Ch 8-9 Underwriting and Laws
Mary is the sole proprietor of her business and has a family health plan. She would like to deduct the premiums from her taxes. What percentage of her premiums are tax deductible?
100%
What is the minimum number of employees needed for a small employer medical expense plan in Ohio?
2
EXCEPT for fraud, the time after issuance of a policy during which an insurance company may contest a health insurance claim due to the statements on an application is
2 years
Under the Affordable Care Act (ACA), parents can insure their dependent adult children up to their:
26th bday
An Ohio agent's license to sell insurance may be revoked for all of the following reasons EXCEPT
30 days
An individual who declines coverage under a small group accident and health benefit plan and later enrolls is called
A late enrollee
Ohio requires advertisements for accident and health insurance policies covering ONLY a specified illness to prominently display
A statement that the policy is limited
In Ohio, a group accident and health certificate of insurance must contain
A summary of policy features and benefits
An insurance company is normally responsible to its appointed agents for all of the following EXCEPT
Absorbing all of the agent's liability
Which of these is NOT considered a preventative service in a dental plan?
Amalgamated filling
When an accident and health insurance policy provision is in conflict with the statutes of Ohio, it is
Amended to conform to the minimum statutory requirements
Misrepresenting pertinent policy provisions relating to coverage after a loss is
An unfair claims settlement practice
If a group endorses an accident and health insurance product in an advertisement, the public must be made aware of
Any control by the insurer over the group
Under HIPPA rules, a medical plan's pre-existing conditions exclusion may be reduced by
Any period of prior coverage
Which of the following situations would a medical exam NOT be required for an individual health insurance applicant?
Applicant's family members have a history of cancer
Under the Affordable Healthcare Act, which group works with states to establish new Health Insurance Marketplaces?
CCIIO
Long-term care insurance policies may contain exclusions for all of the following EXCEPT
Care for incurable conditions
Which event must an agent report to the Director?
Conducting business under an assumed name
In what situation would disability income insurance premiums be a deductible expense?
Corporation paying for group disability income coverage for its employees
In Ohio, a period of accident and health insurance coverage which may be applied to reduce the length of a pre-existing condition exclusion under a new plan is called
Creditable coverage
All of these are used to prevent adverse selection in a group dental plan EXCEPT
Decreased participation
All of the following are examples of unfair claim settlement practices EXCEPT
Denying unsubstantiated claims on a timely basis
Under which marketing system do insurers solicit customers by mass media advertising and mail without the services of an agent?
Direct response
To which of the following group plans do HIPAA rules NOT apply?
Disability income
In Ohio, continuation of medical plan coverage for a handicapped child beyond the age limit stated in the policy may require proof of the child's
Incapacity and dependency upon reaching the age limit
The type of health insurance in which underwriting procedures are the most restrictive is
Individual
An applicant for accident and health insurance has a risk factor that is similar to a majority of the insurer's other applicants. What will be the likely outcome of this applicant?
Issued with a standard premium rate
In Ohio, viatical settlement brokers are permitted to do all of the following EXCEPT
Make the first transaction up to 30 days before approved for a license
Under the Affordable Care Act (ACA), what is the proportion of premium revenues spent on clinical services and quality improvements?
Medical loss ratio
When advertising a life insurance policy, an agent is required to disclose the
Name of the actual insurer
Which of these plans allow a participant to choose either a network or non-network provider at the time when medical care is needed?
Point-of-service
Which of the following describes the treatment service of a crown?
Prosthodontics
Which of the following is NOT a basic underwriting action for accident and health insurance?
Removing uniform policy provisions
The marketing of Medicare Supplements is regulated to prevent all of the following EXCEPT
Replacement of any existing coverage
Claims settlement practices of insurers are regulated by
State insurance departments
Which of the following is true regarding an agent who is found to have violated a state insurance law by the Superintendent of Insurance in Ohio?
The agent must pay the administrate costs associated with the investigation of such violations
In Ohio, a long-term care policy which lapses may be reinstated within five months if
The covered individual was mentally incapacitated
An applicant for life insurance must be informed that testing for Human Immunodeficiency Virus (HIV) infection is used to help determine
The insurability of the proposed insured
Who reports an agent's termination of appointment to the Director?
The insurer
At the request of a small group medical plan policyholder, the insurer must disclose all of the following EXCEPT
The insurer's expenses
All of the following are causes for termination of an employee's group insurance coverage EXCEPT
The plan's coinsurance limit is reached
Inflation protection must be included in all long-term policies delivered in Ohio UNLESS
The policyholder rejects the coverage in writing
A life insurance illustration showing future premiums being paid out of nonguaranteed values must disclose that
The policyowner may need to resume premium payments depending on actual results
How is a community rating used for underwriting purposes?
The same rates are charged for individual and group plans in the same geographical area
Who does a viatical settlement broker represent?
The viator
Under what circumstances must an agent provide his or her business records to the Director of Insurance?
Upon request of the Director
For long-term care insurance, when does Ohio require provision of a written notice of available insurance counseling programs?
When coverage is solicited
According to the Affordable Care Act (ACA), under what circumstances would lifetime limits and annual limits be permitted on a health plan or insurance policy?
When coverages are not considered essential health benefits
When an HIV test is requested for an individual applying for a health and accident policy, who must sign the consent form?
applicant
What is a prosthodontics dental procedure?
bridgework
Reductions in coverage are one feature of _______ in Health insurance policies.
cost containment
Employer group dental plans may attempt to minimize adverse selection by utilizing all of the following EXCEPT
encouragement of reduction in employee participation
When recommending the replacement of a health and accident policy, all of the following provisions should be carefully reviewed EXCEPT
grace period
Under the Affordable Care Act (ACA), health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition UNLESS it is a
granfathered plan
Splitting the commission with the buyer on a sale of insurance is known as
rebating
Attainment of the limiting age for dependent children will not terminate the coverage of a dependent child if
the child is incapable of self-sustaining employment by reason of physical or mental disability
When a Medicare supplement policy is purchased during the open enrollment period
the policy must be issued regardless of health status
To be covered dependents under an accident and health insurance policy, children of the insured generally must be
unmarried