MEDICARE SUPPLEMENT POLICIES (MEDIGAP)
What percentage of the aggregate amount of premiums earned must be returned to policyholders as benefits.
80%
Certain kinds of previous health insurance coverage that can be used to shorten or eliminate a pre-existing condition waiting period is called:
Creditable Coverage
The outline of coverage for Medicare supplement policies is
A summary of the policy applied for or issued.
To be eligible for a Medicare Supplement policy a person must be...
Age 65 and have Medicare Part A and Part B
Who must sign the Notice Regarding Replacement?
Both the applicant and agent
A producer has replaced one Medigap policy with another. Both plans have the same benefits. The producer's first year commission is 20%. Her renewal commission is 10%. Both plans are with the same insurer. The producer's first year commission on the new policy is
10%
A 65-year-old man is being treated for heart disease. His Medicare Part A and Part B started November 1. Before this date he had no health insurance coverage. On March 1 he buys a Medigap policy. His Medigap insurance company refuses to cover his heart disease condition. How long is the pre-existing condition waiting period for his heart disease in the Medigap policy?
2 months; the insured will have to wait 2 months for the Medigap policy to cover his heart disease because he had creditable coverage for four months before his Medigap policy became effective.
An agent sells Medigap insurance in North Carolina. Her renewal commission is 10%. The most that the agent can receive in the first year commission is
20%
A pre-existing illness is defined as
A condition for which medical advice was given within 6 months before the effective date of the policy.
What should be included in a continuation provision?
A continuation provision must include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the policy holders age. Provisions must be captioned and appear on the first page of the policy.
Every insurer providing Medigap policies or certificates in North Carolina is required to file the policy's rates, rating schedules, and supporting documentation. This information must be filed...
Annually
An outline of coverage for a Medicare supplement policy must be delivered to the applicant
At the time of policy application
What is the rule for first year commissions on replacement sales of Medigap policies?
First-year commissions and other first-year compensation received on the sale of Medigap policies may not exceed 200% of the second-year commission or other second-year compensation.
Which of the following describes the renewabability of a Medicare supplement policy
Guaranteed Renewable
Medigap Policies do NOT cover:
Long term care
An insured who has Medigap Policy Plan B is covered for
Medicare Part A deductibel and basic benefits.
What is excluded under Medigap?
Medigap policies do not cover long term care, vision or dental care, hearing aids, private duty nursing, "unlimited" outpatient prescription drugs, skilled care in nursing home beyond the first 100 days, or custodial nursing home care at any time.
A patient covered by Medigap Plan A enters the hospital for a 61-day stay. Which of the following benefits is covered by his Medigap policy? a: Part B deductible b: Part A deductible c: Part A copayment d: all expenses
Part A copayment; Medigap Plan A consists of the basic or core benefits. The only deductible covered is the first 3 pints of blood. Plan A will pay the copayment for days 61-90 and 91-150.
An enrollee has a Medigap policy that is noncancellable. This means that
The company cannot change anything about the contract including the premium.
Which of the following best defines the pre-existing condition waiting period in Medigap policies?
The insurer can refuse to cover a health problem that was diagnosed or treated during the 6 months before the policy issue date, for a specified amount of time.
Which of the following best defines the pre-existing condition waiting period in Medigap policies?
The insurer can refuse to cover a health problem that was diagnosed or treated during the 6 months before the policy issue date.
According to NC law, an informational brochure must be delivered to the prospective insured concurrently with delivery of the outline of coverage. The informational brochure for direct response insurance policies may be delivered:
Upon request of the prospective insured but no later than at the time of delivery.
How long is an open enrollment period for Medicare supplemental policies?
6 months; 6-month period that guarantees the applicants the right to buy Medigap once they first sign up for Medicare Part B.
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following? a: Parts A and B of Medicare b: All four parts of Medicare c: Any private insurance policy d: Only Part A of Medicare
A: Parts A and B of Medicare
Medigap Plan C includes: a: Foreign travel emergency b: Medicare Part B excess charge c: At-home recovery d: preventative care
A: foreign travel emergency
A man has a Medigap policy. The premium increases each year because he is a year older. In addition, the premium is also adjusted for inflation. The method used to calculate his premium is known as
Attained Age
Medigap Plans A-N must include
Basic or core benefits are included in all plans
Medigap Plan A include: a: the coinsurance for care in a skilled nursing facility b: the hospital insurance part a deductible c: core benefits only d: the medicare part b deductible
C; core benefits only
All of the following are true regarding Medicare supplement insurance insurance coverage EXCEPT: a: losses from sickness are covered on the same basis as losses from accidents b: losses incurred more than 6 months from the effective date of coverage cannot be denied on the basis of preexisting condition c: coverage is different from the coverage provided by Medicare d: limitations on coverage are more restrictive than those of Medicare
D; Medicare supplement policies cannot contain limitations or exclusions on coverage that are more restrictive than those of Medicare.
An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own?
Medicare SELECT
Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations?
Medicare SELECT
What is the difference between Medicare SELECT and other Medicare policies?
Medicare SELECT policy is a policy that contains restricted network provisions. Because of this requirement, the premium for a Medicare SELECT policy is usually lower than for one of the other plans.
All advertising for the sale of Medigap insurance in this state has to have the approval of who?
The Commissioner of Insurance
Explain how the premium is affected in policies issued as attained to age.
The premium increases based on the insured's current age. As the insured becomes older, the premium goes up.
What are the disclosure requirements for the Medicare supplement policies issued at attained age?
The rates structure must be fully disclosed at the time of application.
