Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

health stuff > health q's > Flashcards

health q's Flashcards

1
Q

Which situations would NOT potentially involve a prison sentence under federal law?

A

Selling insurance with a nonresidential license

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Every agent licensed in New York must notify the Superintendent within ____ days of any change of address

A

30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Janice forgot to make her insurance premium payment by the due date. The specified period after the due date where she can still make payment and avoid discontinuance of her coverage is called the:

A

Grace Period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an example of an agent’s fiduciary duty?

A

Collecting premiums and remitting them to the insurer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In New York, an insurance agent cannot sell, solicit, or negotiate policies for an insurer unless there is an agreement in place between the agent and the insurer. This agreement is called a(n)

A

Appointment. [Before a licensed agent can legally transact insurance sales, they must first be appointed by an insurance company.]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The superintendent MUST give a MINIMUM of how many days notice of a disciplinary hearing?

A

10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The identity of the ____ must be made clear in every health insurance advertisement

A

Insurer- in all advertisements for health insurance, it should be made clear the identity of the insurer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The right to examine period is ____ days for all long-term care policies solid in New York

A

30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Security laws passed by congress are enforced by which federal agency?

A

Security and Exchange Commission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

As classified by the Affordable Care Act (ACA) a silver plan offers

A

70% actuarial level of coverage provided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In New York, a long term care policy must be _____ renewable

A

Guaranteed renewable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

An agents license may only be suspended or revoked if the agent

A

Has been afforded a right to a hearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who is required to notify the agent in the event of appointment termination?

A

Insurer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If an agent is believed to be causing considerable harm, the superintendent

A

May issue a cease and desist order against the agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which of the following provides affordable health insurance coverage to small employers?

A

Healthy New York Program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is required for an insurer to conduct business in this state?

A

Certificate of Authority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If the cause of death appears to be accidental, an insurer may require an

A

Autopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

As of January 1st, 2014, an employer with up to 25 full time equivalent (FTEs) with average annual wages of less than $50,000 may be eligible for a tax credit of _____ of the premiums paid by the employers

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

According to the affordable care act, any plan in existence prior to which date is considered a grandfather plan?

A

March 23, 2010

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

An example of misrepresentation is

A

Providing incorrect, misleading, incomplete, or materially untrue information in the license applicationAl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

All agents shall maintain full and correct transaction records of the business done by them for a period of at least

A

6 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

An insurance consultant is BEST defined as a(n)

A

An insurance agent who charges fees for advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

There’s many things that are a violation of the federal fraud and false statements act, but NOT

A

Claims reimbursement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which of the following is NOT covered by New York workers compensation laws?

A

On the job injury that was both intentional and self inflicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What’s a TRUE statement regarding the Fair Credit Reporting Act?

A

An insurer does NOT need to discuss any credit history, inconsistencies with the applicant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What would NOT be an eligible dependent on an Accident and Health Policy?

A

A 27 year old married child (would NOT be an eligible dependent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Maria the insurance agent completes a sale by collecting the required signatures on the application and obtaining the initial premium. Afterwards, she deposits the check into her personal checking account. What crime has she committed?

A

Fraud.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The _____ is responsible for determining the appropriateness of a medicare supplement policy for an applicant

A

Agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

A common exclusion or limitation on a dental policy is

A

Endodontics (Endodontics is the branch of dentistry concerning dental pulp and tissues surrounding the roots of a tooth. Endodontic treatment, or root canal treatment, treats the soft pulp tissue inside the tooth.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Long-term care policies solid in New York may exclude coverage related to

A

Substance addictions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

The required grace period for an accident and health policy is ____ days for weekly premium policies

A

7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Jermaine’s individual health policy had recently lapsed upon reinstatement, he must wait ____ days before coverage for illness is available

A

10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

With a scheduled dental policy, how are covered expenses paid?

A

Benefits are limited to a specific maximum dollar amount per procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Insurance agent Kelly offers a prospect a $1,000 shopping card if an insurance policy is purchased through her. What illegal activity is this an example of?

A

Rebating (offering valuable consideration or inducement to a prospective insured that is not specified in the contract)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

An alien insurer

A

Is an insurer operating in the US but headquartered outside the US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

According to the affordable care act, what metal tier is required to have an actuarial value of 70%, with covered individuals paying 30% through deductibles, co-pays, and other cost sharing features?

