ohio life insurance

Which of the following provisions specifies to whom claims are to be paid?

payment of claims

Which of the following statements is true regarding common exclusions from health coverage?

they never cover anything cosmetic

____________ is a misrepresentation, or incomplete or fraudulent comparison of insurance policies that persuades an insured/owner, to his or her detriment, to cancel, lapse, or switch policies from one to another.

twisting

Medicare SELECT

type of Medigap policy available in some states where beneficiaries choose from a standardized Medigap plan. list of providers and lower premium

How are state insurance guaranty associations funded

by their members/ authorized insurers

An insurance producer who by contract is bound to write insurance for only one company is classified as a/an

captive agent

What type of consideration does the proposed insured offer to an insurance company?

$ plus statements in the app

The most the Insurance Guaranty Association will pay for net cash surrender values is

100,000

Social Security disability is defined as the inability to engage in any substantially gainful activity by reason of a physical or mental impairment that will last for at least

12 months

What is the minimum length of benefit period that a long-term care policy must provide?

12 months

To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?

18 months

An insured is covered by a partially contributory group disability income plan that pays benefits of $4,000 a month. If the insured pays 25% of the monthly premium, how much of the monthly benefit would be taxable?

3,000

Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months?

30 months

Elimination period for social security disability

5 months

medical info cannot be required of plan participants in groups of ______ or more

50

How long is an open enrollment period for Medicare supplement policies?

6 months

How many days after being licensed to place business transactions in Ohio must an insurer have an antifraud program in place?

90 days

Capital Amount

A percentage of the principal amount of a policy paid to the insured if he/she suffered the loss of an appendage.

Payment of Claims

A provision that specifies to whom claims payments are to be made.

Which of the following best describes the concept that the insured pays a small amount of premium for a large amount of risk on the part of the insurance company?

Aleatory

inducement

An action aimed at persuading

Surplus Lines Insurance

An insurance co that is authorized to sell unauthorized insurance. You can only go to a surplus lines co if you cant get it from a regular insurance company

Rebating

Any inducement offered in the sale of insurance products that is not specified in the policy.

Guarantee of Insurability

Benefit levels increase without the insured needing to prove insurability. The benefit increase is typically limited to 5% per year.

COBRA

Consolidated Omnibus Budget Reconciliation Act; law to provide terminated employees or those who lose insurance coverage because of reduced work to be able to buy group insurance for themselves and their families for a limited amount of time.

Which of the following terms describes making false statements about the financial condition of any insurer that are intended to injure any person engaged in the business of insurance?

Defamation

An insurer who suspects a person of committing insurance fraud must notify

Department of insurance

aleatory

Exchange of unequal amounts

ERISA (Employee Retirement Income Security Act)

Federal law that increased the responsibility of pension plan trustees to protect retirees, established certain rights related to vesting and portability, and created the Pension Benefit Guarantee Corporation

Free Look Provision

Generally 10 days after policy delivery to cancel policy w/ full refund, except 30 days for seniors or for replacement policies.

Why do group health providers usually require a certain amount of participation in the plan by eligible employees?

Guard against adverse selection

what are the two types of flexible savings accounts

HCA and DCA

Which of the following statements concerning Medicare Part B is correct?

It pays for physician services, diagnostic tests, and physical therapy.

Which of the following combines a high-deductible insurance plan with medical savings accounts?

Medicare MSA

part C

Medicare advantage, expanded benefits for a fee through private plas like HMOs,PPOs

When is the annual open enrollment for state insurance exchanges?

November 1 through January 31

The Medical Information Bureau (MIB) helps insurers compare medical information they have collected on a potential insured with the information received from

Other insurers

Under a disability income policy, the insurer does not pay a monthly benefit that is equal to the insured's previous income. The reason for paying a benefit amount that is less than the insured's income is to

Prevent overutilization and malingering.

Insurance that is the result of agreements of indemnity between subscribers is known as

Reciprocal

In the event of a loss, business overhead insurance will pay for

Rent.

HIC

Services instead of reimbursment, preventive care, outpatient basis, can go out of service

Which of the following is a private health insurance plan?

Supplement / medigap

A nonadmitted insurer who provides unique insurance coverage that is not available from an admitted insurer is called a/an

Surplus lines insurer.

