Health Insurance Basics

Most health policies will pay the accidental death benefits if the death is caused by an accident and occurs within how many days?

90 days

What is the capital sum in Accidental Death and Dismemberment coverage?

A percentage of the principal sum

Who is a field underwriter?

Agent/Producer

What are two types of expenses that are covered by healthcare?

All healthcare expense and expenses to compensate for loss of income

What document describes an insured's medical history, including diagnoses and treatments?

Attending Physician's Statement (APS)

In medical expense contracts, what is the term for the payment method when the insureds pay medical expense, and then insurer directly pays insured?

Reimbursement

Who must sign a health insurance application?

The policyowner, the insured (if different), and the agent

During which stage in insurance do insurers evaluate information that identifies adverse selection?

Underwriting

Under a credit disability policy, payments to the creditor will be made for the insurer until what point in time?

Until the period of disability ends or until the debt is repaid

When should an agent obtain a Statement of Good Health?

When premium is paid upon the policy delivery rather than the time of application

A hospital indemnity policy will pay

a benefit for each day the insured is in the hospital

Which of the following losses will be covered by a group medical expense policy?

a pre-existing condition

In which of the following situations is it illegal for an insurer to disclose priviledged information about an insured? a. an auditor for auditing pruposes b. a researcher for marketing purposes c. the Department of Insurance to assess legal compliance d. law enforcement authorities for law oriented purposes

a researcher for marketing purposes

The insured's health policy only pays for medical costs related to accidents. Which of the following types of policies does the insured have?

accident-only

If an insurance company makes a statement that its policies are guaranteed by the existence of the Insurance Guaranty Association, that would be considered

an unfair trade practice

In a replacement situation, all of the following must be considered EXCEPT: a. limitations b. exclusions c. assets d. benefits

assets

Under a typical health insurance policy, claims that result from injury while the insured was intoxicated or under the influence of drugs are generally

excluded

Health coverage become effective when the

first premium has been paid and the application has been approved

Which of the following entities protects policyowners, insureds, and beneficiaries under insurance contracts when insurers fail to perform contractual obligations due to financial impairment?

insurance guaranty association

Who must pay the cost of a medical examination required in the process of underwriting?

insurer

Under the affordable care act, which classification applies to health plans based on the amount of covered costs?

metal level classification

An insured is covered by a disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and breaks an ankle. What coverage will apply?

no coverage will apply, since the injury could've been forseen

Which of the following do the Standard and Preferred risk categories have in common? a. possible modifications to include expanded coverage b. permanant coverage c. premiums are not elevated d. more medical evaluations are required

premiums are not evaluated

An agent tells an insured that her new policy rquires lower premiums than the original, even though the premium amounts are actually the same. What could be a consequence of the agent's actions?

suspension of license

An insurer hires a representative to advertise its company at a local convention. The representative lies about the details of some of the policies, in an attempt to secure more business for the company. Who is responsible for the representative's claims?

the insurer

An agent is in the process of switching the insured's current health policy witha new one. Which of the following would be a proper action?

the old policy should stay in force until the new policy is issued

Which of the following is true about limited health insurance policies?

they cover specific accidents or diseases

A health insurance policy may cover all of the following risks EXCEPT: a. War-related injuries b. Dental expenses c. Loss of income due to disability d. Medical expenses

war-related injuries