Health Exam
T is receiving $3,000/month from a Disability Income policy in which T's employer had paid the premiums. How are the $3,000 benefit payments taxable?
Benefits are taxable to T
Which of these circumstances is a business disability Buy-Sell policy designed to help in the sale of a business?
Business owner becoming disabled
X is insured with a disability income policy that provides coverage until age 65. This policy allows the insurer to change the premium rate for the overall risk class assigned. Which of these renewability features does this policy contain?
Guaranteed renewable
Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of the participating physicians and hospitals that have an agreement?
Health Maintenance Organization (HMO)
Which of the following statements about Health Reimbursement Arrangments (HRA) is CORRECT
If the employee paid for qualified medical expenses, the reimbursements may be tax-free
What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision
Insured must be under a physician's care
Which of the following claims are typically excluded from Medical expense policies?
Intentionally self-inflicted injuries
J has a Disability Income policy that does NOT provide benefits for losses occurring as the result of his employment. What kind of coverage is this?
Nonoccupational coverage
What is the consideration given by an insurer in the consideration clause of a life policy ?
Promise to pay a death benefit to a named beneficiary
Insurance policies are offered on a "take it or leave it" basis, which make then
contracts of adhesion
An ______ is a signed document that starts the free-look period
delivery receipt
In regards to representations or warranties, which of these statements is TRUE?
if material to the risk, false representations will void a policy
Insurance policies are considered aleatory contracts because
performance is conditioned upon a future occurence occurrence
What is considered to be a characteristic of a conditionally renewable health insurance policy?
premiums may increase at time of renewal
What is the purpose of the Time of Payment of Claims provision?
prevents delayed claim payments made by the insurer
A major medical policy typically
provides benefits for reasonable and necessary medical expenses, subject to policy limits
A long-term care lapse notice must be delivered to both the applicant and
secondary addressee
Insured losses are covered immediately after a health policy is reinstated when:
the losses result from accidental injuries
Which of the following reimburses its insured for covered medical expenses?
Commercial Insurers
Which of the following types of health coverage frequently uses a deductible?
Major Medical policy
M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force?
45 days
M applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional receipt is left with the applicant. The insurance company's underwriting department request's M's medical records and determines that M has had asthma for many years. All of the following are probable underwriting outcomes, EXCEPT:
Changing the policy's provisions
In order to terminate a producer's appointment, the insurance MUST
send notice of termination to the comissioner
P is an employee who quits her job and wants to convert her group health coverage to an individual policy. After the expiration of COBRA benefits, which of the following statements is TRUE?
she DOES need to provide evidence of insurability
P is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period?
sign an enrollment card
When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the:
entire contract provision
Medicare Part B does NOT cover
inpatient hospital services
A life insurance policy would be considered a wagering contract WITHOUT
insurable interest
The ____ clause identifies which losses resulting from an accident or sickness are insured by the policy
insuring
A foreign insurance company doing business in Iowa
is a company that was formed under the laws of another state
A medicare supplement policy can be cancelled by the insurer for
nonpayment
In Iowa, monthly-premium health insurance policies must provide a grace period of at least
10 days
K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?
Reinstatement
What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims form provision?
Submit the claim in any form
Which of the following services is NOT included under hospitalization expense coverage?
Surgical fees
Which of these situations is NOT considered to be a replacement?
Term coverage is converted to an individual permanent plan with the same insurer
T was insured under an individual Disability Income policy and was severely burned in a fire. As a result, T became totally disabled. The insurer began making monthly benefit payments, but later discovered that the fire was set by T in what was described as arson. What actions will the insurer take?
The insurer will rescind the policy, deny the claim, and recover all payments made
Which of the following statements best defines usual, customary, and reasonable (UCR) charges?
The maximum amount considered eligible for reimbursement by an insurance company under a health plan
J is a produced who has induced an insured through misrepresentation to surrender an existing insurance policy. What is J guilty of ?
Twisting
R becomes disabled and owns an individual disability income policy. When is R eligible to receive disability benefits?
Upon satisfying the elimination period requirement
A health reimbursement arrangement must be established
by the employer
A disability elimination period is best described as a
time deductible
The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the
waiting period
Which of these statements is NOT true regarding health coverage for a newborn?
Coverage is limited to only congenital defects
An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to
Determine if the applicant is an acceptable risk by the completing standard underwriting procedures
A CEO's personal assistant suffered injuries at home and as a result, was unable to work for four months. Which type of policy will pay a monthly benefit to the personal assistant?
Disability income
Which of the following statements does NOT accurately describe the tax treatment of premium and benefits if individual Accident and Health insurance?
Disability income policy premiums are tax-deductible
M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?
Earned but unpaid benefits
Which of the following health insurance policy provisions specifies the health care services a policy will provides?
Insuring clause
A life insurance arrangement which circumvents insurable interest statutes is called
Investor-originated life insurance -
Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT
Premiums normally increase at time of renewal
T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. Under the Model Group Coordination of Benefits provision, when T files a claim, his employer's plan is considered the
Primary carrier
Which of the following involves analyzing a case before admission to determine what type of treatment is necessary?
Prospective review
P loses an arm in a farm accident and is paid $10,000 from his Accidental Death and Dismemberment policy. This benefit is known as the
Capital Sum
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
Commercial insurer
