Missouri Statutes, Rules and Regulations Pertinent to Health Only: Practice Questions

If an insurer imposes a maximum lifetime benefit for breast cancer treatment using stem cell transplants, this limit must be at least a-$25,000 b-$50,000 c-$75,000 d-$100,000

$100,000

All individual health policy's issued in the state of Missouri which provide coverage for hospital treatment must also provide coverage for treatment of alcoholism, which may be limited to how many days? a-There is no limit for the treatment of chemical dependency b-30 c-60 d-180

30

How long is the free look period on a Medicare supplement policy? a-30 days b-10 days c-15 days d-20 days

30 days

If a health carrier providing prescription drug coverage makes any deletions on its health benefit plans prescription drug formulary, within how many days of the deletion must it notify the affected enrollees? a-7 days b-15 days c-30 days d-45 days

30 days

When a health carrier uses retrospective review procedures, within how many days of receipt of information must the carrier make the determination? a-30 working days b-24 hours c-48 hours d-15 calendar days

30 working days

Within what timeframe after the effective date of coverage of an individual long term care policy may an insurer exclude coverage of a loss related to a pre existing condition? a-3 Months b-once the policy takes effect, all losses will be covered c-6 months d-12 months

6 months

Every insurer marketing long-term care insurance must establish marketing procedures to ensure all of the following except a-LTC policy's are marketed affectively two perspective insureds b-comparisons of policy's are fair inaccurate c-excessive insurance will not be sold d-every reasonable efforts is made to identify an applicant's other insurance

LTC policy's are marketed affectively two perspective insureds

A 65 year old enrolls for benefits under Medicare Part B and submits an application for a Medicare supplement policy two months later. For which of the following reasons may the insurer deny the application? a-Marital misrepresentation b-health status c-claims experience d-medical condition

Marital misrepresentation

A long term care insurance shoppers guide must be provided in the format development by which of the following? a-Medical information Bureau b-NAIC c-office of insurance regulation d-director

NAIC

Which of the following documents provides a disclosure of a Medicare supplement policy? a-Outline of coverage b-buyers guide c-statement of renewal provisions d-policy summary

Outline of coverage

A long-term care shoppers guide must be presented at what point? a-Prior to the time of application b-at the time of application c-between the completion of the application and the delivery of the policy d-at the time of policy delivery

Prior to the time of application

All individual and group health insurance policy's issued in this state that cover dependents of the insured must provide coverage for newborn children of the insured starting a-at the moment the insured pays the first premium for the child b-at the moment of birth c-31 days after birth d- 90 days after birth

at the moment of birth

An individual and group health insurance policies issued in this state that covered dependents of the insured must provide coverage for newborn children of the insured starting a-31 days after birth b-90 days after birth c-at the moment the insured pays the first premium for the child d-at the moment of birth

at the moment of birth

Which of the following is true regarding coverage for diabetes in Group health insurance policy's in Missouri? a-Coverage is optional with a higher copayment b-coverage is available in limited benefit health plans c-coverage must be provided without deductibles d-coverage is required for type one and two diabetes

coverage is required for type one and two diabetes

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is also contained in the contract is the a-time limit on certain defenses clause b-incontestability clause c-legal action against us clause d-entire contract clause

entire contract clause

An insured pays a monthly premium of $100 for a health insurance policy. What would be the duration of the grace period under the policy? a-7 days b-10 days c-31 days d-60 days

10 days

What is the maximum percent of customary charges for immunizations that a health care provider may charge? a-25% b-50% c-100% d-150%

100%

Within what period of time are unintentional misrepresentations grounds for contest ability of a policy? a-Unintentional misrepresentations are contestable at anytime b-1 year c-2 years d-there is no specific time period; unintentional misrepresentations are never contestable

2 years

What is the maximum first year Commission that a producer may receive for the sale of a Medicare supplement policy? a-50% of the aggregate commissions for the year b-100% of the aggregate commissions for the year c-100% of the commission paid for the servicing of the policy in the second year d-200% of the Commission paid for the servicing of the policy in the second year

200% of the Commission paid for the servicing of the policy in the second year

A child with phenylketonuria (PKU) will have its physician-recommended foods covered by a health insurance policy, provided the child is under what maximum age? a-1 months old b-3 months old c-3 years old d-6 years old

6 years old

Colorectal screenings performed under individual in Group health policies are required to be in compliance with the standards set by which of the following organizations? a-American fellowship of physicians b-American Cancer Society c-colorectal center of America d-American Association of doctors

