Health insurance test attalah's guide

An insured pays monthly premium of 100$what would be the duration under something

10 days

Irrevocable beneficiary

A beneficiary who has a vested interest in policy therefore the policyowner may not excerise certain rights without beneficiary consent

Debtor

A borrower of funds

In order for a foreign insurer to do business in this state, it must obtain

A certificate of authority

Agent/producer

A legal representation of an insurance company.

Creditor

A lender of funds

Lump sum

A pay out method that pays the beneficiary the entire benefit in one payment

Guaranteed renewable

A policy that is written on a noncancellable basis with the right to renew gaurenteed

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

A pre existing condition

Tax deductible

A qualified expense that may reduce the amount of income

Claim

A request filled with an insurance company asking for payment according to the terms of an insurance policy

What are two causes of loss

Accidental bodily indury and sickness

Riders

Added to the basic insurance policy to add modify or delete policy provisions

What documentation grants express authority to an agent

Agent contract with the principal

What are the elements of a legal contract

Agreement, consideration,competent parties, legal purpose

A producer sold a policy right after his license was suspended how much commission will the producer receive

All of it

Deductible

Amount you pay to doctor or hospital before insurance benefits start

Solicitation

An attempt to persuade a person to buy an insurance policy it can be done orally or in writing

Which of the following hospice expenses would NOT be covered in a cost-containment settings

Antibiotics

In a replacement situation all of the following must be considered except

Assets

The act of voluntarily giving up insurance by the insured

Cancellation

Peril

Cause of loss (what caused the accident)

In order for an insurer to legally transact insurance it must maintain which of the followings

Certificate of authority

What is the major difference between stock company and mutual company

Company

Hazards

Conditions that increase the probability of loss

The purpose of care health insurance plan is to

Control health insurance claims expenses

The gate keeper of an HMO helps

Control specialist costs

Which of the follow is considered a qualifying event under COBRA

Divorce

What is the goal of the hmo

Early detection through regular checkups

The requirement that an agent not co mingle insurance monies with their own funds is known as

Fiduciary responsibility

How are hmo territories typically divided

Geographic areas

Fraud is

Grounds for voiding an insurance contract

In insurance transactions fiduciary responsibility means

Handling insurer funds in a trust capacity

Comprehensive coverage

Health insurance that provides coverage for most type of medical expenses

Which of the following LTC is NOT provided by institutional setting

Home health care

What is necessary in order to be eligible for long term care

Insured must be unable to preform ADLs

Which of the following entities has the authority to make changes to an insurance policy

Insurers executive officer

IRS

International Revenue service: responsible for collecting taxes and enforcement of IRC

Which of the following is true regarding a term health policy

It is nonrenewable

In a group health policy a probationary period is intended for people who?

Joined the group after effective date

Which of the following is the basis for a claim against an insurance policy

Loss

All of the following are characteristics of a major medical expense policy except

Low-maximum limits

All of the following are true regarding the medical information bureau(MIB) except

MIB reports are based upon information supplied by doctors and hospitals

Reciprocity/reciprocal

Mutual interchange of rights and privileges

Nais

National association of insurance commissioners formed to resolve insurance regulatory issues

When is the annual open enrollment for state insurance exchanges

November 1 through January 31st

Which renewability provision allows an insurer to terminate policy and increase premiums for any class of insured

Optionally renewable

Applicants

Person applying for insurance

Which of the following provisions is mandatory for health insurance policies

Physical examination and autopsy

What are the 3 types of hazards

Physics (birth defect)moral(lie) and morale (state of mind)

Which of the following is the most common time errors and omissions to occur on the part of the insurer

Policy delivery

Expense-incurred basis

Policy pays health policy benefits as a reimbursement of actual expenses

Laspe

Policy termination due to nonpayment of premium

If your health care plan has characteristics of an HMO and ppo what type of plan do you have

Pos

Which of the following do the standard and preferred risk category share

Premiums are not evaluated

All of the following are considered to be supplemental benefits under an HMO except

Preventive care

What is the term for the entity that an agent represent regarding contractual agreements with third parties

Principal

Pertaining to insurance what is the definition of fiduciary responsibility

Promptly forwarding premiums to the insurance company

The Gramm-Leach Billey act was passed to

Protect private customer information filed with a financial institution

Which of the following insurance options would be considered a risk sharing arrangement

Reciprocal

In event of a loss business overhead insurance will pay for

Rent

Reinstatement

Returning a lapsed policy to activate status

Underwriting

Risk selection and classification process

Which is not covered under part b of Medicare pilicy

Routine dental care

Face amount

The amount of benefits stated in the insurance policy

Defined benefit pln

The employer specifies an amount of benefits promised to the employees

Who has the authority to make changes to an entire contract?

The executive officer of company

Which of the following entities established the do not call regristry?

The federal trade commission

Hippa

The health insurance portability and Accountability Actis federal law that protects health information

Who chooses primary care position in HMO

The individual member

Coinsurance

The insurance company and the insured shares the expenses 60/40

The insuring clause of a disability policy usually states all of the following except

The method of premium payments

Premium

The money paid to the insurance company for the insurance policy

Grace Period

The period of time after the premium due date in which premiums may still be paid before the policy lapses for nonpayment of premium

Policyowner

The person entitled to excerise privileges in policy

Insurable interest

The policyowner facing the possibility of losing something of valued in event of loss

Elimination period

The time immediately following the start of disability when benefits are not payable

Risk

The uncertainty of loss there is two types of risks pure risk and speculative risk

Which of the following answers do NOT describe the goal of a PPO

To provide medical service only from physician in network

Indemnity

To return back to original state

Cafeteria plan

Type of employment benefit plan that allows insureds the to choose between different types of benefit

Rein bursement

When insurance pay doctors directly

When is the insurability conditional receipt given

When the premium is paid at the time of application

How soon can you submit a notice of claim

Within 20 days of loss or ASAP

Broker

an insurance producer not appointed by an insurer and is deemed to represent the client