Iowa accident and health
T has a disability income policy that pays a monthly benefit of $ 5000, if T becomes partially disabled, what can he likely expect?
Less than $5000 per month benefit regardless of the cause
Nursing home benefits must be provided for at least 12 consecutive months in which of the following types of policies?
Long- term care
An insurance application may be rejected on the basis of all of these factors except
Gender
With accidental death and dismemberment policies, what is the purpose of the grace period
Gives the policyowner additional time to pay overdue premiums
X is insured with a disability income policy that provides coverage until age 65. This policy allows the insurer to change the premium rate for the overall risk class assigned. Which of these renewability features does this policy contain?
Guaranteed Renewable
Which of these types of coverage is best described as a short term medical policy
Interim Coverage
Which mode of payment is not used by health insurance policies
Single premium
According to the affordable care act, a dependent child's eligibility status is determines by
age
Under an individual Health insurance policy, the time limit of certain defenses provision states that nonfraudulent misstatements first become incontestable two years
from the date that the policy was issued
Which of the following services is not included under hospitalization expenses coverage?
surgical fees
Q is hospitalized for 3 days and receives a bill for $10, 100. Q has a major medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?
$ 2, 100
An insurer must provide an insurer with claim forms ______ within days after receiving notice of a loss
15
A producer does not have the authority to change a policy or waive any of its provisions the health provisions that best describes this statement is called the
Entire contract
Which health policy clauses stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?
Entire contract
Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefit has been used, or after the policy has been in effect for a particular period of time?
Restoration pf used benefits
Which of these terms accurately defines an underwriter's assessment of information on a health insurance application?
Risk classification
Which of these situations is not considered to be a replacement?
Term coverage is converted to an individual permanent plan with the same insurer
Which of the following statements is true about most blue cross/blue shield organizations?
They are nonprofit organizations
P is self- employed and owns an individual disability income policy. He becomes totally disabled on June 1 and receives $2000 a month for the next 10 months. How much of this income is subject to federal income tax?
0
Which of the following is considered to be misrepresentation?
A producer guaranteeing a policy's dividends
What does the Iowa life and health insurance guaranty association provide?
Claim payments of admitted, insolvent insurance companies
P is a major medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking, How will the insurer most likely handle this?
Claim will be denied
Which of the following would be a likely candidate for disability income insurance on a key employee?
Company executive
Which of the following correctly explains the actions an agent should take if a customer wants to apply for an insurance policy?
Complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company
P is insured under a basic cancer plan. which of the following conditions would be covered under the plan?
Operation for a malignant tumor
Which of of the following phrases refers to the fees charged by healthcare professionals?
Usual, customary, and reasonable expenses
Which of these is considered a statement that is assured to be true in every respect?
Warranty
As a condition for a loan, a bank requires the borrower to purchase credit insurance from a specific company. what is the bank guilty of?
coercion
T applied for a disability income policy and has a history of back injuries. The insurer issued the policy with a statement that excludes coverage for back injures. This statement is called an
impairment rider
When determining the monthly benefit amount for a disability income policy, the factor that limits the amount a prospective insured may purchase is
income
If the insurance and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the uniform simultaneous death act?
insured's contingent beneficiary
which of the following situations does a critical illness plan cover?
leukemia
Under a Guaranteed renewable health insurance policy the insurer
may cancel the policy for nonpayment only
Convincing a prospective insured to buy an insurance policy based on exaggerations is called
misrepresentation
convincing a prospective insured to buy an insurance policy based on exaggeration is called
misrepresentation
What type of renewability guarantees premium rates and renewability
noncancellable
C is a policyowner of a c comprehensive individual major medical policy. C pays an annual premium which is due September 1. If C forgets to pay the premium and is hospitalized September 10, how will the insurer handle this claim?
pay the claim in full minus the premium due
Which of the following statements about a guaranteed renewable health insurance policy is correct
premiums normally increase at time of renewal
T is covered by 2 health insurance plans, a group plan through his employer and his spouse's plan as a dependent. Under the model group coordination of benefits provision, when T files a claim, his employer's plan is considered the
primary care
insured losses are covered immediately after a health policy is reinstated when
the losses result from accidental injuries
Essential benefits without annual and lifetime limits are required on any health policy purchased
through the federal marketplace
An example of an unfair claims settlement practice is
turning down a claim without providing the basis of denial
ABC Insurance company failed to accept a valid proof of loss statement. This is considered to be an
unfair claims practice
Life and health insurance policies are
unilateral contracts
When must insurable interest be present in order for a life insurance policy to be valid
when the application is made
What is the purpose of the time of payment of claims provision?
Prevents delayed claims payments made by the insurer
The free look period in Iowa for individual health insurance policies is ___ days
10
An insured owns an individual disability income policy with a 30- day elimination period for sickness and accidents and a monthly indemnity benefit of $500. If the insured is disabled for 3 and a half months, what is the maximum amount he would receive for an approved claim ?
