health insurance
an insured has a major medical policy with a $500 deductible and a coinsurance clause of 80/20. if he incurs medical expenses of $4000, the insurer would pay
$2800
an insured is covered under 2 group health plans. under his own and his spouse's. he had suffered a loss of $2000. after the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1500 of medical expenses. what amount, if any, would be paid by the secondary insurer?
$500
a group must have
-100 members -be organized not just to buy insurance -be active for 2 years -have constitution, bylaws and hold annual meetings
medicare is only for who?
-65 and up -social security eligible for 2 years or more -end stage renal failure
contract consist of 4 things
-agreement(offer, acceptance) -consideration -competent parties -legal purpose
an underwriter cannot deny risk based on
-blindness -deafness -genetic characteristics -marital status -sexual orientation
what requirements must an association group have to purchase group insurance?
-have 100 members -be organized for a reson other than buying insurance -be active for 2 years -have a constitution, by laws -hold annual meetings -can be business or proffesional( professional associations, college alumni)
3 important underwriting factors
-physical factors -mutual and morale hazards -occupation
common exclusions are
-war -self inflicted injuries -elective cosmetic surgery (only covered if treatment is required to correct condition due to an accident or birth defect) -experimental/investigation procedures -conditions covered by workers comp -government plans (medicare, federal, state, local medical expense program) -injury due to criminal act -injury while drunk/drugs
an employer pays all of the premium for key-person disability income insurance. what percentage of this can the employer deduct as a business expense?
0
what is the shortest possible elimination period for group short-term disability benefits provided by an employer?
0 days
what percentage of individually owned disability income is taxable?
0%
long term care policies may have the following exclusions
1. preexisting conditions or diseases 2. mental and nervous disorders( Alzheimer's, dimentia, Parkinson's) 3. alcoholism, drug addiction 4. treatment or illness caused by war, injury due to crime or self inflicted 5. treatment payable by government, medicare or worker's compensation
long term policies generally cover which 3 levels of care?
1. skilled nursing care 2. intermediate care 3. custodial care
an insured pay a monthly premium of $100 for her health insurance. what would be the duration of the grace period under her policy?
10 days
an association group must have how many member?
100
in a noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective?
100%
long term policies must provide coverage for how many monthes in settings other than the acute care unit of a hospital?
12 consecutive monthes
a hearing for a cease and desist order must occur within how many days within the order date?
15
what is the minimum age for obtaining an insurance agent license in this state?
18
to be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?
18 monthes
what is the minimum length of benefit period a long term care policy must provide?
2 years
benefit period for long term care
2-5 years
long term care policies have a benefit period of
2-5 years, and some being lifetime coverage the longer the benefit period, the higher the premium
what is a penalty tax for non qualified distributions from a health savings account?
20%
what is the minimum length of benefit period that a long term care policy must provide?
24 monthes
in long-term care policies the elimination period for which the individual must be confined in a nursing home before benefits can begin is how many days?
30
the open enrollment for an HIC must last for the minimum of how many days?
30
what is the maximum age for qualifying for a catastrophic plan?
30
Time of Payment of Claims are to be paid immediately upon written proof of loss, but no longer than
30 days
how many days after a medicare policy is delivered is the return policy(free look) period?
30 days after delivery
elimination period for long term care
30 days or more
what is the elimination period for social security disability benefits?
5 monthes
a group is how many people
50 or more
one of the differences between group underwriting and individual underwriting is that there is little or no medical information required regarding plan participants in groups of
50 or more
policy will pay full if principal for the loss of both eyes or two limbs but will pay what percentage for the loss of one hand or foot?
50%
to attain currently insured status under social security, a worker must have earned at least how many credits during the last 13 quarters?
6 credits
if death is caused withing how many days of an accident, the accidental death benefit will be paid?
90 days
most policies will pay the accident death benefits as long as the death is caused by the accident and occurs within
90 days
proof of loss must be submitted within
90 days of a loss or as soon as possible
which of the following produces evaluations of insurers financial status often used by state departments of insurance?
