Health 4 Flashcards
What is the own occupation disability?
Insureds’s inability to perform duties of his or her current job or an occupation for which the insured is educated and trained
Why: Under an own occupation plan, if the insured cannot perform duties of his or her current job that he or she was educated and trained for because of sickness or accident, disability will be paid.
How will changing one’s occupation to be more hazardous affect the health insurance policy in force?
Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation
Why: If the insured makes a change to a more hazardous occupation, upon claim, benefits will be reduced to which premiums paid would have purchased assuming the more hazardous occupation.
Who decides which optional provisions would be included in a health policy?
The insurance company
Why: The insurer has the option of including certain provisions in a health insurance policy. The company may change the wording of the optional provisions as long as it is not less favorable to the policyholder.
What is a deductible in a health insurance policy?
A specified dollar amount that the insured must pay before the insurer will pay the policy benefits
Why: The purpose of a deductible is to have the insured absorb the smaller claims, while the coverage under the policy will absorb the larger claims.
Which policy rider on health insurance policies allows an insured to purchase additional amounts of disability income coverage without evidence of insurability?
Guaranteed Insurability Rider
Why: The guaranteed insurability rider is also referred to as the the future increase option and allows the insured to purchase additional amounts of coverage without evidence of insurability at specified future dates (such as every 2 years).
Under the uniform required provisions for health insurance policies, proof of loss usually needs to be filed within how many days?
90 days
Why: After a loss occurs, the claimant must submit proof of loss within 90 days of the loss or as soon as reasonably possible
How is Medicaid funded?
Medicaid is a federal and state funded program
Why: Medicaid is a federal and state funded program for those whose income and resources are insufficient to meet the cost of necessary medical care.
What are the activities of daily living?
Mobility, bathing, dressing, eating, transferring, toileting and continence
Why: Activities of daily living (ADL’s) include all of the listed above. Inability to perform several ADL’s usually triggers eligibility for long-term care coverage.
Can Alzheimer’s disease be excluded from coverage under a long-term care policy?
No, organic cognitive disorders, such as Alzheimer’s or Parkinson’s must be covered
Why: Long-term care policies must cover organic cognitive disorders. No limitations or exclusions are allowed for these types of diseases.
When is the initial enrollment period for Medicare part A?
When an individual first be ones eligible for Medicare, starting 3 months before turning age 65 and three months after the 65th birthday
Why: Initial enrollment period (IEP) usually begins 3 months before the month in which the individual turns 65 and ends 3 months after the birthday month.
What is the purpose of Medicare supplement plans?
To fill in the gaps in Medicare coverage
Why: Medicare supplement plans, referred to as Medigap, are designed to fill in some of the gaps in Medicare coverage, such as deductibles and copayments.
What is the required free-look period for Medicare Supplement policies?
30 Days
Why: All Medicare supplement policies must contain a 30 day free-look period during which the insured may return the policy for any reason for a complete refund.
What Medicare part provides a prescription drug benefit?
Part D
Why: Medicare Part D provides a prescription drug benefit. This optional coverage is provided through private drug plans that contract with Medicare.
What Medicare part helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care?
Part A
Why: Medicare Part A is considered hospital insurance and pays for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care.
How is medicare Part B funded?
By Monthly premiums and from the general revenues of the federal government
Why: Medicare Part B is optional and is funded by monthly from the enrollees and from the general revenues of the federal government.
