4/3 OH Accident and Health Agent Series 11-45
An insurer may deny health insurance claims based on misstatements in the application for how long from the policy's date of issue?
2 years
To be classified as a small employer in Ohio, an employer must employ
2-50 employees
Written notice of a claim must be given within __ days after a covered loss starts or as soon as reasonably possible.
20
Ohio requires a licensee to complete ___ hours of continuing education hours each licensing period.
24
An employer may qualify for health care tax credits through SHOP Marketplace if that employer has fewer than how many employees?
25
Which of the following is NOT an eligible dependent on an Accident and Health policy?
27 year old married child
In Ohio, legal action can be taken for up to ___ year(s) against an insurer for failure to pay health insurance claims after proof of loss was submitted.
3
Open enrollment for Medicare Supplement coverage starts
3 months before your 65th birthday
An agent's appointment has been terminated by the insurer. The insurer must then notify the superintendent within ___ days of the termination.
30
An employee has ___ days after the date of marriage to add a new spouse to a small group health plan.
30
Within ___ days after policy delivery, both Medicare Supplement and Long-Term Care policies can be returned for a 100% premium refund.
30
The first payment for newborn accident and health coverage is due ___ days after the birth.
31
In Ohio, accident and health policies that are paid less-frequent than monthly must provide a grace period of at least
31 days
In Ohio, semiannual-premium health insurance policies must provide a grace period of at least
31 days
An insurer can exclude coverage for a preexisting condition on a Medicare Supplement policy for up to
6 months
Proof of loss on a health insurance claim must be submitted to an insurer within ___ days after the insured's date of loss.
90
An insurance company advertises an accident and health insurance product in a local Ohio newspaper and refers to dollar amount benefits. This insurer must also disclose which of the following in the advertisement?
Any applicable benefit reduction
Which of the following is a requirement to obtaining an Ohio insurance agent license?
At least 18 years old
An attending physician's statement would be appropriate for which health insurance purpose?
At the request of the insurer to assist in the underwriting decision
How are health plans classified according to the Affordable Care Act?
Bronze, Silver, Gold, Platinum
Which of the following is required for an insurer to conduct business in this state?
Certificate of authority
The entire contract provision includes all of the following EXCEPT the
Changes made by the agent
Which of the following is NOT considered to be an act of fraud?
Collecting an insurance charge that is less than what is required
In which of the following processes will the insurer oversee the insured's hospital stay to confirm everything is going according to schedule and that the insured will be released as planned?
Concurrent review
All of the following may be an unfair claims practice EXCEPT
Denying an insured's fraudulent claim
Which of the following is NOT a specific power given to the superintendent?
Enact insurance legislation
What is the purpose of the Ohio Life and Health Insurance Guaranty Association?
Ensures that claims filed against insolvent insurance companies will be paid
How often must the superintendent examine each domestic insurance company?
Every 3 years
One of the most important considerations when replacing health insurance would be the
Exclusions on a new policy
An example of an Unfair Claims Settlement Practice is
Failing to promptly provide reasonable explanations for the denial of claims
Which of the following is considered to be an act of misrepresentation?
Falsifying the terms, benefits, advantages, or conditions of an insurance policy
Violations of US Code Title 18 section 1033, may result in
Fine and/or imprisonment
All of the following are primary risk factors in underwriting individual health insurance policies EXCEPT
Geographical location
In Ohio, a Long-Term Care policy must be _______ renewable.
Guaranteed
An insurer is REQUIRED to offer which of the following to each long-term care applicant at the time of purchase?
Inflation protection
Who is required to notify the agent in the event of appointment termination?
Insurer
Which of the following typically does NOT provide a form of managed care?
Major medical indemnity plan
Which of the following is considered to be a point of service (POS) plan?
Managed care plan
All of these are considered key factors in underwriting health insurance EXCEPT
Marital status
An example of an Unfair Claims Settlement practice is
Misrepresenting insurance policy provisions affecting a loss
The _______ of Coverage describes policy features, benefits, exclusions, and riders in a Long-Term Care policy.
Outline
Which of the following actions by an agent would NOT result in a license suspension or revocation?
Producing an insufficient amount of new premium
What does the Ohio Life and Health Insurance Guaranty Association provide?
Protection to insureds from financially insolvent insurers
Which of these is NOT an Unfair Claims Settlement Practice?
Providing claim payments to insureds according to the guidelines of the policy's coverage
Insurance agent Kelly offers a prospect a $1,000 shopping card if an insurance policy is purchased through her. What illegal activity is this an example of?
Rebating
_________ is "the act of replacing an existing insurance policy with another".
Replacement
All of the following factors would affect a health insurance policy's premium rate EXCEPT
Residential address of the insured
Which of the following statements is CORRECT regarding an individual applying for life or disability insurance?
The applicant's medical history may be analyzed and reported
Bill the producer is collecting the initial premium on a health policy. Which of the following statements is true?
The contract is not in force without the initial premium being paid.
Which of the following statements most aptly describes health insurance benefits?
