KY Health insurance

A second period of disability arises as a result of the same or related cause of prior disability

Recurrent disability

Disability income insurance is

Vital to the financial health of every family that relies on one or more wage earners for income

The amount payable as a death benefit in an accidental death and dismemberment policy is known as the

principal sum

Miss statements in an application can be used to avoid a policy within how many years

2

Which of the following is the usual a grace period for a semi annual policy

31 days

Which of the following is the usual grace period for an Annual premium policy

31 days

I cancellation provision gives an insurer the right to cancel a policy at any time after giving how many days notice to the insured

5

Under the standard cancellation provision, a company has the right to cancel my policy at any time within how many days written notice to the insured

5

Partial disability indemnity is what percent of the monthly or weekly indemnity for total disability

50%

Which provision is designed it to prevent over insurance

6

Supplemental income provides additional income during the first ___ months of long-term disability

6 to 12 months

Most short term disability income policies provide benefits for

6months

Or contributory plans, what percentage of employees must participate

75%

Proof of loss must be furnished within how many days

90

Monthly premium policies require

A 10 day grace period

A health insurance company organized in Illinois with his home office in Philadelphia is license to conduct business in Kentucky. In Kentucky this company would be considered which of the following types of ensures

Foreign

All of the following are primary wrist factors in underwriting individual health insurance policies except

Geographic location

Which kind of health insurance policy assures renewability up to a specific age of the insured, although the company reserves the right to change the premium rate on a class basis?

Guaranteed renewable

A company may change the wording of a uniform policy provision in its health insurance policies only if

The modified provision is not less favorable to the insured

Theodore received a $15,000 cash benefit from his $50,000 accidental death and dismemberment policy for the accidental loss of one eye. The amount he received could be identified as the policies

Capital sum

All of the following are considered service providers except

Commercial insurance companies

Because the obligations of the insurance company hinge on certain acts of the policyholder, the beneficiary, or both, the insurance contract is termed

Conditional

The fact that an insurance contract promises to pay benefits contingent on a future uncertainty makes it what type of contract

Conditional

Which of the following probably would not be considered in underwriting a health insurance risk

Credit rating

What option provides lump sum payments for certain injuries or amputations on a weekly or monthly payment period

Elective benefits or indemnities

Which provision of a health insurance policy stipulates that the endorsements and attached papers constitute the contract for insurance

Entire contract

All of the following groups may contract with PPOs except

Health insurance benefit providers

The Social Security writer will pay benefits

If it turns out the insured is not eligible for benefits from social insurance

Aron submit a claim and proof of loss for medical expenses covered by her major medical policy. According to the time of payment of claims provision, how Soon must accompany pay the claim

Immediately

And insurance contract is prepared by one party, the insurer, rather than by negotiation between the contracting parties. This characteristic means that the insurance contract

Is a contract of adhesion

Which of the following statements about the restoration of plan Benefits is not correct

It is more important than ever to have the restoration of benefits clause because of the low maximums written on major medical policies

Which of the following statements about the ensuring clause in a health insurance policy is not correct

It is one of the 11 NAIC optional provisions

All of the following are basic forms of health insurance coverage except

Limited pay health

Which of the following expenses would not be covered by a business overhead expense policy

Merchandise for a special weekend sale

Any policy that is in conflict with the statutes of the state will be amended to come form to what requirements

Minimum

Which of the following statements pertaining to provisions and health insurance policies is correct

Miss statement of age provision allows the insured to adjust the benefits payable under the policy

Disability income policies must pay such benefits at least

Monthly

Under the timer payment of claims provision, policies that provide for periodic payment of Benefits must pay such benefits at least

Monthly

Compared with a group policy the coverage under an individual policy is generally

More costly and more limited

Which of the following statements about maternity benefits is correct

Most maternity benefits are paid in flat sums for normal childbirth

Which of the following statements regarding health insurance policies is correct

Most medical expense policies are contracts of reimbursement

Which of the following situations is an example of a presumptive disability

Nancy is completely blind and will not recover her site

Maurice has an optional renewable policy. When can the insurance company refuse to renew Maurices policy

Only at premium payment renewable time

Which occupation definition is less restrictive

Own occupation

What is the biggest difference between PPOs and HMOs

PPOs have no separate physical facility

What is coinsurance

Percentage of costs the insurance company and insured each pay (usually 80/20)

Victor changes to a more hazardous job than the one he had when he applied for his disability income policy. According to the policies change of occupation provision, what will happen when the insurer learns of his job change

Policy benefits will be reduced to an amount the premiums would have purchased originally on the basis of the more hazardous occupation