AM best
individuals of the same class can be discriminated against? T/F
F
a long-term care insurance shoppers guide must be provided in the format developed by which of the following?
NAIC
which type of medicare policy requires insureds to use specific healthcare providers and hospital(network providers), EXCEPT in emergency situations?
SELECT
a hospital indemnity policy will pay
a benefit for each day the insured is in a hospital
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
a master policy is issued to
a policyowner or employer
an agent accepts the premium payment 35 day after it is due, telling the insured that there will no be a problem keeping the policy in force. this is an example of what type of agent authority?
apparent
under a key person disability income policy, premium payments
are made by the business and are not tax deductible
what document describes an insureds medical history, including diagnoses and treatments?
attending physicians statement
all of the following are requirements of eligibility for social security disability income benefits EXCEPT
being age 65
which of the following is not true of disability buy sell coverage?
benefits are considered taxable income to the business
which of the following is not true of disability buy-sell coverage?
benefits are considered taxable income to the business
an insured is receiving hospice care. his insurer will pay for painkiller but not for an operation to reduce the size of a tumor. what term best fits this arrangement?
cost containment
under which of the following employer provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer?
disability income
which benefits would a disability plan most likely pay?
income lost by the insureds inability to work
the benefits received by the business in a disability buy sell policy are
income tax free
hazards
increase probability of insured loss occurring
in long term care (LTC), policies, as the benefit period lengthens, the premium
increases
which of the following entities has the authority to make changes to an insurance policy?
insurers executive officer
the section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the
insuring clause
dread disease is
limited risk policy with benefits for cancer or heart disease
indemnify
payable by government
with respect to the consideration clause, which of the following would be considered consideration on the part of the applicant for insurance?
payment of premium
long term care covers a fixed amount
per day
medigap
policies issued by private insurance, designed to fill in gaps of medicare(deductible and copays)
coinsurance
portion of medicares approved amount beneficiary responsible for paying
HMOS
preventative care
the federal fair credit reporting act
regulates consumer reports
if the insured dies under long term policies the percent of the premium is
returned
other insurer allows an individual to buy?
several policies
all of the following long-term care coverages would allow an insured to receive care at home EXCEPT
skilled care
a provision found in insurance policies which prevent the insured from collecting twice for the same loss is called
subrogation
which of the following are responsible for making premium payments in an HMO plan?
subscribers
an agent misrepresents the details of an insureds new insurance contract that will be replacing the current contract. which of the following will most likely happen?
suspension of license
which of the following is NOT a feature of a noncancellable policy?
the insurer may terminate the contract only at renewal for certain conditions
who is the beneficiary in a credit health policy?
the lending institution
which of the following is NOT a characteristic of an insurable risk?
the loss must be catastrophic
the insuring clause of a disability policy usually states all of the following EXCEPT
the method of premium payment
which of the following will vary the length of the grace period in health insurance policies?
the mode of the premium payment
which of the following statements about qualified long term care policies is FALSE?
the policy may duplicate medicare benefits
which of the following is true regarding METs?
they allow several small employer purchase less expensive insurance together
after notice of claim is provided a claims form must be provided in how many days?
usually 15
when may an insured deduct unreimbursed medical expenses paid under a long-term care policy?
when the expenses exceed a certain percentage of the insureds adjusted gross income
net cash surrender amount
$100,000
which of the following is the term for the specific dollar amount that must be paid by an HIC member for a service?
copayment
limited health insurance policies cover specific
accidents or diseases
an insurer has made all of the decisions regarding the provisions included in the insured policy. the insured finds an objectionable provision and wants to negotiate it with the insurer but is not allowed to do so. her only options are to reject the policy or accept it as is. which contract feature does this describe?
adhesion
because the insurer is the party who controls the language used in the policy, and the insured cannot change that wording, an insurance policy is considered what type of contract?
