Final Exam 1 Flashcards
In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?
a) Insurer to the insured
b) Insured to the insurer
c) Insurer to the Department of Insurance
d) Insured to the Department of Insurance
a) Insurer to the insured
Upon receipt of a notice of claim, the company must supply claims forms to the insured within a specified number of days.
Which of the following would NOT be an underwriting consideration for a health insurance applicant?
a) Applicant’s credit rating
b) Applicant’s sexual orientation
c) Applicant’s personal habits
d) Applicant’s medical history
b) Applicant’s sexual orientation
Sexual orientation is not an underwriting consideration for most health insurance policies.
Which of the following is NOT an enrollment period for Medicare Part A applicants?
a) General enrollment
b) Automatic enrollment
c) Initial enrollment
d) Special enrollment
b) Automatic enrollment
There are 3 types of enrollment periods for Medicare Part A: initial enrollment period, general enrollment period and special enrollment period.
The Coordination of Benefits provision in Utah requires that both primary and secondary plans pay the benefit in equal shares if the plans cannot agree on the order of payment within how many days after receiving the claim information?
a) 10 days
b) 30 days
c) 60 days
d) 90 days
b) 30 days
If plans cannot agree on the order of benefits within 30 days of the receipt of all necessary claim information, these plans will immediately pay the claim in equal shares. However, in these instances, no plan will be required to pay more than its policy limits.
All of the following are characteristics of a Major Medical Expense policy EXCEPT
a) Coinsurance.
b) Low maximum limits.
c) Deductibles
d) Blanket coverage.
b) Low maximum limits.
Major medical expense contracts are characterized by high maximum limits, blanket coverage, coinsurance, and a deductible.
All of the following are covered by Part A of Medicare EXCEPT
a) Home health services.
b) Physician’s and surgeon’s services.
c) In-patient hospital services.
d) Post-hospital nursing care.
b) Physician’s and surgeon’s services.
Physician’s and surgeon’s services are covered under Part B.
A policy with a 10-day grace period implies
a) If something happens within 10 days the insurer does not pay.
b) The policy remains in force without penalty for 10 days even though the premium due has not been paid.
c) The policyholder may return the policy for a full refund of premium.
d) The policy lapses if premium is not paid 10 days before it is due.
b) The policy remains in force without penalty for 10 days even though the premium due has not been paid.
A mandatory provision of health insurance policies requires that a grace period of 10 days be provided.
All of the following are ways in which a Major Medical policy premium is determined EXCEPT
a) The stop-loss amount.
b) The average age of the group.
c) The amount of the deductible.
d) The coinsurance percentage.
b) The average age of the group.
Major medical policy premiums vary depending on the amount of the deductible, the coinsurance percentage, the stop-loss amount and the maximum amount of the benefit.
An association could buy group insurance for its members if it meets all of the following requirements EXCEPT
a) Holds annual meetings.
b) Is contributory.
c) Has at least 50 members.
d) Has a constitution and by-laws.
c) Has at least 50 members.
All of the above characteristics would make an association group eligible for buying group insurance, except the group must have at least 100 members.
The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT
a) Individual tax deduction for premiums paid.
b) Right to appeal.
c) No lifetime dollar limits.
d) Coverage for preventive benefits.
a) Individual tax deduction for premiums paid.
The Act does not offer tax deductions for health insurance premiums. The Act does offer a tax credit, which is different from a tax deduction. All the other provisions are included in the Act.
Which of the following riders would NOT increase the premium for a policyowner?
a) Payor benefit rider
b) Waiver of premium rider
c) Multiple indemnity rider
d) Impairment rider
d) Impairment rider
The impairment rider excludes a specified condition from coverage, therefore, reducing benefits. An insurance company will not charge extra for a rider that reduces benefits.
The provision that states that both the printed contract and a copy of the application form the contract between the policyowner and the insurer is called the
a) Master policy.
b) Entire contract.
c) Certificate of insurance.
d) Aleatory contract.
b) Entire contract.
The policy, together with the attached application, constitutes the entire contract. This provision limits the use of evidence other than the contract and the attached application in a test of the contract’s validity. This is a mandatory provision in life insurance.
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?
a) The claim most likely will not be paid since the official claims form was not submitted.
b) The insurer will be fined for not providing the claims forms.
c) The insured must submit proof of loss to the Department of Insurance.
d) The insured was in compliance with the policy requirements regarding claims.
d) The insured was in compliance with the policy requirements regarding claims.
If claims forms are not furnished to the insured, the claimant is deemed to have complied with the requirements of the policy if he or she submits written proof of the occurrence, nature of the loss, and extent of loss to the insurer.
In order to maintain coverage under COBRA, how soon from termination of employment must an employee exercise extension of benefits?
a) 7 days
b) 10 days
c) 30 days
d) 60 days
d) 60 days
Under COBRA, terminated employees must exercise extension of benefits within 60 days of separation from employment.
Which document helps ensure that full and fair disclosure is provided to the recipient of a policy?
a) Policy Summary
b) Statute of Limitations
c) Outline of Coverage
d) Benefit Limitations
c) Outline of Coverage
The Outline of Coverage is created to ensure full and fair disclosure to the recipient of a new policy. This document can be released at the time of application or upon delivery of the policy.
