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Florida Health Insurance > Basics of Health Insurance > Flashcards

Basics of Health Insurance Flashcards

1
Q

What are the two types of insurance providers through “Private insurance”?

A

Commercial
Health and managed care

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2
Q

list two insured perils

A

accidental injury
illness

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3
Q

BOTH commercial and managed care providers offer coverage to ___?

A

Individuals and Groups

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4
Q

Name of government insurance provider on the state level?

A

Medicaid

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5
Q

Name of the government level insurance provider?

A

Medicare

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6
Q

Income replacement when disability prevents insured from working?

A

Disability income

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7
Q

Type of health insurance that covers the cost of medical care and medical services ?

A

Medical expense - commercial or managed care company

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8
Q

Pays lump sum benefits in event of accidental death or dismembering injury

A

Accidental death and dismemberment (AD&D)

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9
Q

Private insurance that supplements Medicare

A

Medicare supplement

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10
Q

Covers the cost of long-term care (nursing home, home health care)

A

Long-term care

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11
Q

type of health insurance for: dental, vision, prescription drug, specified ‘dread’ disease.

A

Limited benefits

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12
Q

How many types of health insurance?

A

6

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13
Q

Covers the cost of medical care and medical services on an indemnity (reimbursement) basis.

A

commercial insurer-medical expense

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14
Q

Insurance like coverage through the “provider” that combines medical care and insurance services.

A

Managed care company -Medical expense-

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15
Q

AD&D (accidental death&dismemberment) also covers what other condition?

A

blindness

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16
Q

Provides care to people under 65 who become totally disabled.

A

Social security disability

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17
Q

Medicare supplement is also referred to as what other name?

A

Medigap- “covers the gaps”

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18
Q

Name of insurance plan that the employer holds the contract and each employee is issued a certificate of coverage.

A

Group insurance

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19
Q

No single type of health insurance policy can cover every health risk. what is the option to do?

A

instead a variety of policies can address the different risks.

20
Q

Basic principle that the PPACA (affordable care act) requires 100% participation by americans not covered by employer health plans?

A

to lower the cost of health insurance by having a maximum # of healthy people in the “pool” and not just sick people.

21
Q

What are the essential differences between a bronze, silver, gold, and platinum plan of ACA?

A

the difference is the percentage of essential health benefits paid = to the percentage of copay.

22
Q

What contract has a set amount of money payable for a claim that is set in stone when the policy is issued?

A

Valued contract

23
Q

Whats the name of the contract that pays the amount of actual loss suffered?

A

Indemnity aka reimbursement

24
Q

List two examples of a type of valued contract

A

Life
AD&D (accidental death & dismemberment)

25
Q

What is an example of a indemnity contract?

A

Medical expense plan

26
Q

For the ACA coverage must meet what kind of standards?

A

Minimum

27
Q

ACA does not apply to what two types of health insurance?

A

disability and long term care

28
Q

When is OEP (open enrollment period)?

A

Nov 1- Jan 15

29
Q

When can a person enroll for insurance after open enrollment window has ended?

A

if a life event qualifies them during a special enrollment period.

30
Q

What are 5 life events that qualify for the special enrollment period?

A
  1. marriage
  2. birth of a child
  3. loss of other health insurance
  4. becoming a US citizen
  5. release from prison
31
Q

Name of plan that is for people younger than 30, cannot afford any other health insurance, or want minimal coverage w/ a high deductible and low premium?

A

catastrophic plan

32
Q

Under ACA insurance plans issued on or after Jan 1 2014 must cover what?

A

pre-existing conditions

33
Q

An insured’s health policy pays a flat rate of 200$ a month if she becomes disabled, regardless of her actual income. What kind of policy does she have?

A

A valued policy.

34
Q

Under ACA dependent children are covered under their parents medical plan until the age of?

A

26

35
Q

Under ACA- what is the term for when insurers must spend a minimum % of premium money earned on providing health care coverage and improving the quality of health care?

A

Medical Loss ratio

36
Q

Medical loss ratio is a standard that insurer’s must follow to ensure that they spend premiums primarily on health care coverage and NOT on ?

A

business expenses.

37
Q

What is the name of the contract used to make a clear plan on how to distribute the policy owners business interest/estate.

A

a buy-sell agreement

38
Q

When is a statement of good health typically required in the insurance process?

A

When there is a “reinstatement”

39
Q

When does coverage become effective if the first premium has not been paid and a conditional receipt has been issued?

A

At the time of delivery with the collection of premium

40
Q

What is the source of medical information provided for applicants seeking high coverage amounts?

A

The attending physician’s statement

41
Q

How long is a temporary insurance license typically valid for?

A

90 days

42
Q

Under the fair credit reporting act, for what purpose can a consumer report NOT be used?

A

for preparation of a lawsuit

43
Q

Who is the Certificate of authority, issued by the insurance commissioner, intended for?

A

The insurance companies and agents

44
Q

If an agent provide’s false statements about a policy’s benefits to a proposed client during a sale, what offense is committed?

A

Twisting

45
Q

how often does an agent have to renew their license? How many hours total? What is the breakdown of the hours of CE required?

A

every two years
24 hours total
20 hours elective and 4 hours MUST be law and ethics in the license type held.

46
Q

Can a material misrepresentation made by an insurance agent result in license suspension, revocation, or denial?

A

yes.

Florida Health Insurance (14 decks)

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