The greater the benefits, the higher the premium.
An agent has committed an insurance crime that violates US Code 1033 (interstate commerce). Who would be responsible for the prosecution of this crime?
US Attorney General
Long-Term Care policies or certificates issued in Ohio are required to have
a nonforfeiture value
An individual who has a contract with an insurance company to represent it is called a(n)
agent
Insurance companies that are organized in countries outside the United States are referred to as
alien
A change in an insurance application requires
an initial made by the applicant
Coverage for newborns under an accident and health plan MUST include coverage for
birth abnormalities
An order issued by the superintendent that prohibits a specific practice listed in the order is called a(n)
cease and desist order
Publishing information that is false and maliciously critical to an insurer and intended to cause injury is a prohibited practice known as
defamation
A Medicare Supplement policy's outline of coverage MUST include a(n)
description of policy benefits
Replacement can be BEST described as
exchanging a new policy for one already in force
XYZ insurance company took out billboard advertisements in Ohio indicating that it can transact business in this state. This insurer, however, is NOT approved in Ohio. XYZ may be found guilty of
false advertising
A client told an intentional lie to an insurer in order to receive a favorable premium. This is an example of
fraud
Long-term care insurance applications MUST contain plain and unambiguous health questions. The exception to this rule would be applications for
guaranteed issue
An agent's license may only be suspended or revoked if the agent
has been afforded a right to a hearing
An example of a primary care physician would be a(n)
internist
A domestic insurance company in Ohio
is formed under the laws of Ohio
Commissions may be shared by
licensed and appointed agents
Pete the agent recently had his license suspended because he was found to be in violation of a state insurance law. Due to this suspension, Pete
may be assessed the administrative costs sustained by the Department
If an agent is believed to be causing considerable harm, the superintendent
may issue a cease and desist order against the agent
When screening an applicant for HIV, the insurer
may require a blood test for HIV
A license applicant who provides misleading, incorrect, or materially incomplete information can be found guilty of
misrepresentation
Informing an insured of inaccurate terms of an insurance policy is considered to be a form of
misrepresentation
Tara the producer is delivering a specified disease insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT a(n)
modified application with a new signature
The superintendent determines an examination of an insurer's books and records is necessary. After receiving the notification, the insurer
must not impede the examination
An insurer may refuse to renew an employer's small group health plan due to
nonpayment of premium
The difference between pre-certification and concurrent review is that pre-certification
occurs before the treatment is provided
Which of the following is NOT an example of utilization review?
ongoing inspection of accident prone individuals
Advertisements for accident and health policies that ONLY cover a stated illness MUST display a statement that the
policy is limited
Unmarried children who are incapable of self support and have proof of incapacity are included under their parent's health coverage until
policy termination
An insurance agent agrees to pay the first monthly premium for an insurance applicant. This is called a(n)
rebate
Barry the agent offers Chris his mountain cabin for the weekend to secure his order for his insurance business. This is an example of
rebating
Offering to return a portion of the premium to an insurance applicant as an inducement to purchase insurance is an illegal act known as
rebating
All of the following actions are considered rebating EXCEPT
sharing commissions with other agents
An insurer may non-renew an individual health benefit plan for all the following reasons EXCEPT
the individual is eligible for health care benefits from the Veterans Administration
An advertisement for an insurance product may contain
the insurer's name
An agent's renewal date for his/her license is on or before
the last day of the licensee's birth month
When a health policy is reinstated, insured losses are covered immediately if
the losses result from accidental injuries
Backdating an insurance policy occurs when
the policy's effective date is earlier than the present
A field underwriter's main task is
to ensure an applicant's medical information is accurate and complete
The Fair Credit Reporting Act protects consumers
with guidelines regarding credit reporting and distribution
An agent's license has been suspended for non-renewal. The agent may apply for reinstatement
within 12 months of the license renewal date
Pierre is covered by his employer's group major medical plan. His employer pays for 75% of the premium and he pays for 25%. How much would a $10,000 benefit be taxable as income under this plan?
$0
According to the Affordable Care Act, what is the maximum amount an individual can contribute to a Flexible Savings Account?
$2,500
The free look period in Ohio for individual health insurance policies is ___ days.
10
Lorenzo is self employed with an S corporation. He is unmarried and had a net profit for the tax year. What are the tax ramifications of his health insurance premiums paid for the year?
100% of his health insurance costs can be deducted from his gross income
An employer with under 20 employees must allow a terminated employee to continue accident and health coverage for a MINIMUM of ___ months.
12
What is the MINIMUM benefit period that must be offered by a Long-Term Care policy?
12 months
How many days is a temporary agent's license valid?
180
If health insurance benefits are not paid on a timely basis, the benefits paid shall bear simple interest from a date ___ month(s) after satisfactory proof of loss was received by the insurer.
2
Mary's Medicare Supplement policy had been in effect for 12 months. She recently replaced the policy with a new one that provides better coverage. The replacing policy may only impose a ___ month time exclusion for pre-existing conditions.
0
