Exam FX Iowa Accident & Health or Sickness
Under the mandatory uniform provision Notice of Claim, written notice of a claim must be submitted to the insurer within what time parameters
20 days
policy holder have to return medicare supplement
30 days
a disability income policy has a waiting period of 7 days. if the insured is disabled for 15 days, how many days of benefits will the policy pay
8 days
which federal act defines rules pertaining to protected health information
HIPAA
according to the fair credit reporting act, all of the following statements are true except
If an applicant is declined for an insurance policy, he or she has no right to know what was in the report
An applicant gives her agent a completed application and the initial premium. What can the agent issue her that acknowledges the initial premium payment?
conditional receipt
the purpose of fair credit reporting act is to
protect consumers against the circulation of inaccurate or obsolete personal or financial information
purpose of hipiowa
provide health insurance to individuals who have been denied coverage
an insured had a heart attack while jogging, but is expected to return to work in approximately 6 weeks. the insureds disability income policy will
replace a percentage of his lost income
a hospital indemnity policy will pay
a benefit for each day the insured is in a hospital
a notice regarding replacement of medicare supplement coverage must be signed by
agent and applicant
insurance companies must be members of the Iowa individual health benefit reinsurance association
all capital stock insurance companies authorized to transact casualty insurance in Iowa
in which medicare supplemental policies are the core benefits found
all plans
with respect to the entire contract clause in health policies, who has the authority to make changes to an existing policy
only an executive officer of the company
insurance contracts are unilateral in nature. what does that mean?
only one party makes a promise
all of the following are true regarding key person disability income insurance except
premiums are tax deductible as a business expense
on an accidental death and dismemberment policy, the death benefit payable is known as the
principal sum
used to define any person, firm, or corporation appointed by an insurer that possesses the authority to transact insurance
producer
an insured purchased a health insurance policy with a renewability clause that states the policy is guaranteed renewable. this means that as long as the required premiums are paid, the policy will continue until the insured
reaches 65
An employee is covered under COBRA. His previous premium payment was $100 per month. His employer now collects $102 each month. Why does the employer collect an extra $2?
to cover the employers administration cost
Elaine's basic hospital expense policy has a $500 per day limit for room and board in a hospital with a max of 5 days. Elaine got sick and had to spend 3 days in the hospital at $650 a day. How much will elaine have to pay to cover the rest of her room and board charges?
$450
Core benefits are included in all Medicare supplemental policies. What percentage of Part B coinsurance is required?
20%
A long-term care insurance policy shall provide coverage for at least
24
in Iowa to be marketed as long term care the policy must cover
24 months
within how many days of requesting an investigative consumer report must an insurer notify the consumer in writing that the report will be obtained
3 days
how soon after the receipt of a properly complete claim form and proof of loss must a health insurance company accept and pay or dent a claim
30 days
if a producer changes his address, the commissioner must be notified within
30 days
if the commissioner receives a certificate of noncompliance from the child support recovery unit the producer will have his or her license suspended for how many days
30 days
period coverage for events such as death or divorce under cobra
36 months
which of the following statements is not true regarding health insurance policy provisions
All additional provisions written by insurers are cataloged by their respective states
Occasional visits by which of the following medical professionals will not be covered under LTC's home health care?
attending physician
document describes an insureds medical history
attending physicians statement
accidental death and dismemberment policy loses her left arm
capital amount in lump sum
an order issued by the commissioner that required someone to stop engaging in unfair method of competiton or an unfair deceptive act
cease and desist order
a leader who conditions approval of a loan on the condition that the borrower purchase insurance from that lender may be guilty of
coercion
An applicant for an individual health policy failed to complete the application properly before being able to complete the application and pay the initial premium she is confined to a hospital this will not be covered by the insurance because she has not met conditions specified in the
consideration clause
which of the following includes information regarding a persons credit, character, reputation, and habits.
