Health insurance questions

Continuing education requirements do not apply to:

- producers serving full time in US armed forces; or - producers licensed for credit accident and health or credit life ONLY

The 3 levels of LT care are:

- skilled nursing care - custodial care - intermediate nursing care

After how many days is coverage automatically reinstated if the insurer has not disapproved the application and notified the insured?

45 days

Exclusions fro pre-existing conditions help to avoid:

Adverse selection against an insurer

Medicare supplement (or Medigap) policies pay:

All or most of Medicare's deductibles

A stop-loss feature in a major medical policy specifies the maximum...

Amount the insured must pay toward covered expenses

A deductible that is measured in time rather than dollars is called

An elimination period

When it is used, the time limit on the certain defenses provision in a health insurance policy provides that the policy cannot be contested and claims cannot be denied after 2 years EXCEPT for:

Fraudulent statements in the application

What organization protects owners of life insurance policies issued by insurers who become insolvent?

Iowa Life and Health Insurance Guaranty Association

The Iowa Life and Health Insurance Guaranty Association covers...

Iowa Residents who own covered policies

Medicare is an example of:

Social insurance

With an optionally renewable policy, the insurance company reserves the right to:

Terminate coverage at any policy anniversary date or premium due date

All Medicare supplement policies must cover 100% of the Part A hospital coinsurance amount for each day used from:

The 61st through the 90th day in any Medicare benefit period

All laws that relate to insurance in Iowa are administered by:

The Insurance Division

Employee groups receiving group life insurance must cover at least how many employees at the date of issue?

10 employees

What is the maximum number of days of skilled nursing facility care for which Medicare will pay benefits?

100 days

LT Care insurance must provide coverage for at least...

12 consecutive months

The minimum benefit period for a LT care policy is:

12 months

According to the claims form provision, the insurer must provide a claim form within ___ days of receiving written notice of claim

15 days

In major medical and comprehensive medical expense policies, a coinsurance provision....

Provides for percentage participation by the insured

In the standardized Medicare supplement policy, Plan A is characterized by:

Providing the LEAST comprehensive coverage

A producer who offers an applicant a job as an inducement to purchase insurance has engaged in the unfair trade practice of:

Rebating

Major medical policies that pay 100% of covered expenses above a specified amount and after the insured's deductible contain what kind of a provision?

Stop-loss

Keenan has coverage with two separate insurers that provide similar benefits. If he has a loss,

The amount paid by the insurers will be PRORATED and Keenan will be refunded any excess premium

By most insurers' definitions, partial disability is:

The inability of an insured to perform at full capacity

10 CORE health care benefits - Essential Health Benefits:

1) Ambulatory patient services 2) emergency service 3) hospitalization 4) maternity and newborn care 5) mental health and substance use 6) prescription drug 7) rehab services 8) laboratory services 9) preventative and wellness services (chronic disease) 10) pediatric services - oral and vision

What three actions constitute the transaction of insurance?

1) delivering insurance contracts to Iowa residents; 2) collecting premiums; 3) receiving insurance applications

A contract that is designed primarily to augment reimbursement under Medicare for hospital, medical, or surgical expenses is known as:

A Medicare supplement plan

Joni is covered under a dental insurance plan that requires her to annually pay the first $200 of dental expenses, at which point the plan reimburses her for 80% of the cost of routine care. Joni is most likely covered under:

A comprehensive plan

A basic medical expense policy is usually written with first-dollar coverage, which means it does NOT have:

A deductible

What does the entire contract of an individual health insurance policy NOT include?

Buyer's guide

Under the relation of earnings to insurance provision, the insured's benefit:

Cannot exceed earnings

What organization reimburses its insureds for covered medical expenses?

Commercial insurers

Leonard owns a major medical health policy that requires him to pay the first $200 of covered expenses each year before the policy pays its benefit. The $200 is the policy's:

Deductible

From the insured's prospective, which of the types of disability coverage would be the LEAST restrictive as to qualifying for benefit payments?