adhesion
factors determining rates
age, medical history, occupation, sex
payment of claims specifies to whom?
all payments are to be made if no beneficiaries, benefits will be paid to the insurer's estate
comprehensive plans cover
all sicknesses or accidents that are not specifically excluded
assuming that all of the following people are covered by a high deductible health plan and are not claimed as dependents on anyone' tax returns, which would NOT be eligible for a health savings account?
amanda is 67 and is covered by a basic medical expense policy
stop-loss
amount insured pays out of pocket each year
federal law makes it illegal for any individual convicted of a crime involving dishonesty or breach of trust to work in the business of insurance affecting interstate commerce
without receiving written consent from an insurance regulatory authority
can alumnis have group insurance?
yes
under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer?
disability income
in an underwriting consideration, the occupation is more important for which type of insurance?
disability income insurance
period payments when an insured is unable to work because of sickness or injury is called?
disability income insurance
when twin brothers applied for life insurance from company A, the company found that while neither of them smoked and both had a similar lifestyle one of the twins was in a much stronger financial position than the other. because of this, the company charged him a higher rate for his insurance. this practice is considered
discrimination
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
what is the difference between the medicare approved amount for a service or supply and the actual charge?
excess charge
ERISA
federal law that was enacted to ensure employees receive pension and other benefits promised by employers
PPOS
fee for service,not required to use physicians or facilities that have contracts with PPO
health coverage becomes effective when the
first premium has been paid and the application has been approved
in disability income insurance, the own occupation definition of disability applies
for the first 2 years of a disability
in which of the following health plans are benefit payments attributed to employer contributions taxable to the employee?
group disability income
association group can buy what for members?
group insurance
long term care policies are mostly
guaranteed renewable(insurers have the right to increase premiums)
what insurance concept is associate with the names Weiss and Fitch?
guides describing company financial integrity
long term policies have a higher premium if they have a higher or lower premium?
higher premium
long term policies cover
home health, adult day care, hospice, respite, care at home
a health insurance policy lapses but is reinstated within an acceptable timeframe. how soon from the reinstatement date will coverage for accidents become effective?
immedicately
time limit on certain defenses is similar to
incontestability no statement or misstatements made in application will be used to deny claim if policy has been in force for more than 2 years
in order to minimize adverse selection, employer group dental plans may require employees who enroll after they were initially eligible to participate to do all of the following EXCEPT?
increase benefits for a period of one year
which type of a hospital policy pays a fixed amount each day that the insured is in a hospital?
indemnity
long term care policies include
individual, group, riders to life, coverage for individuals who, at least 12 monthes
reinsurance
insurance company, indemnifies another insurance company
what are investigative consumer reports?
interviews of associates, friends of applicant
disability insurance payment
is paid weekly and determined by past income
what is the benefit of experience rating?
it allows employers with low claims experience to get lower premiums
which of the following is NOT true regarding flexible spending account?
it does not have limits on contributions
which of the following is true regarding a risk retention group?
it is a liability insurance company owned by it members
which of the following statements is NOT correct concerning the COBRA act of 1985?
it requires all employers regardless of the number of age of employees, to provide extended group health coverage
the provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as
legal actions
an insurer may change the wording of an optional policy provision as long as the rewording is not
less favorable to the policyholder
an insurance organization that does not issue insurance policies but provides a meeting place for underwriters to conduct business is known as a
lloyds association
which of the following insurance coverages would be allowed with an MSA?
long-term care
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
speculative risk
loss or gain, not insurable
(MET) multiple employer trust
made up of two or more employers in similar or related business who do not qualify for group insurance on their own
which of the following information regarding an insured is NOT included in an investigative consumer report, which is requested by an underwriter?
medical history
where can reports from previous insurance info. be obtained from?
medical information bureau(MIB)
the basic purpose of health insurance underwriting is to what?
minimize adverse selection
a person filed a report about an insurance fraud practice. the person could be sued for civil damages by which of the following?
