Health Insurance
How many consecutive months of coverage must long-term care insurance policies provide?
12
No examination is required of a person licensed as an insurance producer in another state who moves to Tennessee as long as application is made within how many days of establishing legal residence?
90 days
Under the Uniform Required Provisions for health insurance policies, proof of loss should be filed within how many days after the loss?
90 days
Which type of authority is based on the actions or words of the agent?
Apparent authority
How long does an insurer have to contest fraudulent misstatements made in a health insurance application?
As long as the policy is in force
What document describes an insured's medical history, including diagnoses and treatments?
Attending physicians statements
A health insurance plan that covers all accidents and sicknesses that are not specifically excluded from the policy is referred to as a
Comprehensive Plan
Benefit periods for individual short-term disability policies will usually last for
No more than 2 years
Premium payments for personally-owned disability income policies are
Not tax deductible
Regarding benefit periods in long-term care policies as the benefit period lengthens, the premium __________.
rises
Underwriting process for insurance:
selection, classification, and rating of risks
What would be the deductible for basic surgical expense?
0 (Basic medical expense coverage-there is no deductible, but coverage is limited.
For how many days of skilled nursing facility care will Medicare pay benefits?
100 (full coverage first 20, days 21-100 patient must pay daily copay)
The sole proprietor of a business who owns a medical expense plan can deduct what maximum percentage of the plan cost?
100%
Any licensed person in this state may be assessed a civil penalty for an unintentional violation of a state insurance statute up to
1000
A person must have been entitled to Social Security benefits for ___ years to qualify for Medicare
2
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
OBRA requires employer health plans to provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months?
30 Months
How long is a free-look period for a Medicare supplement policy?
30 days
The term "fully insured" refers to someone who has earned _______ credits of coverage.
40 (10 years of work times 4 max annual credits)
If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?
5 days
Once a person meets the Social Security disability benefits requirements, how long is the waiting period before any benefits will be paid?
5 months
To be considered partially insured, an individual must have earned ____ credits during the last 13-quarter period.
6
The term "Continuous period of creditable coverage" only applies if the individual had no breaks in coverage greater than
63 days
If an employer provides long-term group disability insurance for its employees, what percentage of monthly wages are lower-paid employees eligible to collect?
66 2/3 % (50% for higher paid employees)
Medical expense premiums are deductible as medical expenses if along with all of the other unreimbursed medical expenses, the total exceeds what percentage of the adjusted gross income of the insured?
7.5%
How is the state Insurance Guaranty Association funded?
By its members- authorized insurers
An insurance agent sold a health insurance policy to his sister. What type of transaction is this?
Controlled business
What rider, when added to disability income policy, provides for changes in the payable benefits based on change in the consumer price index?
Cost of living adjustment
Which feature of a dental expense plan is NOT typically found in a medical expense insurance plan?
Diagnostic and preventative care
What is not a type of hazard: Morale, Exposure, Moral, Physical
Exposure
If an insured is eligible for retirement, disability, and survivor benefits under Social Security their status is-
Fully Insured
To be eligible for a Health Savings Account, an individual must be covered by which plan?
High-deductible health plan
What are three types of coverages for medical expense insurance?
Hospital, Surgical, Medical
The Time Limit on Certain Defenses provision is the same as-
Incontestability
How does reinsurance benefit the insurer?
It helps protect against catastrophic losses.
What describes the taxation of the premium in group accidental death and dismemberment policies?
It is deductible as an ordinary business expense.
When an employee covered under an HRA changes employers, what happens with the HRA account?
It remains with the employer.
Which type of care is NOT covered by Medicare: respite, hospice, hospital, long term
Long term
A long-term care insurance shopper's guide must be provided in the format developed by which entity?
NAIC
Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of insureds?
Optionally renewable
When insurers negotiate contracts with health care providers or physicians to provide health care services to subscribers at a favorable cost, it is called
Preferred Provider Organizations
In what type of medical insurance plan does the provider receive a scheduled fixed amount for care to the insured and no additional compensation regardless of the services provided?
Prepaid
Which of the following is an example of apparent authority?
The agent accepts a premium payment after the end of the grace period
Who sets the limits for a health reimbursement account?
The employer
What is the maximum amount that can be contributed to an MSA on the high-deductible plan for individuals?
The max amount that can be contributed to an MSA is 65% of the high-deductible plan for individuals or 75% of the family deductible for those with family coverage.
Under a credit disability policy, payments to the creditor will be made for the insured until what point?
The period of disability ends or the debt is repaid
Which entity has the power to grant accident and health producer license?
The state Department of Insurance
Which type of misrepresentation persuades an insured, to his or her detriment, to cancel, lapse, or switch policies from one to another?
Twisting
A statement guaranteed to be true, if untrue, may breach insurance contract
Warranty
All of the following benefits are available under Social Security except: Welfare, Death , Survivor, Disability
Welfare
If an insurance agent is suspected to be in violation of an insurance law or engaged in an unfair business practice, the Department of Insurance will most likely issue
a cease and desist order
Insurable risk loss must be due to:
chance, definite, measurable, and predictable, but not catastrophic.
Retention is a planned assumption of risk, or acceptance of responsibility for the loss by an insured through the use of:
deductibles, copayments, or self-insurance
Major medical expense contracts are characterized by:
high maximum limits, blanket coverage, coinsurance, and a deductible.
The longer the benefit period, the _________ the premium will be.
higher
Part A of medicare is known as ______________. Part B covers ________________.
hospital insurance, physician and surgeon services
If a disability policy is rated up, the premium _____________.
increases
When compared with individual coverage, the per capita administrative cost in group health insurance is
lower
Disability insurance benefits taxation is determined by-
whether the premiums were tax deductible