$1250
A producer who intentionally violates an insurance law of Iowa may face a penalty of up to
$5 000
After purchasing an individual health insurance contract, policyowners have __days from the date to receiving the policy to return it for a full refund for any reason
10
An insured must notify an insurer of a medical claim within __ days after an accident.
20
Insurers may request a hearing within ___ if their policy is rejected
20
Within __ days after policy delivery, a Medicare supplement policy can be returned for a 100% premium refund
20
A producer must notify the insurance division within __ days pf a felony conviction
30
How long is the typical free look period for long term care insurance policies?
30 days
An insured pays premiums on an annual basis for an individual health insurance policy. What is the minimum number of days for the grace period provision.
31
M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force?
45 days
The waiting period for pre- existing conditions on Medicare supplement policies is __ months
6
How many days must the insured wait to take legal action against a health insurer after submitting written proof of a loss of the insurer refuses to pay?
60
__ is the authority given to a producer to transact business on behalf of the insurer.
Appointment
When is a group health policy required to provide coverage for a newborn child?
At the moment of birth
When does a probationary period provision become effective in a health insurance contract?
At the policy's inception
G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which best addresses this concern is:
Business overhead expense
K applies for a health insurance policy on herself and submits the initial premium with the application. She is given a receipt by the producer stating that coverage begins immediately if the application is approved. What kind of receipt was used?
Conditional
Which of the following consists of an offer, acceptance, and consideration?
Contract
In the event of an illness, a(n) _______ _______ policy would reimburse an insured for loss of earnings.
Disability Income
In a disability income policy, which of these clauses acts as a deductible
Elimination period
When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the
Entire contract provision
The commissioner may
Examine insurer solvency
What is the required renewability status of all Medicare supplement policies?
Guaranteed renewable
Which type of renewability best describes a disability income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class?
Guaranteed renewable
All of these are characteristics of a health reimbursement arrangement Except
HRA is entirely funded by the employee
which type of provider is known for stressing preventative medical care and routine physical examinations
Health maintenance organizations
Which of these actions should a producer take when submitting an insurance application to an insurer?
Inform insurer of relevant information not included on the application
A person covered by a group major medical policy leaves the group and converts the coverage to an individual policy. Which of the following statements is incorrect about the new policy?
It pays the same benefits as the group policy
Which type of plan normally includes hospice benefits
Managed care plans
Z owns a disability income policy with a 30 day elimination period. Z contracts pneumonia that leaves him unable to work from January 1 until January 15. Z then becomes disabled from an accident on Feb 1 and the disability lasts until July 1 the same year. Z will become eligible to receive benefits starting on:
March 15
The entity whose sole purpose is sharing medical data among its member companies is called the
Medical information Bureau
Which of the following best describes a short- term medical expense policy ?
Nonrenewable
S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning
Novemeber 1
Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?
Obtain prior approval from the insurer for the medical service
If a Medicare supplement policy involves replacement, it must be verified on a question located
On the application
Which dependent of an insured is eligible for coverage under a health insurance policy issued by the Iowa comprehensive health insurance association?
One who is incapable of self - sustaining employment due to physical handicap
Which of these statements is incorrect regarding a preferers provider organization?
PPO's are not a type of managed care systems
which parts of a health insurance policy are guaranteed to be true?
Warranty
Which of the following statements describes what an accident and health policyowner may not do?
adjust the premium payments
Iowa insurance laws address diabetes coverage. Under Iowa insurance laws, policies must
apply the same deductible and copays to covered diabetic supplies as other medical conditions
What is one of the roles of the commissioner
enforce state insurance laws
Health insurance benefits not covered due to an act of war are
excluded by the insurer in the contract provisions
What does a Medicare supplement policy cover?
non- allowable amounts covered by Medicare part A
The notice of claims provisions requires a policyowner to
notify an insurer of a claim within a specific time
Consumer reports requested by an underwriter during the application process of a health insurance policy can be used to determine
probability of making timely premium payments
An insured covered by Accidental death and dismemberment insurance has just died. What will happen if the primary beneficiary had already died before the insured and contingent beneficiary?
proceeds will go to the contingent beneficiary
Which of the following is not a reason for the commissioner to revoke a producer's license?
producer is insolvent
Which of the following actions by a producer would not result in a license suspension or revocation?
producer sells a preplacement policy that causes an insured to lapse an existing policy
What must the policyowner provide to the insurer for validation that a loss has occurred?
proof of loss
A major medical policy typically
provides benefits for reasonable and necessary medical expenses, subject to policy limits
statements made on an insurance application that are believed to be true to the best of the applicant's knowledge are called:
representations
An __ sells, solicits, or negotiates insurance on behalf of insurance companies for compensation.
representative
which mode of payment is not used by health insurance policies
single premium