no one
on a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are
not taxable since the IRS treats them as a return of a portion of the premium paid
which provision concerns the insured duty to provide the insurer with reasonable notice in the event of loss?
notice of claims
when is the annual open enrollment for state insurance exchanges? for medicare too
november 1 through january 31
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
pure risk
only loss or no change and are insurable
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 renewable provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of insuresd?
optionally renewable
mutual companies
owned by policyowner and issue participating policies
to be eligible for medicare advantage one must be enrolled in part/parts of medicare?
part a and b
what is credit disability?
policy issued to those in debt to creditor, if insured is disabled those payments will be made until the borrower is back to work
a guaranteed renewable health insurance policy allows the
policyholder to renew the policy to a staged age, with the company having the right to increase premiums on the entire class
long term care exlusions
pre-existing conditions, mental disorders, alcohol and drug addiction, war injury, treatment payable by government
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
all of the following are examples of risk retention EXCEPT
premiums
all of the following are examples of risk retention EXCEPT?
premiums
all of the following are true regarding key person disability income insurance EXCEPT
premiums are tax deductible as a business expense
all of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT
an association of 35 people
under which condition would an employee's group medical benefits be excempt from income taxes?
an employee's group medical benefits are generally exempt from taxation as income
underwriting prime considerations
-age -gender -occupation -physical condition -avocations -moral and morale hazards -financial status
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
First year commission may not be more than what percentage of the second year policy?
200%
the omnibus budget reconciliation act of 1990 requires employers to provide coverage for end stage renal disease for how many monthes before medicare becomes primary?
30 monthes
the minimum number of credits required for partially insured status for social security disability benefits is
6 credits
under the affordable care act, a special enrollment period allows an individual to enroll in a qualified health plan within how many days of a qualifying event?
60 days
the maximum amount that can be contributed to an MSA is what percentage of the family deductible for those with family coverage?
75%
capital sum
amount of the benefit will vary according to severity of injury
all of the following are correct about the required provisions of a health insurance policy EXCEPT
a reinstated policy provides immediate coverage for an illness.
which of the following conditions would a disability income policy most likely NOT require in order to qualify for benefits?
a specified income status prior to the disability
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 deliver?
a statement of good health
under the mandatory uniform provision notice of claim, the first notice of injury or sickness covered under an accident and health policy must contain
a statement that is sufficiently clear to identify the insured and the nature of the claim
principal sum
amount paid from an accident death. usually equal the amount of coverage under the insurance contract or face amount
which of the following would be deducted from the death benefit paid to a beneficiary, if a partial accelerated death benefit had been paid while the insured was still alive?
amount paid with the accelerated benefit, plus the earnings lost by the insurance company in interest income from the accelerated benefit
under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?
an individual who was previously covered by group health insurance for 6 monthes is eligible
which of the following statements isbtrue concerning the alterationof optional policy provisions?
an insurer may change the wording of optional provisions, as long as the change does not adversely affect policyholder
which of the following statements is true concerning the alteration of optional policy provisions?
an insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder
group policies are subject to what on anniversary date?
annual renewal
how often must health insurance corporations, other than specialty health care insurers, provide current company information, providers lists, methods of operation and other reports to its insured?
annually
how often must health insuring corporations, other than specialty health care insurers, provide current company information, providers list, methods of operation and other reports to its insured?
annually
in a replacement situation, all of the following must be considered EXCEPT
assets
at what point must an outline of coverage be delivered?
at the time of application or upon delivery of the policy
outline of coverage is delivered when?
at time of application or upon delivery of policy
group disability income insurance premiums paid by the employer are
deductible by the employer as an ordinary business expense
an individual is insured under his employers group disability income policy. the insured suffered an accident while on vacation that left him unable ro work for 4 monthes. if the disability income policy pays the benefit, which of the following would be true?
benefits that are attributable to employer contributions are fully taxable to the employee as income
to be eligible for tax credits under the ACA, individuals must have income that is what percent of the federal poverty level?