Own occupation

A fully insured retired worker is entitled to full Social Security disability benefits. This equals 100% fo what?

PIA

Jack is covered under a dental plan that encourages him to obtain care from a select group of dentists but allows him to get care from any dentist. Jack's plan is most likely:

PPO dental plan

The illegal practice of making misleading statements or incomplete comparisons about the terms, conditions, or benefits of a policy to induce a person to lapse, forfeit, surrender, exchange, or otherwise dispose of an insurance policy is called:

Twisting

Dental plans pay benefits on a...

UCR basis

Arthur incurs total hospital expenses of $8,300. His major medical policy includes a $500 deductible and an 80%/20% coinsurance feature. If this is the first covered expense he has incurred this year, how much will Arthur have to pay toward his hospital bill?

$2,060

Naomi is killed in an auto accident before she is able to pay the semiannual $80 premium on her $30,000 accident policy. Under the policy's unpaid premium provision, her beneficiary will receive a check for:

$29,920

Medicaid provides:

- funds to states to assist their medical public assistance programs

Smith and Jones Insurance has totally revised its individual health insurance policy. Tamika likes the coverage she already has and is concerned about the changes. She contacts the producer who sold her the policy, who tells her that:

- her policy will NOT be affected by the changes - entire contract provision: no changes can be made to the policy after it has been issued

What type of plan integrates its coverage with basic medical expense coverage, providing benefits in excess of those specified in the basic plan?

- supplementary major medical

The calendar year deductible provision of a major medical policy stipulates that:

- the deductible is applied only ONCE during the calendar year

Three distinct categories of basic health insurance:

1) medical expense 2) disability income 3) accident-only

The Iowa Individual Health Benefit Reinsurance Association does what three things:

1) prevents abusive rating 2) sets limits on the exclusion of preexisting conditions 3) sets rules for renewing coverage

Comprehensive Medical Expense Insurance covers what three things:

1) room and board 2) surgical fees 3) misc. hospital expenses

Lynn is insured under Medicare Part A and enters the hospital for surgery. Assuming that Lynn has not yet tapped into her lifetime reserve, what is the maximum number of days that Medicare will pay for her hospital bills?

150 days

All individual health insurance policies must include a notice of claim provision requiring that a written notice of claims must be given tot he insurer within how long after the occurrence of the loss?

20 days

The notice of claim provision requires that written notice be given to the insurer within...

20 days after any loss

Under Medicare Part B, the participant must pay:

20% of covered charges above the deductible

Identify the number of days the insured or insurer must do the following in this order: Notice of Claim, Claim Forms, Proof of Loss, Waiting Period for Sickness Claims Upon Reinstatement.

20, 15, 90, 10

For LT care policies to be considered qualified, a health professional must certify that a chronic illness will last for a minimum of:

3 months

Disability income benefits for partial disability typically are payable to eligible insureds for a maximum of:

3 to 6 months

A Medicare supplement policy must have a free look period of how many days?

30 days

The free-look provision of a LT care policy allows for an insured to return a policy within how many days for a full refund?

30 days

An insurer can cancel a health insurance policy by delivering written notice to the insured at least how many days before the effective date of cancellation?

5 days

A disabled worker's unmarried dependent child, who is younger than 18, is eligible for monthly benefits equal to how much of the worker's primary insurance amount (PIA)?

50%

To be considered CURRENTLY insured, and therefore eligible for disability benefits under Social Security, a worker must have earned a minimum of:

6 credits in the last 13 quarters

A Medicare supplement policy cannot deny claims for losses occurring more than how long after the effective date of coverage because of a preexisting condition?

6 months

Benefit periods for ST disability income policies typically range from:

6 months to 2 years

An individual may take legal action to recover on an accident and health insurance policy no sooner than how many days after a written proof of loss is provided?

60 days

The typical coinsurance ratio for dental insurance plans is:

80/20

An individual must complete a license application within how many days after passing the licensing exam?

