Health Part 1

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.

In the event a discontinued policy is replaced by another group policy, what costs will the prior insurer be NOT liable to pay?

A small percentage of basic medical expenses after the switch has been made

A deductible is

A specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits.

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.

A small hardware store owner is involved in a car accident that renders him totally disabled for half a year. Which type of insurance would help him pay for expenses of the company during the time of his disability?

Business overhead expense policy

Regarding Medicare, which provision discloses the insurer's right to change premiums based on the insured's age?

Continuation Provision

All of the following statements concerning Accidental Death and Dismemberment coverage are correct EXCEPT

Death benefits are paid only if death occurs within 24 hours of an accident.

Applications for policies advertised by what method must include a statement announcing that the policy excludes pre-existing conditions from coverage?

Direct response

Long-term care coverage may be available as any of the following options EXCEPT

Endorsement to a health policy.

Which of the following is an example of an unfair claims settlement practice?

Failure to promptly settle a claim when liability has been clearly established

Hospital confinement indemnity coverage may not exclude emergency confinement in what type of facility?

Federally operated hospital

Which of the following is another name for a primary care physician in an HMO?

Gatekeeper

Regarding long-term care coverage, as the elimination period gets shorter, the premium

Gets higher.

Each Medicare supplement policy must be

Guaranteed renewable.

When John fills out his Medicare application, he intentionally omits his long-standing history of heart disease. Which of the following is most likely to happen?

His policy will be canceled.

Which of the following riders would NOT increase the premium for a policyowner?

Impairment rider

Which of the following would a Traditional LTC plan NOT cover?

Intensive care unit essential costs

Which of the following is NOT true regarding a Premium Fund Trust Account?

It could be used as a claim payment account.

ccording to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

It could be used as a claim payment account.

If an agent changes address on January 1st, by what date must he or she inform the Director?

January 31

All policy applications must identify which of the following?

Licensee which solicited the applicant's business

Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?

Metal level classification

All of the following are the most common variations in a Long-Term Care policy EXCEPT

Number of family dependents.

Long-term care partnership policies concern which of the following issues?

Nursing home expense payment

Which type of long-term care policy is designed to prevent people from impoverishing themselves in order for Medicaid to take over their nursing home expenses?

Partnership Policy

Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's accidental death?

Principal sum

Insurers may change which of the following on a guaranteed renewable health insurance policy?

Rates by class

Which of the following entities determines who can receive a Limited Lines Producer License?

The company that the person represents

Which statement is NOT true regarding underwriting group health insurance?

The group is assessed individually for insurability.

On a health insurance application, a signature is required from all of the following individuals EXCEPT

The spouse of the policyowner.

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of Payment of Claims

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.

Which of the following entities keeps a file of all of an insurer's advertisements?

Which of the following entities keeps a file of all of an insurer's advertisements?

An insured's long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged $100 per day. How much will the insurance company pay?

$120 a day

If a loss covered by a policy is continuing when a policy is terminated, for how long must the coverage be extended?

1 year

An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?

102

According to the Recurrent Disability Provision, disability coverages cannot be separated by more than

6 months.

according to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

60%

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within

90 days of a loss.

Which of the following is true regarding elimination periods and the cost of coverage?

the longer the elimination period, the lower the cost of coverage

An HMO is required to supply to the insured an evidence of coverage within how many days?

Within 30 days of enrollment and again at renewal

Which of the following is NOT a factor in determining qualifications for Social Security disability benefits?

Worker's occupation

Which of the following would be considered an unfair claims settlement practice?

A claims adjuster advises the insured that if the claim goes to arbitration, the insured would probably receive less than what is currently being offered

To comply with Fair Credit Reporting Act, when must a producer notify an applicant that a credit report may be requested?

At the time of application

Which of the following is NOT considered a misrepresentation as it pertains to unfair trade practices?

Making comparisons between different policies

If an insured is receiving a transplant, which of the following must the insurer do for the live donor?

Provide coverage

Under standard circumstances, if a change occurs to a Medicare supplement policy that reduces benefits, which of the following must occur?

Signature of the policyholder