missed (general)

Service

HMOs are known as what type of plans?

preferred provider plan

Ed is covered under a health plan provided by his employer. he was told that his insurance would pay the majority of the covered expenses if he would choose to see a provider in his plan's list. if Ed chose to be treated by a provider who was not on the list, his portion of the bill would be greater. Ed is covered under a/an

A

Insureds have the right to do which of the following if they have NOT received the proper claim forms within 15 days of their notice to the insurer of a covered loss under a major medical policy? A. submit the description in their own words on a plain sheet of paper B. be reimbursed any copayment or deductable on the claim C. demand full payment immediately for the claim D. speak with a claims adjuster or another representative from the insurance company

A

Regarding the consideration clause, which of the following is NOT correct? A. Consideration of the insurer and insured must be equal B. Considerations defined as the exchange of values C. The insurer's consideration consists of providing coverage D. The insured's consideration consists of proving information on the application, as well as agreeing to pay the premium

A

Which of the following NOT true regarding a nonchancellable policy? A. insurer can increase the premium above what is stated in the policy if claims experience is greater than expected B. insurer cannot cancel the policy C. the guarantee to renew coverage usually only applies until the insured reaches age 65 D. insured has the unilateral right to renew the policy for the life of the contract, and may discontinue paying premiums to cancel it

A. part A deductible

a core medicare supplement policy (plan A) will cover all of the following expenses EXCEPT A. part A deductible B. the first 3 pints of blood C. 20% of part B coinsurance amount for medicare-approved service D. part A coinsurance

Family

a husband and wife both incur expenses that are attributed to a single major medical insurance deductible. what type of deductible do they have in their policy?

the insurance company will pay the claim according to the benefits available if the correct premium had been paid

a man is an attorney when he applied for a health policy. he decides to become a professional bungee jumper. he files a claim. what should happen?

30 days

a medicare supplement policy must have a free-look period of at least

a gatekeeper HMO plan to control the costs

a subscriber has been treated for a medical condition by his primary care physician for 3 months with experimental remedies without a significant health improvement before being referred to a specialist. which of the following types of plans does the subscriber have?

A

all of the following are excluded from coverage in an individual health insurance policy EXCEPT A. Mental illness B. Experimental procedures C. Purely cosmetic surgery D Treatment received in a government hospital

B health insurance application require the signature of the following

all of the following must sign an application for health insurance EXCEPT the A. Producer B. Insurer C. The proposed insured D. Applicant

A

all of the following would be classified as "limited insurance coverage" EXCEPT A. supplement social security coverage B. traveling insurance policy C. dread disease policy D. accidental death and dismemberment policy

he left the policy with the insured without collecting the premium

an agent delivers a life policy. he explains a policy changes was made and asks the applicant to sign a statement acknowledge the changes were explained. the agent says the premium has not been paid and must be paid before the policy goes into effect. he collects a statement of good health, relinquishes the policy, and leaves. what did he do wrong?

legal

an agreement that is enforceable by law is known as what kind of contract?

conditional receipt

an applicant gives her agent a completed application and the initial premium. what can the agent issue her that acknowledges the initial premium payment?

to cover the employer's administration costs

an employee is covered under COBRA. his previous premium payment was $100 per month. his employer now collects $102 each month. why does the employer collect an extra $2?

replace a percentage of his lost income

an insured had a heart attack while jogging, but is expected to return to work in approximately 6 weeks. the insured's disability income policy will

full benefits, as if the policy were still completely in effect

an insured's cancelable health insurance policy is being cancelled. one day before the policy is scheduled to end, he is involved in a major accident and is hospitalized for a week. Which of the following best describes the that he would receive?

Paying a claim

consideration on the part of an insurer?

capiatl sums are percentages of principal sums

describe the relationship between a capital sum and a principal sum

supplementary major medical

if a basic medical insurance plan's benefits are exhausted, what type of plan will then begin covering those losses?

taxation of benefit

if the insurance premiums were not tax deductible, what other taxation will this affect?

A

in order for an alumni association to be eligible to purchase group health insurance for its members, all of these statements must be true EXCEPT when the association A. has been active for five years minimum B. has a constitution, by-law, and must hold at least annual meetings C. is organized for reasons other than buying insurance D. has at least 100 members

completed insurance policy to the policyowner

policy delivery refers to the delivery of the

tax deductible to employer

premiums paid by an employer for group health insurance are

the periods of time an insured must wait after the onset of an illness or injury before benefit begin

the elimination period in a disability income policy is better known as

future increase option

the guaranteed purchase option is also referred to as the

B

under a group health insurance plan, benefits may be extended to all of the following dependent EXCEPT A. a dependent parent living with the primary certificate holder B. a 27-year-old married daughter who is attending college and lives with her parents C. the spouse of the certificate holder D. a 30-year-old mentally handicapped son of the primary certificate holder

90 days

under the mandatory uniform provision proof of loss, the claimant must submit proof of loss within what time period after the loss?

the insured's primary beneficiary

under the payment of claims provision, to whom will the insured's benefits be paid if the insured's deceased?

C

which of the following is NOT mandatory under the Uniform Provisions Law as applied to accident and health policies? A. physical examination and autopsy B. entire contract C. change of occupation D. time limited on certain defences

D

which of the following statements is NOT true regarding health insurance policy provisions? A. all individual policies contain Universal Mandatory Provisions B. Insurer may only offer optional provisions that are allowed by the state where the policy is delivered C. Insurers may add provisions that are not in conflict with uniform standards D. all additional provisions written by insurers are cataloged by their respective states