Health insurance test attalah's guide
An insured pays monthly premium of 100$what would be the duration under something
10 days
Irrevocable beneficiary
A beneficiary who has a vested interest in policy therefore the policyowner may not excerise certain rights without beneficiary consent
Debtor
A borrower of funds
In order for a foreign insurer to do business in this state, it must obtain
A certificate of authority
Agent/producer
A legal representation of an insurance company.
Creditor
A lender of funds
Lump sum
A pay out method that pays the beneficiary the entire benefit in one payment
Guaranteed renewable
A policy that is written on a noncancellable basis with the right to renew gaurenteed
Which of the following losses will be covered by a group medical expense policy
A pre existing condition
Tax deductible
A qualified expense that may reduce the amount of income
Claim
A request filled with an insurance company asking for payment according to the terms of an insurance policy
What are two causes of loss
Accidental bodily indury and sickness
Riders
Added to the basic insurance policy to add modify or delete policy provisions
What documentation grants express authority to an agent
Agent contract with the principal
What are the elements of a legal contract
Agreement, consideration,competent parties, legal purpose
A producer sold a policy right after his license was suspended how much commission will the producer receive
All of it
Deductible
Amount you pay to doctor or hospital before insurance benefits start
Solicitation
An attempt to persuade a person to buy an insurance policy it can be done orally or in writing
Which of the following hospice expenses would NOT be covered in a cost-containment settings
Antibiotics
In a replacement situation all of the following must be considered except
Assets
The act of voluntarily giving up insurance by the insured
Cancellation
Peril
Cause of loss (what caused the accident)
In order for an insurer to legally transact insurance it must maintain which of the followings
Certificate of authority
What is the major difference between stock company and mutual company
Company
Hazards
Conditions that increase the probability of loss
The purpose of care health insurance plan is to
Control health insurance claims expenses
The gate keeper of an HMO helps
Control specialist costs
Which of the follow is considered a qualifying event under COBRA
Divorce
What is the goal of the hmo
Early detection through regular checkups
The requirement that an agent not co mingle insurance monies with their own funds is known as
Fiduciary responsibility
How are hmo territories typically divided
Geographic areas
Fraud is
Grounds for voiding an insurance contract
In insurance transactions fiduciary responsibility means
Handling insurer funds in a trust capacity
Comprehensive coverage
Health insurance that provides coverage for most type of medical expenses
Which of the following LTC is NOT provided by institutional setting
Home health care
What is necessary in order to be eligible for long term care
Insured must be unable to preform ADLs
Which of the following entities has the authority to make changes to an insurance policy
Insurers executive officer
IRS
International Revenue service: responsible for collecting taxes and enforcement of IRC
Which of the following is true regarding a term health policy
It is nonrenewable
In a group health policy a probationary period is intended for people who?
Joined the group after effective date
Which of the following is the basis for a claim against an insurance policy
Loss
All of the following are characteristics of a major medical expense policy except
Low-maximum limits
All of the following are true regarding the medical information bureau(MIB) except
MIB reports are based upon information supplied by doctors and hospitals
Reciprocity/reciprocal
Mutual interchange of rights and privileges
Nais
National association of insurance commissioners formed to resolve insurance regulatory issues
When is the annual open enrollment for state insurance exchanges
November 1 through January 31st
Which renewability provision allows an insurer to terminate policy and increase premiums for any class of insured
Optionally renewable
Applicants
Person applying for insurance
Which of the following provisions is mandatory for health insurance policies
Physical examination and autopsy
What are the 3 types of hazards
Physics (birth defect)moral(lie) and morale (state of mind)
Which of the following is the most common time errors and omissions to occur on the part of the insurer
Policy delivery
Expense-incurred basis
Policy pays health policy benefits as a reimbursement of actual expenses
Laspe
Policy termination due to nonpayment of premium
If your health care plan has characteristics of an HMO and ppo what type of plan do you have
Pos
Which of the following do the standard and preferred risk category share
Premiums are not evaluated
All of the following are considered to be supplemental benefits under an HMO except
Preventive care
What is the term for the entity that an agent represent regarding contractual agreements with third parties
Principal
Pertaining to insurance what is the definition of fiduciary responsibility
Promptly forwarding premiums to the insurance company
The Gramm-Leach Billey act was passed to
Protect private customer information filed with a financial institution
Which of the following insurance options would be considered a risk sharing arrangement
Reciprocal
In event of a loss business overhead insurance will pay for
Rent
Reinstatement
Returning a lapsed policy to activate status
Underwriting
Risk selection and classification process
Which is not covered under part b of Medicare pilicy
Routine dental care
Face amount
The amount of benefits stated in the insurance policy
Defined benefit pln
The employer specifies an amount of benefits promised to the employees
Who has the authority to make changes to an entire contract?
The executive officer of company
Which of the following entities established the do not call regristry?
The federal trade commission
Hippa
The health insurance portability and Accountability Actis federal law that protects health information
Who chooses primary care position in HMO
The individual member
Coinsurance
The insurance company and the insured shares the expenses 60/40
The insuring clause of a disability policy usually states all of the following except
The method of premium payments
Premium
The money paid to the insurance company for the insurance policy
Grace Period
The period of time after the premium due date in which premiums may still be paid before the policy lapses for nonpayment of premium
Policyowner
The person entitled to excerise privileges in policy
Insurable interest
The policyowner facing the possibility of losing something of valued in event of loss
Elimination period
The time immediately following the start of disability when benefits are not payable
Risk
The uncertainty of loss there is two types of risks pure risk and speculative risk
Which of the following answers do NOT describe the goal of a PPO
To provide medical service only from physician in network
Indemnity
To return back to original state
Cafeteria plan
Type of employment benefit plan that allows insureds the to choose between different types of benefit
Rein bursement
When insurance pay doctors directly
When is the insurability conditional receipt given
When the premium is paid at the time of application
How soon can you submit a notice of claim
Within 20 days of loss or ASAP
Broker
an insurance producer not appointed by an insurer and is deemed to represent the client