consumer report
which of the following reports will provide the underwriter with the information about insurance applicants credit
consumer report
medicare supplement may
contain pre existing condition limitations
which of the following is not an exclusion in medical expense insurance policies
coverage for dependents
which is not true regarding basic surgical expense coverage
coverage is unlimited
which of the following programs expands individual public assistance programs for people with insufficient income
medicaid
all of the following statements concerning medicaid are correct except
medicaid is a state funded program that provides health care to persons over age 65 only
long term partnership creates partnerships with
medicaid recipients
all of the following are excluded from coverage in an individual health insurance policy except
mental illness
which of the following is not a mandatory health insurance provision
misstatement of age
in health insurance, the length of the grace period varies according to the
mode of premium payment
premium payments for personally owned disability income policies
not tax deductible
which provision concerns the insureds duty to provide the insurer with reasonable notice in the event of a loss
notice of claim
Hospital indemnity/hospital confinement indemnity policy provides payment based only on
number of days confined in a hospital
all of the following are the most common variations in a long-term care policy except
number of family dependents
In long-term care insurance, what type of care is provided with intermediate care?
occasional nursing or rehabilitative care
A brain surgeon has an accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for losses
own occupation - less
which of the following cases would a credit disability policy be issued
if an individual is in debt to a specific creditor, payments will be made for him/her until the return of work
which of the following is not correct concerning taxation of disability income benefits?
if paid by the individual, the premiums are tax deductible
which of the following riders would not increase the premium
impairment rider
locations would skilled care most likely be provided
in an institutional setting
elimination period gets shorter, the premium
increases
underwriting a group health insurance plan that is paid for by the employer requires all of the following except
individual members may select the level of benefits for their own coverage
policy owner names his 5 children
remaining 4 primary
an application for a disability insurance policy has a heart condition of which they are unaware and therefore they answer no to the questions
representation
A stop-loss feature in a major medical policy is intended to
Establish a maximum amount of out-of-pocket expense that an insured will have to pay for medical expense in a calendar year
which of the following was designed to investigate and collect evidence relating to insurance fraud
insurance fraud bureau
all of the following must sign an application for health insurance except
insurer
legally bind coverage
insurer
The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the
insuring clause
which of the following beneficiary designations cannot be changed by an insured without first receiving the consent of the beneficiary
irrevocable
a fraternal benefit society
is operated for the benefit of its members
a guaranteed renewable disability insurance policy
is renewable at the insured option to a specified age
After a hearing, if the Commissioner finds that a producer is in violation of unfair business practices, his or her initial action will be to
issue a cease and desist order
not a benefit of POS plan
it allows guaranteed acceptance of all applicants
Which of the following statements is not correct concerning the COBRA ACT of 1985?
it requires all employers, regardless of the number or age of employees, to provide extended group health coverage
which of the following time periods is the general enrollment period for Medicare Part B
jan 1 - march 31
in a group health policy, a probationary period is intended for people who
join the group after the effective date
an agreement that is enforceable by law is known as what kind of contract
legal
provision which prevents the insured from bringing any legal action against the company for 60 days
legal action
Under workers compensation, which of the following benefits are NOT included?
legal benefits
which of the following does the insuring clause not specify
list of available doctors
which of the following terms relates to disability income insurance
residual benefits
An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?
revocable
Under the Payment of Claims provision, to whom will the insured's benefits be paid if the insured is deceased?
the insureds primary beneficiary's
which of the following is not a feature of a guaranteed renewable provision
the insurer can increase the policy premium on an individual basis
which of the following is not a feature of a noncancellable policy
the insurer may terminate the contract only at renewal for certain conditions
the insuring clause of a disability policy usually states all of the following except
the method of premium payment
An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action?
