6 - Statues and Regulations Specific to Health Insurance Flashcards

1
Q

Insurer must deliver or mail a copy of the application…

A

-within 15 days after the receipt of the request

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2
Q

Insurers must notify Group certificate holders how many days before the cancellation of a Group Health policy if the employer has failed to pay the premium?

A

-15 days before

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3
Q

“free look” period

A

-10 days

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4
Q

Punishment if a group health fiduciary willfully fails to pay the premiums on a group health plan and does not inform certificate holders?

A

-Class H felony

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5
Q

Employer sponsored Franchise health plans require how many employees for Accident and Health?

A

-5 or more employees

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6
Q

If an applicant has the Hemoglobin C Trait, what will the underwriters do on the application?

A

-ignore the condition

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7
Q

under state continuation, the premium is paid by…

A

-premiums will be paid fully by the certificate holder

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8
Q

Whenever replacement of existing Group insurance occurs, liability for coverage must begin….

A

-within 15 days by the new insurer

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9
Q

Health policies, applications, or riders cannot be used until the expiration of a ________ period after they have been filed unless the Commissioner gives a written approval

A

-90 days

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10
Q

An insured covered by an employer group health policy resigns from the company. The former employee has two (2) options to continue his group health insurance program. The individual elects to continue his benefits under the state continuation program. How will the premium be paid for the coverage?

A

-The former employee will pay the full group rate for the coverage with a 2% administrative charge.

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11
Q

Any company or Producer who issues or delivers a health policy in willful violation of insurance regulations is guilty of a….

A

-Class 3 Misdemeanor

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12
Q

A group health policy fiduciary must provide notice of intent to cancel the group plan with how much notice to certificate holders?

A

-45 days notice

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13
Q

Members of an association may obtain a Blanket Accident and Health insurance policy if the association has at least ______ members.

A

-25

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14
Q

When is State Continuation not available?

A
  • if have access to another group health plan

- if there is no active group plan with the employer

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15
Q

Fraternal Benefit Society

A
  • Non-profit
  • Lodge System
  • It’s members only
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16
Q

Limiting Age on health policies for mentally retarded individuals current on a parent’s policy?

A

-no limiting age

17
Q

If an employer has failed to pay premiums on a group health policy, the insurer must notify each certificate holder (employee) of intent to cancel the group health policy at least _______ before cancellation.

A

-15 days

18
Q

The Life and Health Insurance Guaranty Association will provide payment in the case of the insolvency of a member company up to ___________.

A

-$300,000 total lifetime aggregate on any single person

19
Q

North Carolina law requires parent’s health insurance coverage to begin on newborn children:

A

-from the moment of birth

20
Q

Under North Carolina State Continuation, the insured MUST make premium payments by:

A

-the beginning of each month

21
Q

In an employer sponsored Franchise Group health plan, the employer is required to pay what percent of the premiums for the group?

A

-none

22
Q

an insurance fiduciary cannot be…

A

-insured

23
Q

Continuation of group health insurance benefits requires the employee to have been covered under the group plan for how long to be eligible?

A

-previous 3 months