EXAM INSURANCE PRAC HEATLTH
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?
10 days (the grace period is 7 days if prem is paid weekly, 10 days if paid monthly, 31 days for all other modes)
for how long is the certificate of prelicensing course completion valid
180 caldendar days
which of the following must the patient pay under medicare part b
20% of covered charges above the deductible
an insolvent insurer is one who is unable tto pay its oblications when they are due or has fewer assets than liabilitties for a period of
3 years
which statement best defines a Multiple Employer Welfare Arrangement (MEWA)
a joining together by employers to provide health benefits for employee
how is emergency care covered for a member of an HIC
a member of an HIC can recieve care in or out of the service area, but care is preferred in the service area
in reference to the standard medicare supplement benefit plans, what does the term standard mean
all providers will have the sam coverage options and conditions for each plan
which of the following individuals is eligible for a health saving account
allison is insured by a High deductible health plan (HDHP)
METs purpose
allow several small employers purchase less expensive insurance together
under HIPPA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy
an individual who was previously covered by group health insurance for 6 months is eligible
which of the following hospice expenses would NOT be covered in a cost containment setting
antibitotics
under a key person disability income policy, premium paymens
are made by the business and are not tax deductible
what is the maximum period of time during which an insurer may contest fradulent misstatments made in an application
as long as the policy is in force
in a replacement situation, all of the following must be considered EXCEPT
assets
How many eligible employees must be included in a contributory plan?
at least 75% can be
Which rider, when added to a disability income policy, provides for changes in the benefits payable based on changes in the consumer price index?
cost of living adjustment rider
a health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as
critical illness
according to the future increase option ride (FIO), which of the following is NOT a qualifying event to increase an insured benefit level
death of a spouse
an insurer wants to advertise its new Medicare supplement policy. which authority must review the ad before it can be used
director
which type of insurance provides funds for a business org to purchase the business interest of a disabled partner
disability buy sell
OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage?
end stage renal failure
which of the following. is correct concerning. taxation. of. long term. care insurance
excessive benefits may be taxable
what type of group rating uses the actual experience of the group as a factor in developing the rates to be charged
experience rating
in disability income insurance, the own occupation definition of disability applies
for the first 2 years of a disability
what option allows the insured to periodically increase benefit levels without providing evidence of insurability
guarantee of insurability
franchise insurance
health coverage for small groups whose numbers are too small to qualify for true group insurance
in 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 to work
which of the following factors aboutt the insured determines the amount of disability benefit that the insured will recieve
income
in LTC policies, as the benefit period lengthens, the premium
increases (LTC policies define the benefit period for how long coverage applies, the longer ttthe benefit period, the higher the premium)
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 (1st page of policy, staets the coverage and when it applies)
in health insurance, if a doctor charges 50$ more than what the insurance comp considers usual, customary and reasonable, the extra cost
is not covered
The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as
legal actions
which type of medicare policy requires insureds to use a specific healthcare providers and hospitals, EXCEPTT in emergency situations
medicare SELECT
when an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits bc of an injury or illness profitable, it is called
overinsurance
which of the following must be present in ALL medicare supplement plans
plan A
medicaid
poor people all ages
under a disability income policy, the insurer does not pay a monthly benefit tthat is equal to the insured's previous income, the reason for paying a benefit amound that is less than the insured's income is to
prevent overutilizatiton and malingering
rose bought 3 policies from the same insurer. her benefits have exceeded thte max allowed by the insurer. what will happen
pro rata benefit reduction
pertaining to insurance, whatt is the def of a fiduciary responsibility
promptly forwarding premiums to the insurance company
what would a physician utilize if he/she wanted to know if a treatment is covered under an insureds plan and at what rate will be paid
prospective review
Subrogation
provision found in insurance policies which prevents the insured from collecting twice for the same loss
the Ohio Public Employees Retirement System (OPERS) replaces
social security
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
during the medicare advantage open enrollment period, an individual may do all the following EXCEPT
switch from an original medicare plan to a medicare advantage plan
* an applicants resources and assets may be used when determing eligibility for a low income subsidy under medicare part d, as long as
the assets can be readily coverted into cash within 20 days
in comparison to consumer reports, which of the following describes a unique characteristic of investigative consumer reportts
the customers associates, friends, and neighbors provide the reports data
which statement accurately decribes group disability income insurance
the exttent of benefits is determined by the insureds income
Who chooses a primary care physician in an HIC
the individual member
which of the following is NOT covered under Plan A in medigap insurance
the medicare part a deductible
can an individual who belongs to a pos plan use an out of network physician
yes and they may use any preferred physician even if not part of the HMO
what is thte shortest possible elimination period for group short term disability benefits provided by an employer
0 days
An insured's disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payment from the insurer before Social Security benefits begin?
1
an association could buy group insurance for its members if it has at least
100 members
an open enrollment for an HIC must last for the min of how many days?
30
minimum number of credits required for partially insured status for social securty disability benefits
6 credits
* the max amount that can be contributed to an MSA is what percentage of the family deductible for those with family coverage
75%
the Omnibus Budget Reconciliation Act of 1990 requires that large group healtth plans must provide primary coverage for disabled individuals under
Age 65 who are NOT retired
which of the following is true of a PPO
Its goal is to channel patients to providers that discount services.
which of the following groups seeking group health insurance would represent a bad risk for underwriters
a group that changes insurance annually
comprehensive plan
a health insurance plan that covers all accidentst and sickness that are not specifically excluded from a policy
which of the following losses will be covered by a group medical expense policy
a preecisting condition
When the policy premium wasn't submitted with the application, what should the agent obtain from the insured upon policy delivery?
a statement of good health
which of the following groups would probably be covered by blanket insurance
a universitys sports team
foreign
another state
combination plans are comprised of two types of plan features:
basic and comprehensive
all of the following are true of the key person disability income policy EXCEPT
benefits are considered taxable income to the bus
how often must a specialty health care insurer provide current company info, providers list, methods of operation and other reports to its insured
biennially
medicaid is sponsored by what sources
both state and federal
best desribes how eligibility for a health insuring corp is determined
by geographic boundaries
How are state Insurance Guaranty Associations funded?
by their members - authorized insurers
what is the purpose of the gatekeeper in an hic
controlling costs
An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement?
cost containment
If a dental plan is integrated, it is combined with what type of plan?
medical
what methtod do. insurers use to prottect themselves against catastrophic losses
reinsurance
what are the requirements for health insurance marketplace coverage specific vaccines administered by an in-network provider
they must be covered without copayment or coinsurance
Under the Physical Exam and Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending?
unlimited
an insurance company receives an application with some info missing and issues the policy anyway. this is called
waiver