between 100% and 400%
the first street church plans to sponsor a summer camp for the youth of their congregation. they would like to purchase insurance that would pay benefits should one of the youth get injured while participating in the camp activities. they type of policy they would likely need is
blanket
an underwriter cannot decline a risk based on what
blindness, deafness, genetic characteristics, marital status or sexual orientation
medicaid is sponsored by what kind of sources?
both state and federal
an insured recieves an annual life insurance dividend check. what term best describes this arrangement?
cash option
in order for an insurer to legally transact insurance, it must obtain which of the following?
certificate of authority
which of the following provisions must be included on the first page of a medicare supplement policy, which states the insurer's right to change premium amounts?
continuation provision
a health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as
critical illness
the benefit amount under a long term care(LTC) policy is usually expressed as a fixed dollar amount per
day
the benefit amount under a long-term care policy is usually expressed as a fixed dollar amount per
day
a medical insurance plan in which the healthcare provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called
prepaid plan
what is the term for the entity that an agent represents regarding contractual agreements with third parties?
principal
under the accidental death and dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the even of the insureds accidental death?
principal sum
a medicare SELECT policy does all of the following EXCEPT
prohibit payment for regularly covered services if provided by non network providers
in respect to the consideration clause, which of the following is consideration on the part of the insurer?
promising to pay in accordance with the contract terms
notice of claim is the insurer's duty to
provide the insurer with reasonable notice on the event of a loss, within 20 days or as soon as possible
indemnity
provision in insurance states in event of loss, insured is permitted to collect extent of financial loss, not allowed to have financial gain
which of the following insurance options would be considered a risk-sharing arrangement?
reciprocal
when benefits are paid directly to the insured under a health insurance policy, the policy provides benefits on what type of basis?
reimbursement
insurance is the transfer of
risk
the insurer must wait 60 days but no longer than 3 years after loss to do what?
take legal action against company
an HIC discovers that a subscriber has been diagnosed as manic-depressive. the HIC can
take no action???
cancellation by the insurer provision specifies
that insured can cancel policy anytime my mail or written notice
the annual contribution limit of a dependent care flexible spending account is set by
the IRS
on a health insurance application, a signature is required from all of the following individuals EXCEPT
the spouse of the policyowner
which of the following is true regarding optional benefits with long-term care policies?
they are available for an additional premium
which of the following is NOT a goal of risk retention?
to minimize the insureds level of liability in the event of loss
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 insured owes his insurer a premium payment. since then, he incurs medical expenses. the insurer deducts the unpaid premium amount from the claim amount and pays the insured the difference. what provision allows for this?
unpaid premium
the insurer must be able to rely on the statements in the application, and the insured must be able to rely on the insurer to pay valid claims. in the forming of an insurance contract, this is referred to as
utmost good faith
all of the following benefits are available under social security EXCEPT
welfare benefits
can association groups be contributory and non contributory?
yes
are accidents covered immediately after reinstatement?
yes, but not sickness, sickness is 10 days after reinstatement
what percentage of individually-owned disability income benefits is taxable?
0%
nonqualified distributions from an MSA are included in the employees gross income and subject to a penalty tax of
20%
kevin and nancy are married, kevin is the primary breadwinner and has a health insurance policy that covers both him and his wife. nancy has an illness that requires significant medical attention. kevin and nancy decide to legally seperate, which means that nancy will no longer be eligible for health insurance coverage under kevin. which of the following options would be best for nancey at this point?