the old policy should stay in force until the new policy is issued
which is not a requirement for a partnership qualified LTC policy
the policy must have been issued before jan 1, 2010
A policy with a 31- day grace period implies
The policy will not lapse for 31 days if the premium is not paid when due
when health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost it is called
PPO
Medicare Part d provides
Prescription drug benefit
federal fair credit reporting act
Regulates consumer reports
what does the application of contract of adhesion mean
Since the insured doesn't participate in preparing the contract, and ambiguities would be resolved in favor of the insured
all of the following are correct about the required provisions of a health insurance policy except
a reinstated policy that provides immediate coverage for illness
the benefits for group disability plans are based on
a percentage of the workers income
not true regarding partial disability
form of insurance that covers part-time workers
what phase begins after a new policy is delivered
free-look period
experiencing at least one year of disability
fully insured status
the guaranteed purchase option is also referred to as the
future increase option
true of PPO
goal to channel patients to providers that discount services
most LTC plans have which of the following features
guaranteed renewability
following types of LTC care is not provided in an institutional setting
home health
if an insured is injured while committing an illegal act and the insured's health policy contains the illegal occupation provision, what percentage of the claim will be paid
0%
after hearing a civil penalties imposed by the commissioner for each unfair method of competition may not exceed
1,000
pays $100 monthly
10 day grace period
commissioner believes an individuals unfair trade practice the hearing may be no sooner then
10 days
max fine for cease and desist order
10,000
group nonprofit
1000
how many consecutive months of coverage
12 months
how long must producer maintain records of completing continuing education
4 years
If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?
5 days
how often do commissioner of insurance required to examine
5 years
if producer knowingly violates an insurance law, the producer may be fined up to what amount per violation
5,000
If a producer knowingly violates the insurance code the maximum aggregate penalty cannot exceed
50,000 in 6 month
which of the following best defines the probationary period in group health policies
A specified period of time that a person joining a group has to wait before becoming eligible for coverage
the corridor deductible applies between
Basic and major medical coverage
under the individual health insurance reform act who is responsible for establishing the rule for renewing health insurance policy
Iowa individual health benefit reinsurance association
not correct regarding medicare
Medicare Advantage must be provided through HMO's
what is the primary difference between medigap and medicare select policies
Medicare select policies contain restricted network provisions
an example of an alien insurer doing business in this state is one formed under the laws of
Mexico
in health insurance what is coinsurance?
a percentage of the cost of service that the insured and the insurer share
what is the purpose of a benefit schedule
To state what and how much is covered in the plan
following is a feature of a disability buyout plan
a lump sum benefit payment option
take it or leave it basis are classified as
adhesion contracts
another term for authorized user
admitted
Which of the following long term care benefits would provide coverage for functionally impaired adults on a less than 24 hour basis
adult day care
Group health insurance is characterized by all of the following EXCEPT?
adverse selection
all of the following would be considered rebating except
an agent misrepresents policy benefits to convince a policy owner to replace policies
disability income coverage specifies that the policy covers the insured if he is unable
any occupation more
not the consideration in a policy
application given to prospective insured
in a replacement situation, all of the following must be considered except
assets
skilled nursing care provided under home health care coverage must
be ordered by a license physical
which of the following statements regarding business overhead expense policies is not true
benefits are usually limited to six months
which of the following meets the insureds personal needs, and is provided by a nonmedical personnel
custodial care
A waiver of premium provision may be included with which kind of health insurance policy
disability income
which of the following is considered a qualifying event under COBRA
divorce
who can provide skilled nursing care
doctor
Which of the following best describes the aleatory nature of an insurance contract?A. Ambiguities are interpreted in favor of the insured
exchange of unequal values
items stipulated in the contract that the insurer will not provide coverage are found in the
exclusions
in iowa, the individual health insurance reform act was enacted to promote
fair access to health insurance plans
which of the following is consideration on the part of an insurer
paying the claim
prevent insurance company from paying a reimbursement
payment of claims
regarding the PPACA health tax credit, which of the following is true
person receiving medicaid are not eligible
a guaranteed renewable health insurance policy allows the
policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class
in group insurance, the primary purpose of the coordination of benefits provision is to
prevent overinsurance
A Medicare SELECT policy does all of the following EXCEPT?
prohibit payment for regularly covered services if provided by non network providers
insurers may change which of the following on a guaranteed renewable health insurance policy
rates by class
An insured, who is 44 years old, falls while mountain climbing on vacation. He is left paralyzed. After a year, doctors feel he will never recover from his injuries. From which of the following programs will he be able to collect disability income?
