Disability Flashcards
An insured is covered by a disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and breaks an ankle. What coverage will apply?
No coverage will apply, since the injury could have been foreseen.
All of the following may be excluded from coverage in a Major Medical Expense policy, EXCEPT
Emergency surgery.
If a licensee whose license has been temporarily suspended demands a hearing, the Commissioner must hold the hearing demanded as according to all the following statements EXCEPT
Within 30 days of the license effective date.
All of the following are characteristics of a Major Medical Expense policy EXCEPT
Low maximum limits.
Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage?
Health Maintenance Organization plan
An insured’s disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payment from the insurer before Social Security benefits begin?
1
Which of the following is true of a PPO?
Its goal is to channel patients to providers that discount services.
A health carrier that provides coverage for maternity services must provide the same coverage for newborns as for the mother for at least
3 weeks
Which of the following hospice expenses would NOT be covered in a cost-containment setting?
Antibiotics
The act of voluntarily giving up insurance by the insured is called
Cancellation
An insured submitted a notice of claim to the insurer, but never received claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insurer. Which of the following would be true?
The insured was in compliance with the policy requirements regarding claims.
All of the following events will terminate a producer’s appointment with an insurer EXCEPT
A new Commissioner is put into office.
Which of the following is true regarding inpatient hospital care for HMO members?
Care can be provided outside of the service area
In group insurance, what is the policy called?
Master policy
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in
Medicare Part A.
To receive Medicare prescription drug benefits, beneficiaries must sign up with a plan offering this coverage in their area and must be enrolled in Medicare Part A or in Parts A and B.
Which of the following statements regarding Business Overhead Expense policies is NOT true?
Benefits are usually limited to six months.
In disability income insurance, the own occupation definition of disability applies
For the first 2 years of a disability
All of the following are essential benefits required to be included in all health plans purchased in the Marketplace EXCEPT
Adult dental care.
The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as
Part A.
How often must an authorized insurer be examined?
Every 5 years
What is the maximum period that an insurer would pay benefits in accordance with an Additional Monthly Benefit rider?
1 year
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?
10 days
Which of the following statements is INCORRECT concerning Medicare Part B coverage?
Part B coverage is provided free of charge when an individual turns age 65.
If a licensee whose license has been temporarily suspended demands a hearing, the Commissioner must hold the hearing demanded as according to all the following statements EXCEPT
Within 30 days of the license effective date.
Which is true regarding HMO coverage?
It is divided into geographic territories.
To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?
18 months
In major medical insurance policies, when the insured’s share of coinsurance reaches a certain amount, the insured is no longer obligated to pay it. This feature is known as
Stop-loss.
The general powers and duties of the Insurance Department include all of the following EXCEPT
Enacting statutes to regulate the insurance industry.
Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?
Payment of Claims
An applicant for health insurance has not had a medical claim in 5 years. He exercises daily and does not smoke or drink. What classification do you assume the applicant would receive from his insurer?
Preferred
In the state of Washington, a small employer is defined as any person, corporation or association that employed, during the previous year, between 2 and
50 employees.
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This would indicate that his policy was written with a 30-day
Elimination period.
A participating insurance policy may do which of the following?
Pay dividends to the policyowner
An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do?
Offer the supplement policy on a guaranteed issue basis
Which of the following is a specific dollar amount or a percentage of the cost of care that must be paid by an HMO member?
Copayment
Which of the following options best depicts how the eligibility of members for group health insurance is determined?
By conditions of employment
According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?
60%
Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?
Metal level classification
Which of the following is NOT a cost-saving service in a medical plan?
Denial of coverage
Under the Fair Credit Reporting Act, if a consumer challenges the accuracy of the information contained in a consumer or investigative report, the reporting agency must
Respond to the consumer’s complaint.
Who is involved in completing the agent’s report?
Only the agent