COBRA
which of the following is not an advantage of an HRA for an employers
HRA are not defined benefit programs
under which nonforfeiture option does the company pay the surrender value and have no further obligations to the policyowner?
cash surrender
every subscriber of a health insuring corporations is entitled to
evidence of coverage
which of the following coverages in NOT monitored by the employee retirement income security act ERISA
golden parachutes
what are the 2 types of flexible spending accounts?
health care accounts and dependent care accounts
which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage?
health maintenance organization plan
which of the following is INCORRECT concerning taxation of disability income benefits?
if paid by the individual, the premiums are tax deductible
the benefits received by the business in a disability buy-sell policy are
income tax free
the affordable care act requires all US citizens and legal residents to have qualifiying health care coverage. this is known as
individual mandate
which of the following is true regarding health insurance?
it could provide payments for loss of income
if a insurer makes a statement that its policies are guaranteed by the existence of the life and health guaranty association, which of the following is true?
it would be considered an unfair trade practice
medical savings accounts are only available to groups of how many employees?
no more than 50
in an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. what income taxation will be imposed on the benefits received?
no tax
premium payments for personally owned disability income policies are
not tax deductible
what type of information is NOT included in a certificate of insurance?
the cost the company is paying for monthly premiums
under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to
the insured
according to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?
60%
what is the maximum amount that can be contributed to an MSA of the high deductible plan for individuals?
65%
under uniform required provisions proof of loss under a health insurance policy normally should be filed within
90 days
after a persons employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. which of the following is NOT true
by law the new individual policy must provide the same benefits as the group insurance policy
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
an insured is admitted to the hospital for surgery on a herniated disk. the insurance company monitors the treatment and progress in order to make sure that everything proceeds according to the insurers schedule. this is called
concurrent review
an applicant for an individual health policy failed to complete the application properly. before being able to complete the application and pay the initial premium, she is confined to a hospital. this will not be covered by insurance because she has not met the conditions specified in the
consideration clause
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
a policy which covers medical costs related to a specific condition is called a
dread disease policy
which of the following statements is correct concerning taxation of long term care insurance?
excessive benefits may be taxable
as it pertains to group health insurance, COBRA stipulates that
group coverage must be extended for terminated employees up to a certain period of time at the former employees expense
all of the following are differences between individual and group health insurance EXCEPT
individual insurance does not require medical examinations, while group insurance does require medical examinations
when an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for be
overinsurance
which of the following provisions are you most likely to see on a travel accident policy
period of time
which renewability provision are you most likely to see on a travel accident policy?
period of time
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 answers does NOT describe the principal goal of a PPO(preffered provider organization)
provide medical services only from physicians in the network
insurers may change which of the following on a guaranteed renewable health insurance policy?
rates by class
health insurance underwriting is best defined as
selection, classification, and rating of risks
which of the following is true about the requirements regarding HIV exams?
the applicant must give prior informed written consent
a husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouse's coverage. if one of them incurs hospital expenses, how will those expenses likely be paid?
the benefits will be coordinated
an insured loses her left arm i an accident that is covered by her accidental death and dismemberment policy. what kind of benefit will she most likely receive from this policy?
the capital amount in a lump sum
which of the following statements concerning group health insurance is CORRECT?
the employer is the policyholder
how are excess funds in an employees HSA handled?
the funds can be carried forward o the next year
if an insurer becomes insolvent, which of the following would pay benefits to policyholders?
the guaranty association
an insured had $500 left in his health reimbursement account when he quit his job. what happens to that money?
the insured can have access to the $500 at his previous employer's discretion
how are employer contributions to health reimbursement accounts treated in regards to taxation?
they are a tax deductible
an insured makes regular contributions to his health savings account. how are those contributions treated in regards to taxation?
they are tax deductible
when employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles?
they carry over from the old plan to the new plan
which of the following is true regarding benefits paid to disable employees?
they may be subject to taxation if the premium was paid by the employer
which of the following is true regarding benefits paid to disabled employees?
they may be subject to taxation if the premium was paid by the employer
a medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as
usual, customary and reasonable
under what condition are group disability income benefits received by an employee NOT taxable as income?
when the benefits received are equal or less than the employee's percentage of the contribution
when is the insurability conditional receipt given?
when the premium is paid at the time of application
which of the following determines whether disability insurance benefits are taxed?
whether the premiums were tax deductible
how soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?
within 90 days or as soon as reasonably possible, but not to exceed 1 year
