ACCIDENT & HEALTH POLICY PROVISIONS

Question 1

what is the future increase option or guaranteed insurability rider?

Answer 1

the rider which allows for additional coverage without being required to take a medical exam

Question 2

the ___ rider assists an insured in getting back to work after a disability

Answer 2

rehabilitation rider

Question 3

what term is used to describe the contract that a PPO creates between an employer group and a medical provider?

Answer 3

PPA - preferred provider arrangement

Question 4

which type of health care delivery program emphasizes preventative car

Answer 4

a health maintenance organization

Question 5

what is the term used by insurers to describe the containment of health care costs?

Answer 5

managed care

Question 6

creating a ____ trust lets small employers with a common affiliation join together to buy group benefits

Answer 6

creating a multiple employer trust lets small employers with a common affiliation join together to buy group benefits

Question 7

which health care program provides medical benefits for members and dependents of the military

Answer 7

tri care

Question 8

T or F: a preferred provider organization (ppo) actually provides the insured with medical benefits

Answer 8

false - a PPO negotiates and creates the rate structure used between employer groups and medical providers

Question 9

what is the elimination (waiting) period?

Answer 9

the period of time that must elapse on a disability income policy prior to income benefits being received

Question 10

what term is used to describe a primary care provider that verifies the need for additional and specialized benefits?

Answer 10

gatekeeper

Question 11

what type of A&H policy is designed to pay benefits for chronic conditions and nursing home benefits?

Answer 11

a long term care policy

Question 12

what type of A&H policy is designed to provide income to an insured?

Answer 12

disability income

Question 13

what is the probationary period?

Answer 13

the period of time following the issuance of the policy when benefits may not be provided

Question 14

what organization provides the benefits of both an HMO and PPO?

Answer 14

a point of service organization

Question 15

which nonprofit service provider provides benefits for the expenses related to a doctor?

Answer 15

blue shield

Question 16

what is blue cross

Answer 16

a nonprofit service provider that provides benefits for hospital expenses

Question 17

members of a blue cross blue shield program are called ______

Answer 17

subscribers

Question 18

what is the name for the medical issues that exist prior to policy issuance that may not be covered by a new policy?

Answer 18

preexisting conditions

Question 19

what provision states that the amount of disability coverage allowed is directly related to a person’s income

Answer 19

the relation of earnings to insurance provision

Question 20

what is the general term used to describe medical, disability and LTC policies?

Answer 20

accident and health insurance

Question 21

what is the general term used to describe medical, disability, and LTC policies?

Answer 21

accident and health insurance

Question 22

which concept indicates that the insured will be indemnified for actual losses and not profit from her injury/illness?

Answer 22

the no loss/no gain statute

Question 23

what type of insurance is purchased to protect agents and insurers in the event of a negligent act?

Answer 23

errors and omissions insurance

Question 24

what HMO requires members to use only doctors employed or contracted with the HMO?

Answer 24

closed panel HMO