health and life insurance Flashcards
which of the following insurers are owned by stockholders?
stock
which of the following is another term for authorized insurer?
Admitted
An employee becomes insured under a PPO plan provided by his employer, If the insured decides to go to a physician who is not a ppo provider , which of the following will happen?
The PPO will reduce benefits
A business entity must meet all of the following qualifications EXCEPT?
Have a board of directors
An insurance company requires that both the insured and the insurer meet certain conditions inorder for the contract to be enforceable. what contract characteristic does the describe?
conditional
which of the following is not true of a disability buy sell coverage
benenfits are considered taxable income to the buisness
if during an underwriting process an insurer obtains personal information about an applicant from an application , when will the insurer provide notice of information practices?
At the time of policy delivery
An insured has health insurance that covers them at work and at home. This policy is written on what basis?
Occupational coverage
Which of the following is Not a characteristic of HMOs as defined by state of Maryland
In network physicians must be either employees or partners of HMO
Which of the following organizations are practicing providers compensated on a fee for fee service basis?
PPO
Assuming that all of the following people are covered by a high deductible health plan and are not claimed as dependents on anyone’s Tax return , which would not be eligible for a health savings account?
Amanda 67 and is coovered by a medical expense policy
Which type of service nonscheduled plan typically has large deductibles and pays around 50% for the services provided?
Major services
when the policy premiums wasn’t submitted with the application, What should the agent obtain from the insured upon premium delivery?
A statement of good health
An insured severely burns her hand, but is not considered disabled.which of the following types of coverage would at least cover a portion?
Medicean reimbursement benefits
Under what condition would an employees group Medical benefits be exempt from income taxes
Employees group medical benefits are generally exempt from taxation as income
What is the purpose of COBRA?
To provide continuation of coverage for terminated employees.
What size companies are eligible for health reimbursement account?
Companies of all sizes
Which of the following do standard and preferred risk category shared? 
Premiums are not elevated 
Employers can reduce a health plan, caused by coupling a health reimbursement account with? 
A high deductible health plan 
When is the Medicare supplement buyers guide be presented? 
At the time of application 
In the employer choice option in the shop marketplace what does the employer select? 
A single insuring 
All of the following statements about Medicare supplement insurance policies are correct, except?
They cover the cost of the extended nursing home care 
Which is not true regarding an insured who is considered to be a standard risk
The insured might have to pay slightly higher premiums 
 Units with the same exposure to-loss are referred to as?
Homogeneous 
 A 37-year-old owns a policy with a guaranteed insurability rider. The policy owner would like to increase the benefit amount offered by the policy. What will be required?
No documentation 
How soon following the occurrence of a covered large Mesa insured submit written proof of such loss to the company 
Within 90 days as soon as recently possible, but not to exceed one year 
which type of dental treatment involves a replacement of natural teeth with artificial devices? 
Prosthodontics
Which of the following would disqualify her individual from receiving coverage to the market please? 
Being insured under employer plan, that means minimum value of healthcare cost 
Whom I signed a notice regarding replacement? 
 both the application and the agent 
occasional visits by which of the following medical professionals would not be covered under A LTC home health care?
Attending physician 
{Home health care is provided a minute home and could include occasional visits to the person by registered nurses license practical nurses wear community-based organizations like hospice.}
According to the reinstatement provision, if a policy is reinstated, which of the following benefits will be covered immediately upon reinstatement ?
Accidental injury 
All of the following statements about Medicare supplement insurance policies are correct, except?
They cover the cost of extended nursing home care
TV eligible under HIPAA regulations, and for how long should a individual converting to an individual house plan have been covered under the previous group plan?
18 months
For Maryland residence insured under a long term care policy, the one time long term care insurance tax credit pays what amount?
The lesser of the premiums paid or $500
Which of the following is not considered by underwriter when determining the premium rates for individual seeking insurance?
Race 
What is the material misrepresentation? 
A statement by the applicant that, upon discovery, but the fact that underwriting decision of the insurance company
A broker request a hearing with the commissioner. Within how many days of the request Must the hearing be held?
30 days
Where would long-term care services rendered?
A nursing home or ones own home
In order to maintain coverage under cobra, how soon from termination of employment, must an employee exercise extension of benefits?
 60 days 
When must a Medicare supplement buyers guide be presented?
At the time of application 
In an individual, long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received?
No tax 
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 brakes and ankle. What coverage will apply?
No coverage will apply since the injury could have been foreseen
Which of the following would not be underwriters consideration for a health insurance applicant?
applicant sexual orientation 
Which of the following hot spice expenses would not be covered in a cost containment setting?
Antibiotics 
To what organization must all admitted insurers belong
The guaranty association 
HIPAA applies to groups of?
Two or more 
Which of the following is incorrect concerning taxation of disability income benefits?
It paid by the individual, the premiums are tax deductible.
How many years after furnishing proof of loss does intrude have to take legal action against answer?
Three years 
Under what condition, our group, disability income benefits, received by the employee, not taxable as income?
When the benefits are received, are equal or less than employees percentage of the contribution 
The rider that may be added to a disability income policy that allows for an increase in the benefit amount under certain conditions is called?
Call still living (cola)
Prior to insurance of a long term care Policy to an applicant age, 80 or older, insurer must obtain all of the following, except?
Date of previous doctors visit. 
Which of the following statements about occupational versus non-occupational coverage is true?
Disability insurance can be written as occupational or non-occupational
And insured pays a $100 premium every month for his insurance coverage, get the insured promises to pay 10,000 for a covered loss. What characteristic of insurance contract is describe?
Aleatory
According to the provisions of the patient protection and affordable care act, all of the following are required, preventive care services, except?
 Cervical cancer exams for all women starting at age 40. 
Which of the following is correct regarding business overhead expense insurance?
Premiums are tax deductible. 
Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of the insureds
Optionally, renewable
Under the privacy rule, for HIPAA, protected information, includes all individually, identifiable, health information
How old or transmitted in any form
All of the following statements about Medicare part B are correct, except?
It is a compulsory program
And insured is receiving hospice care. His insurer will pay for painkillers, but not for operation to reduce the size of the tumor. What term best fits this arrangement?
Cost containment 
Which of the following is not a rating for a Medicare supplement insurance policies?
Experience
According to OBRA, what is the minimum number of employees required to constitute a large group?
100 
And health underwriting, it would be inappropriate to decline arrest, using any of the following factors, except
Mental illness 
What is reinsurance?
An agreement between a ceding insurer and assuming insurer
Which provision states that the insurance company must pay medical expense claims immediately?
Time of payment of claims 
And insured who has an accidental death and dismemberment policy loses her left arm in an accident. What type of benefit? Well, she most likely receive from this policy?
A capital amount in a lump sum 
Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within?
90 days of a loss 
In which of the following cases would a credit disability policy be issued?
If an individual is in debt to a specific creditor, payments will be made for him/her until the return to work. 
After an elimination period, a totally disabled insured qualified and started receiving benefits from his disability income policy that has a waiver of a premium rider. What will most likely happen to the premium paid into the policy during the elimination period? 
Premiums will be refunded. 
Which statement best defines a multiple employer welfare arrangement? (MEWA)
A joining together by employers to provide health benefits for employee.
Under the accidental death and dismemberment coverage, what type of benefit will be paid to the beneficiary in the event of the insured’s accidental death? 
Principal Sum. 
Which of the following is not true regarding nonprofit health service plans in the state?
They are regulated by the federal government. 
According to the future increase option rider, which of the following is not a qualifying event to increase and insurance benefit level?
Death of a spouse 
An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles has the insurer violated?
Consideration 
