Health Insurance Flashcards
All of the following statements about noncancellable policies are true EXCEPT
the insurer may increase the premium rate after the policy is in effect provided it does so by classes of insured.
Which of the following qualified as a compensable injury under Workers Compensation coverage?
A factory worker fractures an elbow while working overtime.
Which of the following represent certain consumer safeguards enacted by states and patterned after a model act developed by NAIC?
Information and Privacy Protection Act
The optional short-term disability income benefit that pays a lump sum for specified injuries is called the
elective indemnity benefit.
The type of health care provider that provides both the health care services and the health care coverage is a
Health Maintenance Organization.
Dread disease, travel accident, vision care and hospital indemnity policies are all examples of
Limited Policies
Which of the following are NOT eligible for Medicare coverage?
People with any life-threatening condition
A company that is licensed to sell insurance in particular state is
an authorized company
Optional Provisions 1 and 2, addressing changes of occupation and misstatement of age, permit the insurer to do which of the following?
Pay indemnities equal to benefits that would have been purchased at the premium paid had the insurer known the facts when the premium was established.
With regard to group insurance, who has the responsibility to apply for coverage, provide information about the group, maintain the policy and pay premiums?
The master policyowner
What term describes the concept that the insurer and the insured share in the cost of medical expenses, with the insurer bearing the greater share?
Coinsurance
Trent Bixley is named by the insured, Nancy Bixley, as the first in line to receive the death benefit provided by Nancy’s accident policy. Their daughter Elaine is named as second in line to receive the benefit. Which statement is correct?
Trent is the primary beneficiary and Elaine is the contingent beneficiary.
The type of health insurance policy most likely used to cover all students attending a large university is
a blanket policy
An applicant for insurance may pay the initial premium and receive a document from the agent indicating that if the policy is issued as requested, coverage begins on the date of the document. What is this document called?
Conditional receipt
Under Workers Compensation, a disability that is a permanent physical impairment leaving the individual incapable of performing the previous regular occupation, but capable of performing some other type of work, is a
permanent partial disability
A health insurance policy includes an endorsement indicating the insurer will allow the policy to continue in force without further premiums if the insured is totally and permanently disabled. What endorsement is attached to his policy?
Waiver of premium
Which part of Medicare requires premium payment by most eligible participants?
Part B, supplementary medical insuranace
Select the correct statement about long-term care policies.
Present policies are most likely to pay benefits regardless of the level of care required by the insured.
In noncontributory group plans, how many eligible employees must be covered by the plan?
100%
Brenda names her husband as the beneficiary of the accidental death benefit in her health policy. She has relinquished her right to change the beneficiary designation. According to Required Provision 12, Brenda’s husband is
an irrevocable beneficiary
Under a credit health policy, what is the maximum amount of any accidental death benefit included?
The amount of outstanding indebtedness at any given time.
The factor in premium computation that has to do with the recordkeeping and statistical analysis insurance companies perform is
experience
Before Cranston was disabled, he was a full-time engineer earning about $70,000 annually. Now, 2 years later, he is able to work part-time, earning about $25,000 annually. It is likely that Cranston would be classified as
partially disabled
Select the correct statement about converting from a family policy to an individual policy.
Usually, conversion may be made without evidence of insurability if the individual does so within 31 days after the family coverage ends.
Primary support for Medicare Part A comes from
social security payroll taxes
When medical expenses policies do not state specific dollar benefit amounts, but instead base payments upon the charges for like services in the same geographical area, benefits are designated as which of the following?
Usual, customary and reasonable charges
As compared to individual disability income policies, group disability income policies are generally
less costly and have more liberal provisions
Required Provision 7 indicates that except in the absence of the insured’s legal capacity, if it was not reasonably possible for the insured to provide proof of loss as required in a policy, the latest time the proof of loss may be furnished is
1 year from the time proof is otherwise required
Many major medical policies include a provision whereby when expenses reach a certain dollar amount, the insured no longer shares in the cost of expenses; the insurer pays 100% of remaining covered charges. This is referred to as the
stop-limit
What term describes a situation where a policyowner transfers a portion of his or her rights in an insurance policy to another party in order to secure a debt to that party?
Collateral Assignment
An insured’s disability income policy defines total disability as “the insured’s inability to perform the duties of any occupation for which he or she is reasonably qualified by education, training or experience.” This definition is known as the
“any occupation” definition and is more restrictive than other definitions.
A certain major medical policy states a maximum number of days for which convalescent care will be paid as well as a maximum number of X-rays that will be paid for under any one claim. These are examples of
inside limits
All Medicare supplement (or Medigap) policies must
have the same core benefits
Which of the following most accurately and completely described an application?
A written request from an applicant to an insurer requesting the insurer to issue a policy on the basis of the information in application.
A Health Maintenance Organization (HMO) in a certain city contracts with an independent medical group to provide services to HMO subscriber. The HMO pays the group organization, rather than paying the individual medical practitioners. What type of HMO structure is this?
Group Model
Select the correct statement below.
COBRA protects dependents of employees by mandating for them the same extension and conversion privileges available to employees covered by group plans.
In a disability income policy, there is a period during which no benefits will be paid for illness of any kind. This period usually does not apply to accidents, only illness. The term that describes this interim is the
probationary period
The usual payment arrangement under a Preferred Provider Organization contract is
a fee for each service
Which of the following accurately describes the “free look” provision?
Allows the insured to look over the issued policy for a specific number of days and return it for a premium refund if desired.
Jay, who is employed by Carson Company, is assigned to work temporarily in another state. While in the other state, Jay is injured on the job. He is entitled to benefits of the Workers Compensation law in the state in which he was hired even though his injury occurred in a different state. This indicates that the Workers Compensation law in the state where Jay was hired
includes extraterritorial provisions
