DE Accident & Health Insurance March 2020 Quizlet
A nonresident agent would not apply for a temporary license in Delaware, but for a
nonresident agent's license
Group plans are not tailored to
the individual
Petra is self-employed and pays $5000 a year in premiums for health insurance covering her family. If her spouse also works and is covered by an employer-sponsored health plan, what is the maximum income tax deduction Petra can take for her health insurance coverage?
$0 . THE DEDUCTION IS NOT AVAILABLE TO THOSE WHO COULD BE COVERED BY THEIR SPOUSES GROUP POLICY.
Commissioner charges how much for nonwillful violations and how much for willful violations?
$1000 per violation up to $10,000 for nonwillful violations $5000 fine for willful violations, up to a total of $50,000 in any 6-month period.
Suppose an insurer has knowingly accepted insurance business from an individual who is not licensed. He can be fined up to:
$20,000.00
What is the maximum amount in life insurance benefits covered by the Delaware Life and Health Insurance Guaranty Association?
$300,000
What is the maximum number of days of skilled nursing facility care for which Medicare will pay benefits?
100 days
According to the disability insurance time limit on certain defenses provision, how long after the date of a policy's issue can innocent misstatements on an application be used to void a claim? For the life of the policy 5 years 2 years 1 year
2 years
Benefit periods for long-term disability income policies typically range from:
2 years or longer
Identify the number of days the insured or insurer must do the following in this order: Notice of Claim, Claims Forms, Proof of Loss, Waiting Period for Sickness Claims upon Reinstatement
20, 15, 90, 10
How many continuing education credits must Delaware resident producer licensees earn every two years?
24 credits (12 per year)
A license is being used for controlled business if more than
25% of the agent's total commission is earned from controlled business
The free look provision in a long term care policy allows for how many days for a full refund?
30 days
To be considered currently insured, and therefore eligible for disability benefits under Social Security, a worker must have earned a minimum of
6 credits in the last 13 quarters
To be eligible for disability benefits under Social Security, a worker must have earned a minimum of
6 credits in the last 13 quarters
Benefit periods for short-term disability income policies typically range from:
6 months to 2 years
After an individual has received the eligibility notice for COBRA continuation from the employer, the option to elect coverage expires
60 days from the date of receipt
What is the definition of pre-existing condition in a long-term care policy?
A condition for which advice or treatment was received within 6 months before the effective date of coverage
A group of employers from a similar industry assembled to qualify for group health insurance is
A multiple employer trust
Guaranteed renewable health insurance policies ensure renewability up to
A specific age of the insured
METs can provide benefits on a self-funded basis, or they can
Add benefits through a contract issued by an insurance company.
Medicare—Part D Prescription Drug Coverage is available to
Anyone enrolled in Medicare Part A
Disability benefit payments funded fully by employer
Are taxable
Bob is severely injured after falling off of his roof while cleaning the gutters. If he is unable to provide proof of loss within 90 days, it may
Be filed up to one year after the date of loss
To be eligible for Social Security disability benefits, one of the requirements is that the person
Be totally and permanently disabled for at least 5 months
A POS plan allows a subscriber to access care
Both in-network and out-of-network
Under many dental expense plans, diagnostic care is
Covered
Medicare supplement policies (Medigap) pay for medical costs arising from extended ___________
Custodial (nursing home) care
Medicare Part A covers 80% of the cost of
Durable medical equipment
Injuries covered by workers compensation are technically _______ under health insurance
Excluded. Workers comp is a separate thing.
Major medical policies may include which types of deductibles?
Flat, corridor, per cause
Presumptive Disability provision will provide benefits
For very severe conditions that raise the presumption of total disablement
Who sets the requirements that must be met for LTC policies to be considered qualified
HIPAA 1996
Dentists that are on a specified list, and whom are paid on a flat per capita basis, characterizes an
HMO
An employer funded account that pays employees for qualified medical expenses they incur
Health Reimbursement Account
Most long term care policies provide coverage for ____________ care
Home health care
How long must replaxing and existing insurers maintain a replacement register and copies of all written communications regarding replacement?
Three years
Changes made to a health policy in Delaware must be approved ......
In writing by an executive officer of the insurance company
Major medical policies may include any of the following types of deductibles
Integrated/per-cause, corridor, or flat
Because of Pearson's financial situation, he must rely on Medicaid to pay the cost of long-term care. Pearson is not a good candidate for
LTC
Three distinct categories of basic health coverage exist:
Medical expense, disability income, and accident-only
Coverage for the reasonable cost of the first 3 pints of blood must be included in all _______________
Medicare Supplement Policies. All CORE benefits must be included
Qualifying events under COBRA include
Medicare eligibility, reduction in work hours, termination of a child's dependent status and divorce
Benefits received from a tax-qualified, long-term care insurance plan for employees are
NOT subject to income tax
Is illegal occupation a mandatory provision?
No , it is optional, because in some cases it is not needed
Disability benefit payments with employee contributions are
Not taxable
A nonforfeiture benefit is an ____________ benefit to a long-term care insurance policy?
Optional
Loss-of-time benefit adjustment - optional or required?
Optional , because in some cases it is not needed.
ERISA requires certain information concerning group insurance plans be made available to
Plan participants and their beneficiaries The IRS The Department of Labor
Change of occupation provision states that a change in occupation from a more dangerous to less dangerous occupation specifies that
Premiums will be reduced and the insurer will return the excess pro-rata unearned premium to her
Medicare Part A specifically excludes
Private duty nursing, non-medical services, intermediate care, custodial care, and the first three pints of blood
Change of beneficiary - optional or required?
Required!
What type of plan integrates its coverage with basic medical expense coverage, providing benefits in excess of those specified in the basic plan
Supplementary Major Medical
The commissioner is elected by
The citizens
Utilization review is a set of techniques to evaluate
The clinical necessity of health care services `
The Medical Reimbursement benefit available in some individual disability income policies is a percentage of
The monthly income benefit
Union workers as a class may be excluded since
Their compensation and benefits are covered by a collective bargaining agreement
Which of the following statements regarding persons participating in an HMO is correct? They negotiate health care service fees with contracted HMO providers They pay for health care services are they incurred They pay a fixed periodic fee whether or not health care services are used They pay for health care services as they are incurred, at a rate discounted for the HMO
They pay a fixed periodic fee whether or not health care services are used
A managed health care system that finances and delivers health care services through contract providers is called
a Health Maintenance Organization (HMO)