Health Insurance Markeitng Practices Flashcards
must be delivered to an applicant for a n issued policy
Outline of Coverage
Guaranteed Renewability
Insurer obligated to continue coverage as long as payments are made
Medicare Eligibility Expenses
Expenses Covered under Parts A & B
Sickness
Manifests after effective date
4 Parts of the Outline of Coverage
Cover page
Premium information
Disclosure pages
Charts
What is the Buyers Guide
Medicare must provide pamphlet explaining Medicare health ins
Free look period for Medicare supplement?
30 Days
Premium refunded
Explain Medicare supplement and guarantee issue?
Issuer May issue coverage without evidence of insurability
LTC Education Requirements?
8 hr training
4 hr on going training every 2 years
Penalty for Health Care False Claim ?
Class C Felony
5 Years and/or 10,000$
What is Health Insurance Reform ?
Residents with managed care programs have access to necessary info
Who makes decisions about length of inpatient care Maternity Services ?
Attending Provider
Cannot be denied
How long is A NewBorn child covered for under a mother ?
3 weeks !
Free Look for accident & health insurance?
10 Days
Grace Period for Weekly ? Monthly? Any other?
7 Days
10 Days
31 Days
Obligations that come when Reinstating an insurance contract ?
Not obligated
Might need an application
Collect no more than 60 days of premium
PROOF OF INS
COND RECEIPT
Waiting period for Reinstatement? Why?
10 days before loss relating to sickness are covered
Adverse selection
Insured must notify insurer of loss in how many days ?
Notice of claim
20 days
How long to provide proof of loss?
90 days no later than 1 year
How long after submission of proof can insured take Legal actions ?
60Days
Litigation in 3 years
Comprehensive health care services
Basic consultative, diagnostic, therapeutic, emergency preventative care inpatient outpatient phys care
LICENSED PROFESSIONALS
Continuation of Group coverage by health care service contractors or health maintenance org HMO?
Have the right to continue for a period of time and rate agreed upon once ineligible.
Age coverage stops for a child ?
26 Years
Commissioners powers over individual and HMO agreements ?
Can disapprove them
