Health Exam
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
what guarantees that the information explained in the insurance contract is true?
a warranty
According to the Law of Agency, a principal is represented by a(n) ______
agent
What type of insurance providers must be nonprofit and sell insurance only to its members?
fraternal
a PCP can also be called a ______
gatekeeper
name 4 things that characterize a major medical expense plan:
high maximum limits, blanket coverage, coinsurance, deductible
What type of group insurance plan has benefits that are a result of a collective bargaining agreement between a labor organization and an employer?
modified fully-insured plan
are injuries caused by war covered by major medical expense insurance?
no
are regular dental/vision/hearing covered by major medical expense insurance?
no
the regulation of the insurance industry primarily rests with:
the state
An association could buy group insurance for its members if the group has at least ______ members
100
HIPAA requires that the individual have a previous continuous creditable health coverage for at least _____ months
18
core benefits are included in Medicare supplemental policies. what percentage of Part B coinsurance is required?
20%
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
Coverage under a small employer health benefit plan is generally available only if at least _____% of eligible employees elect to be covered
75
what does HMO stand for?
Health Maintenance Organization
what does PPO stand for?
Preferred Provider Organization
what does PCP stand for?
Primary Care Physician
insurers CANNOT transact insurance in this state without a ______
certificate of authority
______ helps to keep cost down by requiring the insured's participation in the ongoing expense
coinsurance
most scheduled plans provide first-dollar benefits without;
coinsurance and deductibles
______ is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care
intermediate care
In major medical insurance policies, when the insured's share of coinsurance reaches a certain amount, the insured is no longer obligated to pay it. This feature is known as
stop-loss
which type of funding plan is developed through collective bargaining?
premium-delay arrangements
S set up an individual retirement account that her employer is now contributing to. Her employer's contributions are not included in her gross income. What kind of retirement plan does S have?
SEP
______ refers to the nontaxable portion of each annuity benefit payment
cost base
regarding major medical plans, ______ stop-loss means lower premium
higher
if an insurance company requires an autopsy on a deceased insured, who is responsible for the expenses?
insurer
is custodial care covered by major medical expense insurance?
no
an insured's life expectancy is 6 months. how often may a life settlement provider contact the insured and inquire about the insured's health status?
once a month
when a medical caregiver contracts with a health organization to provide services to its members or subscribers, but retains the right to treat patients who are not members or subscribers, it is referred to as ______
open panel
which dividend option will increase the death benefit?
paid-up additions