90 days

Under social security, a fully insured worker is:

A worker who has paid in to SS for 10 years, earning 40 credits

What kinds of risks does a health insurance policy cover during the 10 day waiting period after it has been reinstated?

ACCIDENT ONLY - not sickness

People age 65 or older who enroll in Medicare Part B may also select Medigap coverage during:

An open enrollment period

Changes made to a policy must be:

Approved in writing by an executive officer of the insurance company

Skilled nursing long-term care is provided

Around the clock

Accident and health coverage must continue for an unmarried, dependent child who is incapable of self-sustaining employment due to mental retardation or physical handicap for how long?

As long as the parents provide proof of incapacity

Individual accident and health insurance policies can limit or exclude coverage for all of the following EXCEPT: A) dental care B) family history of heart attack C) alcoholism D) benefits provided under Medicare

B

Bob is severely injured after falling off his roof while cleaning the gutters. If he is unable to provide proof fo loss within 90 days, it may:

Be filed up to 1 year after the date of loss

After a proof of loss is submitted, legal action may be taken to recover on an individual health insurance policy only during what time period?

Between 60 days and 3 years

What disability policy indemnifies the business for certain expenses incurred when he business owner is disabled?

Business overhead expense policy

Beth's health insurance policy contains a provision that allows her to renew coverage up to age 65. However, the policy also states that should Beth lose her job, the insurance company will cancel the policy, regardless of Beth's age. In terms of renewability, what type of policy does Beth have?

Conditionally renewable

Any attempt by the existing insurer or its insurance producer or broker to dissuade a policyowner from replacing an existing insurance policy is called:

Conservation

A guaranteed insurability rider may be attached to what type of policy?

Disability income

One of the requirements of LTC policy is the inability of an insured to perform some number of the ADLs by themselves. Which is considered a measure of the MOST impaired person?

Eating

What is the name of the provision that states that a copy of the application must be attached to the group life insurance policy and that all statements made are representations and not warranties?

Entire contract provision

How often must the Commissioner examine the affairs of all domestic insurance companies?

Every 5 years

What kind of health insurance policy ensures renewability up to a specific age of the insured, although the insurer reserves the right to change the premium rate on a class basis?

Guaranteed renewable

Julie has just received a lump-sum payment from her individual disability income policy provider. Which of the following is the best explanation for this payment?

Her policy includes a return-of-premium provision

Thomas, an insured, submits a claim and a proof of loss for medical expenses covered by his major medical policy. According to the time of payment of claimed provision, how soon must the company pay the claim?

Immediately

Any standard health insurance policy provision that is in conflict with a state statute:

Is automatically amended to conform to the state statute

The scope of an entire contract does NOT include:

Premium computations

Coinsurance is a common provision found in a....

Major medical expense policy

What is the federal and state program designed to help provide needy persons, regardless of age, with medical coverage?

Medicaid

State LT care insurance partnership programs are a joint effort of all the following EXCEPT:

Medicare

A Medicare supplement policy that contains restricted network provisions is known as:

Medicare SELECT policy

Policies that provide for periodic payment of benefits (such as disability income) must pay these benefits at least:

Monthly

What type of health insurance policy prevents the insurer from changing the premium rate or modifying the coverage in any way?

Noncancelable

What is an optional benefit to a LT care insurance policy?

Nonforfeiture benefit

If the insurer cancels policy, unearned premium will be returned to the insured...

On a pro rata basis

Under Medicare Part A, the participant must pay his deductible

Once per benefit period

When separate deductibles are required for each illness or accident, what kind of deductible is in effect?

Per cause

Iowa's disclosure requirements apply to which of the following sales of life insurance?

Policies issued by fraternal benefit societies (NOT credit life insurance, annuities, ERISA)

The abbreviation PDP refers to which part of Medicare?

Prescription Drug Plan - Medicare Part D

An example of a state-administered disability program is:

Worker's compensation

What rider pays a monthly benefit to an insured who is totally disabled while the insured remains disabled and only as long as regular benefits are payable?

social insurance supplement (SIS)