Exam Prep Flashcards
Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured’s other health insurance?
Hospital Indemnity Policy
The limited period of time given to all members to sign up for a group health plan is called the…
Enrollment Period
An insurer may refuse to renew an employer’s small group health plan due to…
Nonpayment of Premium
Preferred risk policies with reduced premiums are issued by insurance companies because the insured has..
Better than average mortality or morbidity experience
The first payment for a newborn accident and health coverage is due ___ days after the birth.
31
Ohio requires that a licensee completes ___ hours of continuing education on the subject of ethics every reporting period.
3
Medicare Part A covers what?
Inpatient hospital stay
If an agent is believed to be causing considerable harm, the superintendent…
May issue a cease and desist order against the agent
An insurer’s ability to make unpredictable payouts to policyowners is called…
Liquidity
The policyholder for a group health benefit plan is considered to be the
Employer
An example of a health insuring corporation (HIC) specialty care provider is a
Neurologist
An agent’s license may only be suspended or revoked if the agent…
Has been afforded a right to a hearing
Replacement can best be described as
Exchanging a new policy for one already in force
Long-Term Care policies or certificates issued in Ohio are required to have what?
A nonforfeiture value
An insurance producer is often responsible for field underwriting during the application process. All of these are possible field underwriting roles except?
Providing commission information to the applicant
An insurer can exclude coverage for a preexisting condition on a Medicare Supplement policy for up to
6 months
Coverage for newborns under an accident and health plan must include coverage for
Birth abnormalities
Insurance represents the process of risk…
Transference
A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease…
Indicates a preexisting condition
Long-Term Care policies may provide coverage for claims arising from
Senile dementia
A Medicare Supplement policy is
Designed to fill in the gaps of Part A and Part B Medicare
Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?
Taxable income
What is not typically included under “hospital care” for most health insuring corporation (HIC) plans?
Private duty nursing
Which three levels of care are long-term policies provided with?
Skilled nursing, intermediate, and custodial care
Confidentiality of health information (stated by Ohio HIC laws) applies to information supplied by…
Both by the covered individual and by the providers
An individual who removes the risk of loosing money in the stock market by never purchasing stocks is said to be engaging in
Risk avoidance
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 signatures is not required on an individual insurance application?
Insurer
Which of these preventative care services is not provided by health insuring corporation (HIC) primary care physicians?
Adult hearing screenings
What is a legal entity created for the sole purpose of providing affordable group health coverage to its participants?
Multiple Employer Welfare Arrangement (MEWA)
Ted has a health insurance plan that requires him to pay a specific sum out of pocket before any benefits are paid in a calendar year. Which of these does his health plan have?
Calendar-year deductible
What does Medicare Part D cover?
Prescription drugs
What do coordination benefits allow?
Allows secondary payor to reduce their benefit payments so no more than 100% of the claim is paid
What is the primary factor that determines the benefits paid under a disability income policy?
Wages
A health care provider claim may be settled using what payment method?
Fee-for-service
Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of…
100% of costs
An employer is issued a group medical insurance policy. This single contract is known as?
Master policy
Which of the following statements is true about Medicaid?
It’s funded by federal, state and local taxes
How many employees must an employer have for a terminated employee to be eligible for COBRA?
20
HIPAA considers what as “individually identifiable health information”?
A person’s health claim information
What is not considered a supplemental health insuring corporation (HIC) service?
Outpatient medical services
An employee has ___ days after the date of marriage to add a new spouse to a small group health care plan
30
Intentional withholding of material facts that would affect an insurance policy’s validity is
Concealment
Medicaid is intended for
Poverty stricken people
Which type of long-term care benefit would be appropriate for a stroke victim who requires speech therapy administered at home?
Home health care
Key Person Disability insurance pays benefits to the…
Employer
An order issued by the superintendent that prohibits a specific practice listed in the order is called?
Cease and desist order
Advertisements for accident and health policies that only cover a stated illness must display a statement that the…
Policy is limited
Group dental plans will frequently place a limit on annual benefits in order to minimize what?
Adverse selection
All plans allow for employee contributions to be taken out on a pre-tax basis except?
Health Reimbursement Arrangement Plan
Which of the following would evidence ownership in a participating health insurance contract?
Policy ownership
_____ is not an element of a valid contract
Countersignature
What percent of a participant’s income are group long-term disability benefit amounts typically limited to?
60%
The typical long-term care insurance policy is designed to provide a minimum of ___ year(s) of coverage
1
An insurance policy that is only renewable only at the option of the insurance company. This policy is considered to be?
Optionally renewable
An agent’s appointment may only be terminated by the
Insurer
An indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called?
Coinsurance
What amount will be paid under a policy where the insured misstated his/her age?
An amount the premium would have purchased at the correct age
Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled?
Business overhead expense policy
An insurer must furnish to a claimant forms for filing proof of loss within ___ days upon receiving a notice of claim.
15
What is not considered advertising?
A rating from a service company
One of the most important considerations when replacing health insurance would be the…
Exclusions on a new policy
What would not be considered a presumptive disability?
Loss of a leg OR arm
Long-term care insurance applications must contain plain and unambiguous health questions. The exception to this rule would be applications for…
Guaranteed issue
The superintendent determines an examination of insurer’s books and records is necessary. After receiving the notification, the insurer…
Must not impede the examination
A Medicare supplement plan can be cancelled by the insurer…
For nonpayment of premiums
The purpose of the Coordination of Benefits provision in group accident and health plans is to?
Avoid overpayment of claims
An example of an endodontic treatment is a
Root canal
What would be considered a possible applicant and contract policyholder for group health benefits?
Employer
An employer with under 20 employees must allow a terminated employee to continue accident and health coverage for a minimum of ___ months
12
A beneficiary change can occur when?
Normally at any time during the policy term
In group health care, what is the purpose of coordination of benefits provision?
Determines what is paid by the primary and secondary insurers in the event of a claim
Loss of income insurance provides what?
An individual the means to replace wages
Backdating an insurance policy occurs when
The policy’s effective date is earlier than the present
In what form do disability income policies typically pay benefits?
Periodic income
Ambiguities in an insurance policy are always resolved in the favor of the…
Insured
