Health Insurance

A contract of unequal value is called...?

Aleatory

In insurance, an offer is usually made when

An applicant submits an application to the insurer

The proposed insured makes the premium payment on a new insurance policy. If the insured should die, the insurer will pay the death benefit to the beneficiary if the policy is approved. This is an example of what kind of contract?

Conditional

What is the purpose of Medigap policies? a)To regulate unfair marketing practices b)To provide supplement coverage for Social Security disability benefits c)To provide health insurance to low-income senior citizens d)To cover expenses for Medicare deductibles and coinsurance

D

What is the difference between the Medicare approved amount for a service or supply and the actual charge?

Excess charge

Which of the following expenses is NOT covered by a health insurance policy? a) Dental b) Funeral c) Hospital d) Disability

Funeral

Which feature do most LTC plans have?

Guaranteed renewability

What type of benefit helps to pay for accidental injuries that are not severe enough to qualify as disabilities?

Medical Reimbursement Benefit

An insured severely burns her hand, but is not classified as disabled. Which of the following types of coverage would cover at least a portion of the insured's medical expenses?

Medical reimbursement benefit

Which document helps ensure that full and fair disclosure is provided to the recipient of a policy?

Outline of Coverage

The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as

Part A

After the elimination period, a totally disabled insured qualified and started receiving benefits from his disability income policy that has a waiver of premium rider. What will most likely happen to the premiums paid into the policy during the elimination period?

Premiums will be refunded

A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called

Prepaid plan

An insurer is preparing to pay disability income benefits to an insured. In order to prevent overinsurance, the insurer monitors the income of the insured before submitting payment. Which rule corresponds to this behavior?

Relation of earnings to insurance

Which health insurance provision describes the insured's right to cancel coverage?

Renewability provisions

In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met?

The insured must have first been hospitalized for 3 consecutive days.

The benefits for individual disability plans are based on?

a flat amount

The insured's health policy only pays for medical costs related to accidents. Which of the following types of policies does the insured have?

accident only

Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as

adhesion

The completion and accuracy of a health insurance application is the responsibility of the

agent

what are the elements of a legal contract?

agreement, consideration, competent parties, legal purpose

When an insured chooses the indemnity method of benefit payment, the insurer will pay a)The amount of the actual expenses incurred. b)The fixed benefit amount, regardless of the actual charge. c)Up to 100% of the usual and reasonable daily rate. d)Up to 80% of the usual and reasonable daily rate.

b

what is a peril

cause of loss

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

how many days after a health insurance policy is reinstated is the insured covered for an illness

10 days or more (injury is covered right away)

Any licensed person whose activities affect interstate commerce and who knowingly makes false material statements related to the business of insurance may be imprisoned for up to

10 years

For how many days of skilled nursing facility care will Medicare pay benefits?

100

The Superintendent may refuse to renew a license if a licensee is receiving more than 10% of the aggregate commissions from controlled business in how many months?

12

To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?

18 months

Every small employer carrier must actively offer to small employers at least how many health benefit plans?

2

When a health insurance policy is purchased in the state of New York, the insured may return the policy to the insurer and receive a premium refund within the maximum period of

20 days

The maximum period of time an employee may be entitled to benefits through the New York State Disability Program is

26 weeks during 52 consecutive calendar weeks

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

To qualify for waiver of premium benefit, an insured must meet the policy's definition of a)Fully insured b)Currently insured c)Total disability .d)Partial disability.

C

Which of the following provisions must be included on the first page of a Medicare supplement policy, which states the insurer's right to change premium amounts?

continuation provision

HMOs operate on what basis? a)Stop-loss b)Community rating c)Deductible d)Capitated

d

Which of the following standards is used to determine premium rates under the Affordable Care Act (ACA)? A) Family composition b)Medical history c)Employment d)Alcohol use

family composition

Of $10,000 in premiums a producer wrote over the past year, $3,000 came from sales to a business which employs the producer's spouse. This is considered

legal as long as more is sold to public

When compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is

lower

Are surgeon's services covered under part A?

no

Disability income policies can provide coverage for a loss of income when returning to work after recovering from total disability. What is the name of this policy?

residual disability

Medicaid is sponsored by what kind of sources?

state and federal

what is an exposure

the unit of measure used to determine rates (age, sex, occupation)

when only one party makes a promise it is called..?

unileteral

What percent of expenses does part B pay

80 percent

How long after the date of issue may an insurer cancel an accident and health policy?

90 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 year

What is the period of coverage for events such as death or divorce under COBRA?

36

In the event a policy lapses due to nonpayment of premium, within how many days would the policy be automatically reinstated once the outstanding premium is paid?

45

What is the elimination period for Social Security disability benefits?

5 months

How many eligible employees must be included in a contributory health insurance plan?

50 percent

In addition to examinations that are specifically authorized by the Insurance Code, the Superintendent may examine each domestic life insurer as often as it is deemed necessary for the protection of the consumers. The Code requires examination of domestic life insurers every

5 years

To be acceptable to insurance companies, what percentage of eligible employees must be enrolled under a contributory group health insurance plan?

50 percent

Under the Affordable Care Act, a special enrollment period allows an individual to enroll in a qualified health plan within how many days of a qualifying event?

60

In order to maintain coverage under COBRA, how soon from termination of employment must an employee exercise extension of benefits?

60 days

Under the New York State Disability Benefit Law, for an employed individual, disability benefits will be payable after a waiting period of

7 days