social security
a provision found in insurance policies which prevents the insured from collecting twice
subrogation
the transfer of an insureds right to seek damages from a negligent party to the insurer is found in which of the following clauses
subrogation
which of the following statements concerning group health insurance is correct
the employer is the policy holder
which of the following is true regarding optional benefits with long term care policies
they are available got additional premiums
notifies a company he is disabled, claims must be paid immediately
time of payment of claims
according to the rights of renewability rider for cancelable policies, all of the following are correct about the cancellation of an individual insurance policy except.
unearned premiums are retained by the insurance company
if one party to an insurance contract has made a legally enforceable promise what kind of contract
unilateral
a medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic are is known as
usual, customary, and reasonable
according to the time limit on certain defenses provision, statements or misstatements made in the application at the time of issue cannot be used to deny a claim after the policy has been in force for a minimum of how many years
2 years
all of the following could qualify as a group for the purpose of purchasing group health insurance except
an association of 35
the benefits from business overhead expense insurance policy
are limited to covered expenses and are taxable to the business
a long-term care policy, certificate or rider may provide coverage to an insured on any of the following bases except
deferred
a medicare supplement policy cannot
duplicate benefits provided by medicare
what advantage does the recurrent disability provision provide to the insured under a disability income policy
eliminates the imposition of a second elimination period for the same disability
An insurer incorporated under the laws of the state in which it is operating is considered to be a(n):
foreign
the commissioner is appointed to a 4 year term by the
governor
an insured has an individual disability income policy with a 30 day elimination period. he becomes disabled on June 1 for 15 days. when will he collect his disability income payments
he won't collect anything
following a covered loss, the time payment of claims provision requires that an insurance company pay disability income benefits no less frequently than
monthly
Among people in the same class and life expectancy, which of the following factors can be used to influence premium rates?
occupation
all individual and group health insurance policies in this state must provide coverage for low dose screening mammograms for deterring the presence of breast cancer. how much for women over 50
one annual mammogram
The legal process that gives the insurer, after payment of a loss, the right to seek recovery from a third party that was responsible for the loss is known as
subrogation
all of the following would be classified as limited insurance coverage except
supplement social security coverage
what organization protects insureds against failure to perform contractual obligations due to impairment or insolvency of an insurer
the Iowa life and health guaranty association
under a debtor group insurance policy, who must be the beneficiary of proceeds
the creditor
an employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. this results in a long hospitalization period. which of the following is true
the group plan will not pay because the employee was injured at work
all of the following are characteristics of group health plans except
the parties that hold a group health insurance contract are the employees and the employer
With regard to labor unions group, which of the following statements are not correct
the premium can be paid solely from insureds fund
what is the purpose of the impairment rider in a health insurance policy
to exclude coverage for a specific impairment
premiums are paid by self employed sole proprietors or partners for medical expense insurance are
totally tax deductible
which of the following services will not be provided by an HMO
unlimited coverage for treatment for drug rehabilitation
an employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA
within 60 days
if a premium is required to provide coverage for a newly born child how many days
60 days
in order to maintain coverage under COBRA, how soon from termination of employment must an employee exercise extension of benefits
60 days
Under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss?
90 days
An applicant misstates his age on his app for a health insurance policy. He states that that he is 39, but is actually 49. When he files a cliam, what most likely will happen?
Benefits paid will be those that would have been purchased at the correct age
An insured is anxious to get treatment for a health condition, and is convinced that a specialist is needed to cure the condition. If the insured has a PPO plan, which of the following is true?
The insured can select any specialist, but non-network specialist will have higher out of pocket costs
regarding consideration clause, which of the following is not correct
consideration of the insurer and insured must be equal
what is the purpose of the gatekeeper in an HMO
control cost
to be valid, an insurance policy must have all of the following except
countersignature
which of the following is not true regarding a noncancellable policy
insurer can increase the premium above what is stated in the policy if claims experience is greater than expected
any provision for long term care established by the Iowa department of insurance cannot be
less favorable
a health policy providing for third party or repayment of health or medical expenses will not provide coverage for benefits for the costs associated with diabetic
low carb foods
which of the following would not be considered a limited coverage policy
major medical expense insurance