A

Silver. (Bronze- 60/40, Gold-80/20, Platinum 90/10)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

A hospital or medical expense policy will typically cover dental treatment expenses under which circumstance

A

Dental treatment is needed to repair an injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

In most dental plans, a deductible typically is NOT applied to

A

Preventative and diagnostic services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

In New York, an agent may have his or her license revoked for what act?

A

Failure to pay state income tax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Within ____ days after policy delivery, both medicare supplement and long-term care policies can be returned for a 100% premium or refund

A

30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

An insurer is REQUIRED to offer which of the following to each long term care applicant at the time of purchase?

A

Inflation protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Violations of US Code Title 18 section 1033 may result in

A

A fine of up to $50,000 per violation and/or incarceration of up to a maximum of 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

The renewability provision for an individual long term care insurance policy must be located on the policy form’s

A

First page

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

An agent’s commission for the sale of a Medicare supplement policy in the first year following its effective date cannot exceed ____ of the commission paid for selling or servicing the policy in the second year.

A

200%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Long term care insurance provides

A

One or more diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

A(n) ___ company is owned by its shareholders

A

A stock insurance company

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which of these is NOT a characteristic of a Fraternal Benefit Society

A

Existing for profit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Twisting is defined in the context of medical insurance as

A

Replacing an insurance policy from one insurer to another based on misrepresentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is NOT considered to be an act of fraud?

A

Collecting a charge for insurance that is less than the charge that is applicable to that insurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the levels of coverage as defined by the Affordable Care Act (ACA)?

A

Bronze, Silver, Gold, and Platinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

An advertisement for an insurance product must contain

A

The insurer’s name

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

An employer may qualify for health care tax credits through SHOP marketplace if that employer has fewer than how many employees?

A

25 employees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Benefits for a Medicare Supplement Policy

A

must not duplicate medicare benefits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

New York Disability Benefits Law provides cash payments to workers unable to work because of

A

Injury or illness that occurred on the job

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

An insurance agent agrees to pay the first monthly premium for an insurance applicant. This is called a(n)

A

Rebate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

An agent may be disciplined by the superintendent for which of the following actions?

A

Misappropriation of premium funds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

After ____ years from date of issue, an individual health insurance policy can no longer be canceled by the insurer for misstatements (except for fraud)

A

2 years- policy terms shall be incontestable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When does a family health plan coverage for a newborn baby begin?

A

At the moment of birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What does shop stand for in SHOP exchange?

A

Small Business Health Option Program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

When a medicare supplement insurance policy is being replaced, who must sign the notice of replacement?

A

The agent AND the applicant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

An agent does NOT have a fiduciary responsibility to

A

The New York Guaranty Association (also known as the Life and Health Insurance Company Guaranty Corporation of New York)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Which of the following is NOT a circumstance to which a temporary agent license can be issued?

A

Prospective agent who is waiting to take the state licensing examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What’s NOT a responsibility of the superintedent?

A

Endorsing insurers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

A domestic insurance company in New York must

A

Be formed under the laws of NY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

An agent license is NOT required when

A

Referring insurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is NOT an Unfair Claims Settlement Practice

A

Providing claim payments to insureds under the guidelines of the insurance contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Employees are required to work at least ____ hours per week to become eligible for a small employer health plan

A

20 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

An agent has committed an insurance crime that violates US code 1033 (interstate commerce). Who would be responsible for the prosecution of this crime?

A

US Attorney General

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Failing to promptly provide reasonable explanations for the denial of claims is considered a(n)

A

Unfair claim settlement practice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

An example of an endodontic treatment is a

A

Root canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

An insurer may exclude preexisting conditions on a medicare supplement policy for _____ months

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

An indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called

A

Co-insurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

A license who is required to take continuing education must complete ____ hours of continuing coursework

A

15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

A temporary license is valid for a maximum of ____ days

A

90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

An example of misrepresentation is

A

Providing incorrect, misleading, incomplete, or materially untrue information in the license application is misrepresentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Which of the following is included in the entire contract according to the entire contract provision?

A

Application

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is NOT a duty of the superintendent?

A

Establishing rates for the insurer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Replacement regulation is designed to protect the interests of

A

Policy owners- the primary purpose of replacement regulation is to protect policy owners from misrepresentations and loss of benefits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

If an insurer refuses to pay a claim, how many days must the insured wait to take legal action against a health insurer after submitting written proof of loss?

A

60 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

A form of medial health insurance covering the treatment and care of gum disease is called

A

Dental expense insurance

81
Q

All health benefit plans issued after January 1, 2014 must provide

A

Preventative health services

82
Q

A foreign insurance company doing business in New York

A

Is a company that was formed under the laws of another state

83
Q

An agent is legally permitted to share his/her commissions

A

With another licensed agent

84
Q

Under Federal Law, what action may result in a producer becoming imprisoned?