American Cancer Society

Which types of insurance companies marketing long term care insurance coverage must establish procedures to ensure that any comparison of policy's by its agents will be fair and accurate? a-Every company is required to establish marketing procedures b-any company that uses any form of media to market policies that yield no less than 20% of its business c-multiple and stock companies d-no companies are required to establish marketing procedures

Every company is required to establish marketing procedures

Which of the following is true regarding maturity benefits in health policy's issued in Missouri? a-They are required in all individual and group policy's b-coverage for inpatient care after a C-section is not included c-maternity benefits may be subject to higher deductibles and copayments d-they may only be available in Group policy's

They are required in all individual and group policy's

If a policy Holder declines the nonforfeiture benefit, what must the insurer provide to the client upon the lapse of the policy? a-Pro rata premiums b-a contingent benefit c-an aleatory benefit d-a full refund of premiums

a contingent benefit

Medicare supplement policies have a notice prominently printed on the first page stating the application is entitlement two a 30 day free look, which allows the applicant to return the policy for which of the following reasons? a-Renewal provisions b-any reason c-unsatisfactory premium rates d-pre existing condition limitations

any reason

All health insurance policy's issued in this state must provide coverage for maternity services. How many hours of inpatient care must be provided to a mother after a delivery by caesarian section? a-At least 36 b-at least 48 c-at least 96 d-at least 24

at least 96

A group health policy providing coverage on an expense-in curd basis will also offer coverage for the necessary care and treatment of what? a-Stroke and aneurysm only b-loss or impairment of speech or hearing c-necessary plastic surgery d-stroke, heart attack, aneurysm

loss or impairment of speech or hearing

Which renewal provisions must be included in a long term care policy issued to an individual? a-Renewable and convertible b-cancellable and conditionally renewable c-renewable at the option of the insurer d-noncancellable and guaranteed renewable

noncancellable and guaranteed renewable

Fred and Jody are covered under a group health insurance plan at his place of employment. When Jody gave birth to their first child, what must he do in order to have coverage for their child? a-Notify the insurer on the anniversary date of the plan b-notify the employer within 10 days c-notify the insurer immediately and provide proof of insurability d-notify the insurer within 31 days in order for coverage to continue without any evidence of insurability

notify the insurer within 31 days in order for coverage to continue without any evidence of insurability

What must a health carrier do within 72 hours of receiving a request for an expedited review? a-Provide written confirmation of the carrier's decision b-acknowledge receipt of the request c-notify the requesting enrollee of the carriers established written procedures for an expedited review d-notify the requesting enrollee of the carrier's determination

notify the requesting enrollee of the carrier's determination

All of the following are required provisions in Group health policy's in this state EXCEPT a-misstatement of age b-proof of loss c-pre existing conditions exclusions d-certificate of insurance

pre existing conditions exclusions

Which of the following does NOT have to be disclosed in a long term care (LTC) policy? a-any limitations or conditions of eligibility for LTC benefits b-any writers or endorsements c-the aggregate amount of premiums due d-the meaning of the terms "responsible" and "customary"

the aggregate amount of premiums due

In which of the following situations would an individual be permitted to exercise conversation privileges in a group health insurance policy? a-The individual was covered by the group policy for two months b-the individuals group policy was replaced with another policy c-the individual's employment was terminated d-the individual failed to make premium payments

the individual's employment was terminated

In which of the following situations would an individual be permitted to exercise conversion privileges in a group long term care policy? a-The individual was covered by the group policy for two months b-the individuals group policy was replaced with another policy c-the individual's employment was terminated d-the individual failed to make premium payments

the individual's employment was terminated

Who maintains responsibility for claims made in an advertisement on behalf of an insurance company? a-The writer b-the insurer c-the producer d-the Department of Insurance

the insurer

When a group health policy is being replaced with another group health policy, what will happen with the ongoing claims? a-They will be limited to the amount of insurance in the new policy b-they will not be covered under the new plan c-they will not be covered if there is a pre existing condition d-they will be covered regardless of pre existing conditions

they will be covered regardless of pre existing conditions

In individual health insurance coverage, the insurer must cover a newborn from the moment of birth, and if additional premium payment is required, how many days should be allowed for payment? a-Within 10 calendar days b-within 15 working days c-within 31 days of birth d-within a reasonable period of time

within 31 days of birth