvania, no legal action may be taken against an insurer for failure to honor a valid claim after the expiration of how many years from the time proof of lost is furnished?

There is a waiting period of 60 days to file a lawsuit after a claim for loss has been filed by the insured. No lawsuit may be filed after three years has passed from when the claim was submitted.

Replacement

A transaction in which a new life insurance policy is purchased and. an existing life insurance policy is surrendered.

Pennsylvania, a Specified disease accident and health plan must provide a minimum benefit in the amount of______?

$5000

Every Pennsylvania insurer, upon receiving notification of a claim, must acknowledge receipt of the notice within______?

10 days. Every insurer, upon receiving notification of a claim, must acknowledge receipt of the notice within 10 days.

A Pennsylvania temporary producer license may be issued for a period to exceed

180 Days

In a Long-Term Care policy, the right to examine period is_____?

30 days. In Pennsylvania, the free look period for Long Term Care policies is 30 days.

Under Pennsylvania statue, first year commission for long-term care insurance may not be greater than___?

50%. An insurer may provide commission to a producer for the sale of a long-term care insurance policy only if the first year commission is not greater than 50% of the first year premium.

Pennsylvania, an employee must request spousal coverage under a group sponsored accident and health plan within______days of marriage.

60 Days

A long-term care plan must provide which of the following options for coverage in the state of Pennsylvania?

A long-term care plan sold in Pennsylvania must make a 5% inflation protection Rider available for purchase at the request of the insured.

According to Pennsylvania law, postnatal care must be delivered within how many days of discharge?

According to Pennsylvania law, postnatal care must be delivered within 48 Hours of discharge.

In Pennsylvania, the definition of total disability changes from one's "own occupation" to "any occupation" by reason of one's education, training and experience after what period of time?

After 24 months

Free Look Period or Right To Examine provision

After purchasing an individual health insurance contract, Pennsylvania policy owners have 10 days from the date of receiving the policy to return it for a full refund for any reason.

If a health insurance claim is not promptly paid, legal action may be taken against the insurer after____?

Although the time payment of claims provision requires the claim to be paid immediately, legal action against the insurer for failure to pay timely cannot commence until 60 days after proof of loss is furnished.

Dental Treatment Expenses

Are required to repair an injury that would normally be covered under a hospital or medical expense policy.

With a scheduled dental policy, how are covered expenses paid?

Benefits will be limited to a specific maximum dollar amount per procedure in a scheduled dental policy.

What are the levels of coverage as defined by the Affordable Care Act?

Bronze, Silver, Gold and Platinum

When soliciting insurance, a producer CANNOT

Emphasize Pennsylvania Guaranty Association benefits.

In most plans, a deductible typically is NOT applied to_____?

Preventative and diagnostic services are normally fully paid in most dental plans.

Restorative Dentistry

The procedure for restoring the function and integrity of missing tooth structures. Examples include fillings, crowns and dental bridges.

If a Medicare Supplement policy replaces another that had been in effect for at least 6 months, the replacing policy me and pools which of the following time exclusions for pre-existing conditions?

The replacing policy May impose anytime. Exclusions for pre-existing conditions as long as there was no Gap in coverage for more than 63 days.

Time Payment of Claims Provision

Requires the claim be paid immediately, legal action against the insurer for failure to pay timely cannot commence until 60 days after proof of loss is furnished.

Prosthodontics

The branch of dentistry concerned with the design, manuacture and fitting of artificial replacements for teeth and other parts of the mouth.