A

Producer embezzling funds from an insurer

85
Q

Tom the agent replaced a client’s insurance policy when it was not in the client’s best interest. Tom could be found guilty of:

A

Twisting

86
Q

Group accident and health insurance policies issued in New York must generally include unmarried dependent child who is ____ years or younger

A

19

87
Q

Long term care policies solid in New York may NOT exclude coverage for

A

Senile dementia

88
Q

Insurance crimes which affect interstate commerce are prosecuted by the

A

US Attorney General

89
Q

How often must the superintendent examine each admitted insurance company?

A

Ever 6 years

90
Q

The superintendent serves a term of ____ years

A

4 years

91
Q

Which does restorative dental treatment cover?

A

Crowns

92
Q

The entire contract provision includes all of the following EXCEPT the

A

Changes made by the agent

93
Q

According to the Federal Fraud and False Statements Act, which of these is considered to be an intentional violation?

A

Making false entries in a company’s books

94
Q

An individual who has a contract with an insurance company to represent it is called a(n)

A

Agent

95
Q

The health plans according to the ACA are classified as

A

Bronze- 60/40, Silver- 70/30, Gold- 80/20, Platinum-90/10

96
Q

Under the affordable care act, a large employer that does not provide health insurance and owes an employer mandate penalty MUST pay an annual penalty, which is calculated by multiplying $12,000 by

A

The number of full time employees MINUS 30

97
Q

An insurer would be committing unfair discrimination if coverage was denied based upon

A

Marital status

98
Q

The maximum prison sentence given under federal law for unfair and deceptive insurance practices is

A

15 years

99
Q

Which of the following unfair trade practices involves an agent who made public, malicious statements about an insurer’s financial condition?

A

Defamation

100
Q

Which of the following is not covered under workers compensation?

A

Pain and suffering

101
Q

A client told an intentional lie to an insurer in order to receive a favorable premium. This is an example of

A

Fraud

102
Q

An agent’s secretary who solicits prospects on the telephone

A

Must be licensed as an agent

103
Q

If an insurer terminates an agent’s appointment, it must notify the superintendent within _____ days of the termination

A

30 days

104
Q

The branch of dentistry which deals with the replacement of missing parts is called

A

Prosthodontics

105
Q

During the examination of an insurer’s books and records by the superintendent, the insurer

A

Must not impede the examination

106
Q

A carrier for a small group health plan may refuse to renew the plan if the employer

A

Fails to pay the premium

107
Q

Under workers compensation laws, a permanent disability would be most likely caused by a

A

Loss of a foot

108
Q

An example of an unfair claims settlement practice is

A

Failing to promptly provide reasonable explanations for the denial of claims

109
Q

To be classified as a small employer in New York, an employer must employ

A

2-50 employees

110
Q

An outline of _____ is required for long-term care policies and provides a brief description of the important failures of the policy.

A

Coverage

111
Q

XYZ Corp was issued a group health policy for its employees. Under this plan a

A

Policy must be issued to XYZ and a certificate for each employee.

112
Q

John has a criminal record in which he was convicted of a felony that involved dishonesty. Under federal laws, how would John be able to engage in insurance transactions?

A

Given written consent by the state insurance regulatory agency.

113
Q

Under which circumstance may a commission be shared between two agents?

A

When they are both licensed in the same line of business.

114
Q

According to the affordable care act, what is the maximum amount an individual can contribute to a flexible savings account?

A

$2,500

115
Q

Group dental plans will frequently place a limit on annual benefits in order to minimize

A

Adverse selection

116
Q

A type of policy that would help pay for uncovered medicare claims is called

A

Medicare supplement

117
Q

One role of the superintendent is to

A

Enforce state insurance laws

118
Q

No insurance company may transact business in New York without a certificate of

A

Authority

119
Q

In NY, a medicare supplement policy must be _____ renewable

A

Guaranteed

120
Q

According to federal fraud and false statements regulation, what is required for a prohibited person to transact insurance business in this state?

A

Written consent from the state insurance regulatory agency

121
Q

When a medicare supplement policy is replaced, the policy owner will have a free look period of ____ days

A

30 days

122
Q

Which is considered to be an act of misrepresentation?

A

Falsifying the terms, benefits, advantages, or conditions of an insurance policy

123
Q

An agent has ____ days to report a felony conviction to a superintendent

A

30 days

124
Q

Which is NOT considered a federal punishment for unfair and deceptive insurance practices?