Who are the owners of a mutual insurance company

Policy holders

Blue Cross/Blue Shield organizations can operate all of the following except

Preferred point plans

What is a Social Security rider

Provides for a monthly payment amount that might be received from Social Security for a total disability

Which of the following statements pertaining to recurrent disabilities for disability insurance is not correct

Recurrent disability policy provisions have no effect on the payment of benefits

Insurers will use all of the following techniques when issuing health insurance policies to substandard risk except

Requiring additional collateral to pay for extraordinary claims

A percentage of the total disability benefit for periods of partial disability is defined as

Residual disability benefit

Which of the following statements about health insurance premiums is not true

The agent six of the insured are considered primary factors that affect health insurance premium rates

The shorter the waiting period or Elimination period means

The higher the premium payment

The longer the waiting period or elimination period means

The lower the premium payment

An entire contract is

The policy, endorsements, and attachments

All of the following statements about deductible provisions in medical insurance policies are correct except

They are most common and basic medical expense policies

All of the following statements regarding Blue Cross/Blue Shield are correct except

They offer health care coverage on both an individual and group basis

The purpose of business overhead expense policies are

To keep the business running due to the owner becoming disabled

All of the following are responsibilities to the master policy holder except

Underwriting individual risks

What are statements that are guaranteed to be true

Warranties

Wednesday policy is reinstated, how many days is the waiting period for accident coverages coverages

0

All other policies require

31 day grace period

HMOs require members to have what

A primary care physician

Partial disability applies largely to

Accidental disability or severe illnesses, such as heart attacks

Most Long term policies provide benefits to

Age 65 or two years

Which of the following statements pertaining to health maintenance organization's is correct

And insurance company that markets group health insurance is also known as an HMO

If the coinsurance feature in a major medical insurance policy is 75 to 25 with $100 deductible how much of the $210 bill would the insured pay

$600

Once a policy is reinstated, how Long is the waiting period for sickness coverage

10 days

For non-contributory plans, what percent of employees must be included

100%

Group policies are required by law to provide maternity benefits with how many employees

15

When an insurer received a notice of a claim, it should furnish the insured with forms to provide proof of loss within how many days

15

Which of the following statements about emergency first aid coverage is correct

A physician who provides life-saving treatment at the scene of an accident might receive payment through the injured persons emergency first aid coverage

What are PPOs

A selected group of independent hospital and medical practitioners that provide a range of services at a prearranged cost

Weekly premium requires

A seven day grace period

Under the mat statement of age provision in a health insurance policy, what can a company do if it discovers that and insured gave a wrong age at the time of application

Adjust the benefits

What is an open panel

All providers who want to provide services for the HMO may do so as long as they agree to the HMOs requirements

A person who makes a representation on a health insurance application

Believes it to be true

Which of the following statements about elimination periods in a disability income policy is not correct

Benefits are not payable during an illumination period, but are paid retroactively to the beginning of the period if the insured remains disabled throughout the period

All of the following are required uniform provisions in an individual health insurance policy except

Change of occupation

A situation where the individual is not disabled immediately but as time passes the person becomes totally disabled

Delayed disability

And insurance company organized in a headquartered in Kentucky can be described as what type of company when transacting insurance business in Kentucky

Domestic

An accidental death and dismemberment policy paying twice the principal some is known as

Double indemnity

Which section of a health insurance policy specifies the conditions, times, and circumstances under which the insured is not covered by the policy

Exclusions

Which of the following is not a basis for occupational sustainability when determining total disability

Job interest

All of the following factors would affect your health insurance policies premium rate except

Location of the insured's residence

Type of data reflects the average number of disabilities due to sickness or accidents at various ages

Morbidity

Common exclusions include

Pre-existing conditions, self-inflicted injuries, suicide, injury while committing a felony, and cosmetic surgery

HMOs are not required to provide

Prescription drugs, vision care, dental care, home health

Vicks policy stipulates that no benefits will be paid for any illness that occurs during the first 30 days after the policies effective date. What period is this?

Probationary period

A less hazardous occupation does what to the premium rate

Reduces

If the total monthly benefits are more than the insured's monthly income, each company will do what

Refund a share of the excess premium

The purpose of disability income insurance is to

Replace income when disability prevents an individual from working to earn a living

All of the following expenses would be covered under a major medical policy except

Replacement of an artificial limb

What are statements the applicant makes that he or she represents to be true to the best of their knowledge

Representation

Which of the following expenses would not be covered as a hospital benefit

Some types of surgery

The type of HMO that employees its own physicians and requires its members to use these physicians is known as

Staff model HMO

If discovered, and intentional or fraudulent misrepresentation can cause the insurer to

Void the policy provided the material

Any standard health insurance policy provision that is in conflict with a state statute

is automatically amended to conform to the state statute.