An agent misrepresents the details of an insured's new insurance contract that will be replacing the current contract. Which of the following will most likely happen?

Suspension of license

Principal Sum

The amount under an AD&D policy that is payable as a death benefit if death is due to an accident.

Which statement accurately describes group disability income insurance?

The extent of benefits is determined by the insured's income.

How does a member of an HIC see a specialist?

The primary care physician refers the member.

Adverse Selection

The tendency of risks with higher probability of loss to purchase and maintain insurance more often than the risks who present lower probability.

indemnity

a payment for damage or loss

PPO (Preferred Provider Organization)

a type of health insurance plan in which a company forms a contract with certain hospitals and doctors to provide health care at a reduced rate

Continuation Provision

aka renewal provision , which of the following provisions must be included on the first page of a medicare supplement policy, which states the insurers right to change premium amounts?

Which of the following is defined as an absolutely true statement upon which the validity of the insurance policy depends?

warranty

An association could buy group insurance for its members if it meets all of the following requirements EXCEPT

as at least 50 members.

in order to qualify for Medicaid, the applicant must

be below poverty level

All of the following characteristics are required in order to establish a group health plan for an association EXCEPT

be contributory

Which of the following mandatory health provisions states the specified number of days given to an insured to return the completed claim forms to the insurance company?

claims forms

Which provision must be included on the first page of a medicare supplement policy, which states the insurers rights to change premium limits?

continuation provision

If an employee terminates her employment, ehat would allow her to continue health coverage under an individual policy, if requested in 31 days

conversion

Who has the authority to make changes to an insurance contract?

executive officer

Which of the following expenses is NOT covered by a health insurance policy?

funeral

The legal process that gives the insurer, after payment of a loss, the right to seek recovery from a third party that was responsible for the loss is known as

subrogation

Adhesion

take it or leave it

Solicitation

the act of requesting or strongly urging someone to do something

coercion

the practice of persuading someone to do something by using force or threats

Underwriting

the process of selecting, classifying, and pricing applicants for insurance

Coinsurance

the sharing of expenses by the policyholder and the insurance company

Grace Period

the time between the billing date and the payment due date when no interest is charged length depending on mode of payment month 10 day

The Guaranty Association is formed to protect which of the following?

policyholders

Any inducement offered to the insured in the sale of an insurance policy that is not specified in the policy is an unlawful practice known as

rebating

Which of the following is NOT provided by an HIC?

reimbursement

Non Scheduled Plans (Comprehensive plans)

-Designed to cover a percentage of the 'usual and customary' charges. -Most common design -Generally includes a calendar year deductible -Reimburses at a different level for procedures in different classes -Preventative and diagnostic services generally covered at full or high cost

Temp License

180 days

An insured was involved in an accident and could not perform her current job for 3 years. If the insured could reasonably perform another job utilizing similar skills after 1 month, for how long would she be receiving benefits under an "own occupation" disability plan?

2 years

An insured who has an Accidental Death and Dismemberment policy loses her left arm in an accident. What type of benefit will she most likely receive from this policy?

The capital amount in a lump sum

According to the Fair Credit Reporting Act, consumer reports are prohibited from reporting negative information about a customer after how many years?

7

Which of the following factors is considered more important to the underwriting decision for disability coverage than for most of the other forms of insurance?

occupation

how many days does medicare pay for skilled nursing

20 days

Part B

is funded by monthly premiums , state, fed and known as "medical insurance"

Which type of care is NOT covered by Medicare?

long term care

what is issued to the employer in a group plan

master policy

In health underwriting, it would be inappropriate to decline a risk using any of the following factors EXCEPT

mental

An insurance company that is owned by policyholders and issues participating policies is known as which type of company?

mutual

A 55-year-old employee has worked part-time for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employee's eligibility?

number of hours worked per week

All of the following are true regarding Health Reimbursement Accounts EXCEPT

they are considered benefit plans

All of the following features of a medical plan are expressed as a set dollar amount EXCEPT

Coinsurance

All of the following are regulated areas of the insurance industry EXCEPT

Commissions.

consideration

The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of premium; the consideration on the part of the insurer is the promise to pay in the event of loss.

Waiting Period

period of time that must pass A period of time when you are not covered by insurance for a particular problem

Health Insurance Corporations offer services to individuals based on

where they live