A

Community service- its more like prison time and massive fines

125
Q

How often must an insurance agents license in NY be renewed?

A

Every two years

126
Q

The free look period in NY for individual health insurance policies is ____ days

A

10 days

127
Q

A licensed agent must report any administrative action taken against the licensee in another jurisdiction or by another agency department in NY within ____ days of the final disposition

A

30 days

128
Q

An insurance company may only pay commissions to a(n)

A

Licensed agent appointed by the insurer

129
Q

What is the minimum benefit period that must be offered by a Long-Term care policy?

A

12 months

130
Q

Which of these individuals would require continuing education?

A

Resident agent

131
Q

Which of the following is required for the renewal of an agents insurance license?

A

Continuing education- license is renewed by playing the applicable renewal fee and completing 15 hours of continuing education every 2 years

132
Q

All medicare supplement policies must contain which provision?

A

Pre-existing conditions may be excluded from coverage for a maximum of 6 months

133
Q

An agent has recently died and leaves behind a spouse. In order for the agents insurance business to continue, the superintendent may issue to the agent’s spouse a(n)

A

Temporary insurance license

134
Q

If an agent would like to start using an assumed name, at what point must the superintendent be notified?

A

Before using the assumed name

135
Q

When a health policy requires payment of an additional premium to provide coverage for a newborn, how many days after the birth is the first payment due?

A

30 days

136
Q

The Fair Credit Reporting Act protects consumers

A

With guidelines regarding credit reporting and distribution

137
Q

Under the Affordable Care Act (ACA) how would a grandfathered health plan lose its grandfathered status?

A

The insurer significantly raises co-insurance charges, deductibles, or co-payment charges

138
Q

Proof of loss on health insurance claims must be submitted to an insurer within ____ days after the insured’s date of loss

A

90 days

139
Q

After a disability policy has been in force for ____ years, it is considered incontestable

A

2 years

140
Q

Which of these may NOT be used in a health insurance ad?

A

An insurance company’s trademark instead of the company’s actual name

141
Q

Charles is an agent who is licensed in NY but resides in NJ. Charles is considered to be a(n)

A

Non-resident agent

142
Q

What is considered interstate travel under the Federal Fraud and False Statements Act?

A

Puerto Rico

143
Q

Agents must complete ______ of continued education biannually

A

15

144
Q

If a new enrollee to a group health plan has had previous creditable coverage for up to ____ days prior to enrollment, the pre-existing condition provision will apply.

A

63 days (weird number)

145
Q

A disability policy where the premiums are due monthly require a grace period of

A

10 days

146
Q

An insurer may pay comission in which of the following scenarios?

A

To a licensed producer who is appointed with the insurer

147
Q

Coverage for newborns under an accident and health plan must include coverage for

A

Birth abnormalities

148
Q

Written notice of a health insurance claim should be given to the insurer within _____ days after the occurrence of any loss covered by the policy

A

20 days

149
Q

John the agent made public statements that falsely portrayed an insurer as insolvent. John would likely be found guilty of

A

Defamation

150
Q

CH 10 XYZ Corp pays the tax-deductible insurance premiums for a key employee disability policy. Which would be an appropriate tax consequence?

A

Benefits are fully taxable

151
Q

Tara the producer is delivering a specified disease insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT a(n)

A

Modified application with a new signature

152
Q

An insured was injured as an innocent bystander when someone committed a felony. The insurer is

A

Liable for the loss

153
Q

Which of these characteristics of an applicant is NOT taken into consideration when assessing risk for disability coverage?

A

Number of children

154
Q

One of the most important considerations when replacing health insurance would be

A

Exclusions on a new policy

155
Q

The gatekeepers role when used by an HMO is

A

Obtaining referrals to specialists from primary care physicians

156
Q

The IRS allows taxpayers to deduct medical expenses that exceed 75% of their AGI. Which of the following is considered to be a tax deductible medical expense under this rule?

A

Long term care insurance premiums

157
Q

In which of the following processes will the insurer oversee the insured’s hospital stay to confirm everything is going according to schedule and that the insured will be released as planned?

A

Concurrent review

158
Q

Which of the following typically does NOT provide a form of managed care?

A

Major Medical Indemnity Plan

159
Q

A 10% excise tax is normally applied to an early withdrawal from the IRA. According to HIPPA, this tax will not be applied if the withdrawal is used for medical expenses that exceed ____ of the individuals adjusted gross income.

