Health Questions
Written notice of claim mist be given to the insurer within ...
20 days
The insured's health policy only pays for medical costs related to accidents. What type of policy is this?
Accident only
A life insurance policy was issued with a face amount of $100,00 and the cash value is $50,000. If the insurer becomes insolvent, what will the Guaranty Association pay to the policy claimant?
$100,000
The Future Increase Option Rider (FIO) allows insureds to increase their benefit level to certain amounts at specified times without proof of insurability. What occasions allows for this benefit increase?
-25, 28, 31, 34, 37, and 40 -marriage -birth of child
Goals of risk retention:
-Fund losses that cannot be insured -Reduce expenses and improve cash flow -Increase control of claim reserving and claims settlements
Medicare Supplement Insurance characteristics are:
-Medicare deductibles and copayments -supplement Medicare benefits -Issued by private insurers
The state provides temporary license for:
-death of producer -producer's disability -producer's time in military
Key person disability income characteristics:
-employee is insured -employer received the benefits if the key person is disabled -employer pays premiums
What is provided by an HMO?
-financing -patient care
Major Medical has
-high maximum limits -copayments -blanket coverage -deductible
Catastrophic plans usually have what premiums and what deductibles?
-lower premiums -high deductibles
Utilization management consists of an evaluation of the appropriateness, necessity, and quality of health care and may include:
-prospective review -concurrent review
HIPAA applies benefits to:
-small employers -self employed -pregnant women -mentally ill -groups of 2 or more
Who must sign an application for health insurance?
-the proposed insured -applicant -producer
Within how many days must an insurance producer reply to an inquiry of the commissioner?
15 days
Health carrier must provide same coverage for newborns for at least
3 weeks
What is the maximum amount of time after submittal can the insured initiate legal action?
3 years
To attain fully insured status under Social Security, and individual must have earned how many credits?
40 credits = 10 years
To attain Social security, worker must have earned how many credits during the last 13 quarters?
6 credits
How long is open enrollment for Medicare Supplement policies?
6 months
Which federal act defines rules pertaining to protected health information?
HIPAA
A change in a health insurance policy will only be valid if approved by:
CEO of the insurer
Any person who makes false claims or conceals material info will be deemed guilty of:
Class C felony
If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 31 days?
Conversion -allows terminated employees to convert their group coverage to individual insurance without evidence of insurability.
What is a specific dollar amount or a percentage of the cost of care that must be paid by an HMO member?
Copayment
During policy solicitation, an insurer exaggerates the financial condition of one its competitors, this is an example of
Defamation
Who is the policy holder in group health insurance?
Employer
General powers and duties of the Insurance do not include
Enacting statues to regulate the insurance industry
How long is a newborn covered without notification to the insurer
From the moment of birth, the insurer must be notified within 60 days
Who would be the insured in business disability insurance?
Key employees
If an insured has a 30 day elimination period, but was disabled for 15 days, how many days will his insurance cover?
None, bc the elimination period is not satisfied
What is NOT an example of risk retention?
Premiums
Federal law makes it illegal for any individual convicted of a crime involving dishonestly or breach of trust to work in the insurance industry without
Receiving written consent from an insurance regulatory authority
A husband and wife are insured under group health plans at their own places of work. Both have each other listed at dependents. If one of them incurs a hospital expense, how will those expenses be paid?
The benefits will be coordinated -when covered under two or more health plans
What is the timeframe for filing relevant Suspicious Activity Reports?
Within 30 days of intial discovery
Disability benefits are based on
applicants earned income
A limited health insurance policy will pay lump sum to an insured diagnosed with a heart attack, stroke, or renal failure is known as
critical illness insurance
Under Major Medical insurance policy, what is required after a claim is submitted?
deductible and coinsurance
What would qualify as a Suspicious Transaction and SAR
deposits, withdrawals, transfers involving $5,000 or more.
The parties in a contract of group health plans are
employer and insurer
Circulating deceptive sales material to the public is considered:
false advertising
When can a producer be allowed to obtain insurance through an unauthorized insurer?
if there are no authorized insurers for a specific type of coverage in this state
The agent's report is ...
not included in the "entire contract
In order to transact long term care insurance, a producer is required to do:
one time 8 hour training course
When may an HIC related test results be provided to the MIB
only if the individual is NOT identified -insurance companies must maintain strict confidentiality regarding HIV related test results
When an employee is upon reaching 65 and eligible for medicare, what is their option?
remain on the group health plan and defer medicare until retirement
Health insurance that pays benefits according to a list which indicates the amount that is payable under each type of treatment provides benefits on a
schedule basis
Dread disease insurance will pay the insured only a
specified amount per day if hospitalized
If insureds submit a claim and have not received claim forms within 15 days, they have a right to:
submit the description in their own words
Group medical and dental expenses benefits are received:
tax free
Coverage for a policy becomes effective when:
the application is approved
What describes the unique characteristic of investigative consumer reports?
the customer's associates, friends, and neighbors provide the reports data
Which entity has the option of including optional provisions in a health insurance policy?
the insurer
if one medicare supplement policy replaces another medicare supplement policy, the replacing issuer must waive any time periods applicable to pre existing conditions if
the pre existing condition period was satisfied under the original policy
Most plans provide for a reasonable coverage extension beyond plan termination for:
totally disabled employees
Claimants must submit proof of loss within what time period
within 90 days
If a producer replaces a medicare supplement, the insurer must issue coverage:
without evidence of insurability
