Accident And Health

Question 1

Medicare part A hospital coverage is how long

Answer 1

They only provide full coverage for the first 60 days

Question 2

How much does medigap cover under core benefits

Answer 2

20%

Question 3

When are most health claims paid

Answer 3

Immediately

Question 4

Hom guarantee association limit per person

Answer 4

500k

Question 5

If employer is notified of group cancellation how many days does he have to inform everyone

Answer 5

10

Question 6

Days if insurer denies claim under a LTC

Answer 6

60

Question 7

Lifetime,per cause, and annual maximums are examples of

Answer 7

Benefit limits

Question 8

What is the most strict definition of total disability

Answer 8

Any occupation

Question 9

Health care FSA contribution is limited to

Answer 9

2550-5000

Question 10

What is the negative rider that excludes body parts

Answer 10

Impairment rider

Question 11

What is the time of payment of claims provision

Answer 11

Insurers must pay claims upon written proof of loss

Question 12

If someone is insure by both workers comp and a major medical who will pay a work related injury

Answer 12

Workers comp

Question 13

Another name for a basic policy that covers hospital expenses

Answer 13

Hospital indemnity plan

Question 14

How many days notify hmo if a baby is born

Answer 14

31 days

Question 15

Farthest back and insurer can name a pre existing condition

Answer 15

6 months

Question 16

Which policy can exclude accident or sickness

Answer 16

Workers comp

Question 17

Which insurers must participate in the life and health guarantee association

Answer 17

All admitted insurers

Question 18

Annual maximum for mental health impatient services

Answer 18

10 days

Question 19

Qualify for Medicaid while still owning assets provisional contract

Answer 19

Asset disregard

Question 20

Notice of claim provision states an insurance company must receive notice of claim by

Answer 20

20 days

Question 21

In a DI policy how many days under payment of claims provision

Answer 21

30

Question 22

What is the insurance clause

Answer 22

Face of the policy and provides the members of the policy

Question 23

Entire contrac

Answer 23

Policy riders endorsements and the application

Question 24

Time limit on certain defense

Answer 24

If a company does not list a préexisting condition within 2 or 3 years from the date of issuethen they cannot void or deny a claim

Question 25

Grace period

Answer 25

Allows insured 7 days on weekly premium minimum 10 day on monthly premium and 31 days on longer modes ex qtr semi or annual

Question 26

Reinstatement

Answer 26

if a policy lapses a new application will be required a conditional receipt will be given if the application is not approved the insurance company has 45 days to tell the insured or it automatically is reinstated

Question 27

notice of claims

Answer 27

the company requires written notice of loss within 20 days

Question 28

cliam forms

Answer 28

once the insured provides notice to company of a claim the company must provide the necessary forms within 15 days

Question 29

proof of loss

Answer 29

written proof of loss must be given to the company within 90 days after the date of loss

Question 30

time payment of claims

Answer 30

claims will be paid immediately upon proof of loss the exception DI incomce and LTC periodic payments for loss of time coverage shall commence not later than 30 days after receipt of proof

Question 31

payment of claims

Answer 31

company pays claims to insured then beneficiary then estate

Question 32

physical examination and autospy

Answer 32

company at own expense examine physical remains state law has priority on autopsy

Question 33

LHSOcoverage

Answer 33

Under a Limited Health Service Organization limited services include ambulance, dental, vision, dental, pharmaceutical and podiatric care

Question 34

Regardless of contract if an insurer goes insolvent, the maximum that will be paid for disability benefits is:

Answer 34

300,000

Question 35

In the event of Group Health Insurance being discontinued or replaced, in the event of total disability, coverage must extend up to ______ in an HMO provided the insured still has benefit limits available under contract.

Answer 35

12 months

Question 36

If an employer is notified of discontinuance of a group carrier, the policyholder has ______ to notify covered enrollees.

Answer 36

10 days

Question 37

Six months into a policy year, the insured has satisfied all deductible and coinsurance requirements and no longer has to share in out of pocket expenses. This is known as

Answer 37

Stop Loss Limit

Question 38

Which of the following provisions is required to be included in an individual disability policy?

Answer 38

Change of Beneficiary

Question 39

The Free Look provision begins on

Answer 39

the policy delivery date

Question 40

A policyholder can change the mode of premium

Answer 40

Anytime

Question 41

If a business owner elects not to have coverage for workers under workers’ compensation, they must have which of the following policies?

Answer 41

: 24-hour coverage

Question 42

T has just returned back to work after a total disability but is only able to work half the day. T’s policy pays the difference between what the employer pays T and what T earned prior to disability. T has:

Answer 42

rESIDUAL DIABILITY

Question 43

If an insured has a Basic Surgical policy, the amount of benefit paid for a covered loss is specified in the:

Answer 43

Benefit SChedule

Question 44

Flexible Spending Accounts are funded:

Answer 44

By the employee through pre-tax salary reduction

Question 45

An Insurer must furnish an insured with Proof of Loss forms within a maximum of how many days after receiving notice of claim?