A

75%

160
Q

XYZ Company has applied for group health insurance for its employees. What information would insurer underwriters likely use to determine the appropriate coverage and final premium rate given to the group?

A

An experienced rating system is used to estimate how much a specific group will have to spend on medical care

161
Q

How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes?

A

Not tax deductible- the premiums paid for personal disability income insurance are not deductible by the individual insured, but the disability benefits are tax-free to the recipient

162
Q

Which is considered to be a point of service (POS) plan?

A

Managed Care Plan

163
Q

Pierre is covered by his employer’s group major medical plan. His employer pays for 75% of the premium and he pays for 25%. How much would a $10,000 be taxable as income under this plan?

A

$0- benefits that fall under a major medical plan are considered to be a reimbursement for a loss, and is not taxable as income.

164
Q

Premium mode is a term used to describe the

A

Frequency of the premium payment

165
Q

The difference between pre-certification and concurrent reviews is that pre-certification

A

Occurs before the treatment is provided

166
Q

Lorenzo is self employed with an S corporation. He is unmarried and had a net profit for the tax year. What are the tax ramifications of his health insurance premiums paid for the year?

A

100% of his health insurance costs can be deducted from his gross income

167
Q

What happens when an insurance policy is backdated?

A

The policy’s effective date is earlier than the present

168
Q

Which of the following is NOT an example of utilization review?

A

“Ongoing inspection of an accident prone individual”

169
Q

Which of the following IS a requirement for ANY change in an insurance application?

A

Change must be initiated by the applicant

170
Q

Bill the producer is collecting the initial premium on a health policy. Which of the following statements is true?

A

The contract is not in force without the initial premium being paid.

171
Q

An example of a primary care physician would be a(n)

A

Internist

172
Q

A field underwriters main task is

A

To ensure an applicants medical information is accurate and complete

173
Q

States that have “no loss no gain” laws require a replacing policy to

A

Pay for ongoing claims under the policy it replaces

174
Q

Employees are required to work at least ____ hours per week to become eligible for a “small” employer health plan

A

20 hours

175
Q

All of these are typically sources of underwriting information for life or health insurance EXCEPT

A

Disclosure Authorization Response

176
Q

XYZ Corp pays the tax-deductible insurance premiums for key employees disability policy. Which would be the appropriate tax consequence?

A

Benefits are fully taxable

177
Q

Which of the following does restorative dental treatment cover?

A

Crowns

178
Q

How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes?

A

Not tax deductible- but disability benefits are tax-free

179
Q

Field underwriting performed by the producer involves

A

Completing the application and collecting initial premium

180
Q

Without a section 125 plan in place, what would happen to an employees payroll attribution to an HSA?

A

It would be considered taxable income to the employee

181
Q

The time limit for filing claim disputes is addressed in which provision of an accident and health policy?

A

Legal actions

182
Q

Tara the producer is delivering a specified insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT

A

Modified application with a new signature

183
Q

A dread disease policy is considered to be a type of

A

Limited health insurance policy

184
Q

The waiting period for a disability insurance policy

A

Excludes payments for a short term illness or injury

185
Q

The waiver of premium does NOT include which provision?

A

All future premiums are waived if the insured recovers from the disability

186
Q

A nonparticipating company is sometimes called a(n)

A

Stock insurer

187
Q

What guarantees the statements supplied by an insurance applicant are true?

A

Warranty

188
Q

Upon policy delivery, which of the following must a producer have an applicant sign if no initial premium was collected with the health insurance application?

A

A good health statement

189
Q

What is the required action to be taken by a New York licensee before operating under an assumed business name?

A

Notifying the superintendent

190
Q

Joe is a medicare participant who receives his benefits through a managed health care plan. Which medicare plan does he have?

A

Part C

191
Q

When does a health insurance policy typically become effective?

A

When initial premium is collected and policy is issued

192
Q

An example of a primary care physician would be a(n)

A

Internist

193
Q

What kind of life insurance policy issued by a mutual insurer provides a return of divisible surplus?

A

Participating life insurance policy

194
Q

All of these are examples of pure risk EXCEPT

A

Losing money at a casino- pure risk-loss is only possible outcome.

195
Q

Bill requires some nursing care and supervision, but NOT full time care. Which of these nursing home options would best serve him?

A

Assisted living

196
Q

Within _____ days after policy delivery, both medicare supplement and long-term care policies can be returned for a 100% premium refund.

A

30 days

197
Q

A type of insurer that is owned by its policy owners is called

A

A mutual insurer

198
Q
A

health stuff (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions