Chapter 2 Flashcards
An insurer must furnish to a claimant forms for filing proof of loss within _____ days
upon receiving a notice of claim:
✔️✔️-15 days
Written notice for a health claim must be given to the insurer ____ days after the
occurrence of the loss:
✔️✔️-20 days
How much does Medicare Part B pay for physician fees?
✔️✔️-80%
Tom has a rider on his disability income policy that guarantees the right to increase his
benefits without a medical exam. What kind of rider is this?
Guaranteed insurability rider
One definition of replacement is “the act of replacing an existing insurance policy with
another.” Replacement is:
✔️✔️-Closely regulated and required full
disclosure
Ambiguities in an insurance policy are always resolved in favor of the:
✔️✔️-Insured
Which would NOT be considered in underwriting a health insurance risk?
✔️✔️-Marital status
If a health insurance claim is not promptly paid, legal action may be taken against the
insurer after:
✔️✔️-60 days from the date proof of loss is furnished
An accident and health policy that provides reimbursement benefits makes them
payable to the:
✔️✔️-Insured
According to Arkansas law, when must a producer deliver the outline of coverage to a
medicare supplement applicant?
✔️✔️-At the time of application
Which is the best way to describe controlled business?
✔️✔️-Policies
written on people that a producer has influence over
An insurance producer must notify the commissioner of a change in legal name, email
or address:
✔️✔️-Within 30 days of change
This mandatory health policy provision states that the policy, including endorsements
and attached papers, constitutes:
✔️✔️-The entire insurance contract
between the parties
Insurable interest does NOT occur in which of the following relationships?
✔️✔️-Business owner/client
Craig submits a $500 claim for medical expenses with a past due premium of $100, the
insurer pays $400. Which of the uniform optional provisions covers this situation?
✔️✔️-Unpaid premium
A pharmacy benefit covers prescription drugs derived from a list called a:
✔️✔️-Drug formulary
How often must a Commissioner examine each domestic insurance company?
✔️✔️-Every 5 years
Which of the following is a legal entity created for the sole purpose of providing
affordable group health coverage to its participants?
✔️✔️-Multiple
Employer Welfare Arrangement (MEWA)
Which is NOT considered to be included in a health benefit plan?
✔️✔️-
Hospital Indemnity Plan
The monthly benefit for an individual disability income policy is usually limited to a
percentage of the insured’s income in order to avoid:
✔️✔️-Over
insurance
Which of the following is considered to be a POS plan?
✔️✔️-Managed
care plan
A health insurance policy that allows an insurer to change the policy owners premiums,
but NOT cancel the policy is called a(n):
✔️✔️-Guaranteed renewal
policy
An accident and health insurer has just received written proof of loss from one of its
insureds. The insured must now wait 60 days before:
✔️✔️-Bringing
legal action against the insurer
Which of the following is NOT a reason for the commissioner to deny or refuse a
producer license application?
✔️✔️-Unintentionally misrepresented a
material fact on the application