Answer 45

15 days

Question 46

Guaranteed Insurability Rider

Answer 46

allows the insured to buy more coverage at future dates without proving insurability, based on attained age rate.

Question 47

corridor deductible

Answer 47

If an insured has comprehensive major medical coverage, all money owed after the basic plan has paid first dollars but before the major medical policy will pay benefits is known as the corridor/integrated deductible.

Question 48

Who establishes the regulations, eligibility, and benefit coverage for Medicaid

Answer 48

federal gov

Question 49

The only way an insurer can legally discriminate against an individual during underwriting is based on:

Answer 49

actuarial principles

Question 50

A basis of prepayment in which a fixed amount of money is prepaid per individual and found in some managed care plan is known as

Answer 50

per capita payment

Question 51

Under law, a LTC policy must provide consecutive coverage for at least

Answer 51

12 months

Question 52

what can stop you from being able to enroll in medicare

Answer 52

To enroll in Medicare under age 65 a person must be either at the end stage of renal failure or collecting Social Security disability for 2 years or more. Individual disability policies do not fulfill requirements to be insured under Medicare.

Question 53

The date the coverage will legally begin is:

Answer 53

Issue Date

Question 54

V’s agent told her that by paying the premium initially upon application, the insurer will provide coverage immediatley. V has just be given a:

Answer 54

unconditional reporrt

Question 55

H has a group major medical coverage through his employer. H’s premiums paid are

Answer 55

ax deductible to the extent that H’s premiums and unreimbursed expense exceed 7.5% of adjusted gross income when itemizing deductions

Question 56

who is eligible for survival benfits under social security

Answer 56

Survivor benefits are for people who have had an insured worker die. Widows who are disabled ages 50-59, children up until age 18/19 if still in high school and dependent parents age 62 or older are eligible for social security benefits.

Question 57

what is an insurance policy purchsed in direct response

Answer 57

a purchase of insurance with no agent where there is no legal requirement for an outline of coverage or policy checklist to be given at application,

Question 58

T has worked for the same company for the last 20 years. T decides that it is time to retire and will elect to continue health benefits under an association that she is part of. If the new group has preexisting conditions, how many days from losing her old group plan does she have before there is a significant gap in coverage?

Answer 58

63 days

Question 59

which date must someone report felonies

Answer 59

30 days from when they are entered (first date)

Question 60

HMO law grace period

Answer 60

10 days

Question 61

A producer earned a fee of $500 and a commission for the sale of an insurance product. Forty-five days after coverage began the insured cancelled the policy. What, if any, refund is the insured entitled to in this instance?

Answer 61

$250When a policy has been written under which the producer was paid a service fee and a commission, a prorated refund is payable within 30 days if the policy is cancelled within 90 days from the inception of the contract. In this case 45 days is half of 90 days and half of the service fee ($250) must be refunded.

Question 62

the most an hmo will guarantee to pay

Answer 62

500000

Question 63

What is a DI

Answer 63

relates to becoming ill or injured away from the job

Question 64

individual DI

Answer 64

income is free from income tax benefits are paid after and elimination period also have probationary period which will tak 10-30 days to cover sickness have idemnity periods (benefit period) and range from 1 2 or 5 years

Question 65

Business overhead expense

Answer 65

does not pay workers salary is a DI for a business elim period is short benefits can only be collected for a year or two premiums are tax deductible

Question 66

Business disability buyout

Answer 66

cross purchase when two business owners take out a DI policy on each other and it covers there business if one goes down have long elim periods of a year or 2

Question 67

Group Disability income policy

Answer 67

When employees of a company receive coverage for disability income as a result of their employment

Question 68

AD&D

Answer 68

death pays a principal (Full) sum Dismemberment pays a capital (less than the principal) double dismemberment is presumptive disability

Question 69

Major Medical POlicy

Answer 69

deals with prolonged coverage for serious illness is the one that requires a deductible and coinsurance also contains a stop loss limit and a corridor deductible the most expensive plan

Question 70

HMO

Answer 70

Lower cost local geographic area based NEED REFERRAL insured is a “subscriber” doctors get paid Capitation(per head) of people under them no deductibles

Question 71

Preferred Provider Organization PPO

Answer 71

An employer/ insurance co contracts with a hospital. Do not need referrals but it is more expensive has deductibles

Question 72

Point of service POS

Answer 72

chracteristics of HMO and PPO no deductible and small copays(HMO) and freedom to choose(PPO)

Question 73

FSA Flexible spending account

Answer 73

EMployer takes money out of your check pre tax dollars and adds it into a saving account that allows for you to prepare against catastrophic events

Question 74

HIgh deductible health plan

Answer 74

Easy to get but requires a 1300 to 6550 deductible for singles and a 2600 13100for families

Question 75

Medicare

Answer 75

offers medical care for almost everyone is over 65 yeas old