Exam questions Flashcards
Workers compensation benefits regulated by which entity?
state
Type of dental plan incorporated into major medical plan
integrated plan
Section of a health policy that states the causes of eligible loss under which insured is assumed disabled
insuring clause
compared to policy that uses accidental means definition, accidental BODILY injury definition coverage is broader limited in general?
broader in general
bodily coverage is broader than means
insured goes from window washer to library manager; insurer is notified and does what?
adjust benefit in accordance to decreased risk
person is disabled at age 27 and meets SS’s definition of total disability; how many work credits?
12 credits
NOT a characteristic of group health insurance
policy issued to each insured individual
Consumer requests additional information from consumer reports. How long does insurer or consumer agency have to comply?
5 days
insured wants to name husband as beneficiary of health policy; wishes to retains all rights of ownership; should have hb. named as what type of beneficiary?
revocable
applicant returns completed application and check for first premium to agent; she receives conditional rcpt. two weeks later; what has the insurer done by this point?
neither approved NOR issued policy
MIB (Medical Information Bureau)
nonprofit maintaining underwriting information on applicants for life and health
Social Security Supplement or SS Riders provide payment of income benefits in each situation EXCEPT
when amount payable under SS is more than amount payable under rider
Which is an eligibility requirement for SS disability income benefits?
fully insured status
in disability income ins., time between onset of injury or sickness and when benefits begin
elimination period
which is NOT provided by an HMO?
reimbursement
purpose of coinsurance provisions?
help insurance company to prevent overutilization of policy
maximum age for qualifying for catastrophic plan
30
taxation of group medical expense premiums and benefits
premiums are tax deductible and benefits are not taxed
which policy covers unusual risks NOT normally included under AD&D coverage?
Special Risk Policy
defamation
making false statements about financial conditions of any insurer that are intended to injure any person engaged in insurance business
banker is ready to close on customer’s loan; bank will offer loan only if customer purchases life insurance policy from bank
COERCION
exists to protect the PUBLIC
State Insurance Department
state provides temporary license for all EXCEPT
producer’s retirement
producers give or promise anything of value not specified in the policy
rebating
specifies minimum number of persons to be covered under a group health insurance plan
state law
participating ins. policy may do what?
pay dividends to the policyowner
NOT considered to be a rebate because policy specifies that they might be paid
dividends from mutual insurer
how long must insurer’s advertisements be kept on file?
4 years
how long is free-look period in long-term policies in this state?
30 days
specifies causes of loss for which insurer will not pay
exclusions
any supplemental agreement attached to and made part of the policy whether the policy’s conditions are expanded and additional coverage added or coverage or condition is waived
rider
the provision in a health ins. policy that ensures that the insurer cannot refer to any document not in the contract
entire contract clause
who can make changes to an insurance policy?
insurer’s executive officer
The relation of earnings to insurance provision allows the insurance company to limit the insured’s benefits to his/her average income over the last how many months?
24 months
What provision requires that no legal action to collect benefits may be started sooner than 60 days after the proof of loss is filed with the insurer?
legal action
When can you change an IRREVOCABLE beneficiary?
only with the written consent of the beneficiary
Under the Uniform Required Provisions, proof of loss under a health insurance policy normally should be filed within ? days of a loss.
90 days
Which provision allows a policyholder 10 days after the policy is delivered in which to decide whether or not he/she wants the policy?
Free Look Period
Ted was a doctor on a Covid ward. He changed to a remote job. What should the insurer do?
Adjust the benefit in accordance with the decreased risk.
waiver of premium provision may be included with what kind of health ins. policy?
disability income
a medical expense policy that establishes the amount of benefit paid based on the prevailing charges falling within the standard range of fees normally charged in that geographic location
usual, customary, and reasonable
premium charged for exercising the Guaranteed Ins. Rider based on insured’s
attained age
what is the purpose of coinsurance provisions?
to help ins. company prevent over utilization of policy
Spells out the insured’s duty to provide the insurer with reasonable notice in the event of a loss.
The Notice of Claim Provision
Who has authority to make changes to insurance policy?
executive officer of the company
section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled
insuring clause
The insured would be the policyowner and wants to be able to make changes even though she names her hb. as beneficiary.
revocable
head of State Dept. of Insurance
Commissioner
ability to meet financial obligations
solvency
an insurance company incorporated in this state
domestic insurer
appointed by the governor
Insurance Commissioner, for four years, at least 30 years old, citizen of Arkansas
insurance exams conducted every how many years?
5
