Idaho Health/ Disability Flashcards

1
Q

What does Newborn Coverage cover?

A

All disability policies that provide coverage for injury or sickness for newborn dependent children must provide same benefits as the other children when they’re born.

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2
Q

What must a Newborn Coverage cover?

A

Congenital abnormalities of infants from birth

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3
Q

What reasons are not valid to deny Newborn Health Coverage?

A

If the child is born out of wedlock
Claimed as a dependent on taxes
Does not live with the parent or in insurer’s service area

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4
Q

Within how many days of being placed must an adopted child be covered under Newborn Coverage?

A

60 days

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5
Q

Who is a dependent?

A

Unmarried child under 25 who receives more than half of income from parent
Unmarried child of any age who is medically disabled and dependent

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6
Q

Within how many days of a child reaching maturity under a Handicapped Dependent policy must the insurer receive proof in order to continue coverage?

A

31 days

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7
Q

How often is proof needed under the Handicapped Dependent Policy?

A

No more than once a year after reaching the 2 year limit after reaching the limit age.

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8
Q

How long is the free look period for health insurance?

A

10 days

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9
Q

If a policy is paid weekly, what is the grace period?

A

Not less than 7 days

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10
Q

If a policy is paid monthly, what is the grace period?

A

Not less than 10 days

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11
Q

If a policy is paid less frequently than monthly, what is the grace period?

A

Not less than 31 days

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12
Q

When must losses caused by pre-existing conditions be covered?

A

If they aren’t specifically excluded
Happen 12 months from effective date of policy
Simplified application with no questions regarding health

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13
Q

Policies where the insurer reserves the right to refuse renewal must begin with a statement providing at least how many days advance?

A

30 days

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14
Q

No Medicare supplement policy can be delivered in Idaho if it limits/ excludes coverage by what?

A

Type of illness
Treatment
Medical conditions
Accident

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15
Q

No Medicare supplement policies may be more restrictive than what?

A

Medicare or duplicate benefits

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16
Q

What is the free look period on Medicare Supplement Insurance?

A

30 days

17
Q

How long must Long Term Care last?

A

At least 12 consecutive months

18
Q

When is the only time that the waiting period for Long Term Care be increased?

A

If policyholder increases benefits

19
Q

Long-Term Care must provide a protection option against what?

A

Inflation

20
Q

Long-Term Care Partnerships

A

Those who have exhausted/ partially exhausted private LTC benefits can apply for Medicaid without having to meet same means-testing requirements

21
Q

In order to sell Long-Term Care insurance an agent must be licensed with what?

A

Life and disability

22
Q

Continuing Education Requirements for Long-Term Care Insurance?

A

One time training course
Ongoing training every 24 months
One time course at least 8 hours
All thereafter must be at least 4 hours each

23
Q

How many employees must an employer have to be considered a small employer?

A

At least 2

No more than 50

24
Q

Who is an eligible employee under the Small Employer Health Insurance Availability Act?

A

Full-time at least 30 hours per week unless there’s an agreement with employer and carrier, then between 20 and 30 per week

25
Q

Every small employer carrier must offer small employers what health benefit plans?

A

Basic
Standard
Catastrophic

26
Q

The restrictions placed on premiums in order to prevent insurers from charging excessive rates is due to what act?

A

Individual Health Insurance Availability Act

27
Q

For Disability Income Protection Coverage, after what age may the payments be reduced and to what amount?

A

62

At least 50% of what was paid before 62

28
Q

What is the elimination period for disability income for a benefit of 1 year or less?

A

No more than 90 days

29
Q

What is the elimination period for disability income for a benefit of 1 - 2 years?

A

No more than 180 days

30
Q

What is the elimination period for disability income for a benefit lasting longer than 2 years?

A

365 days

31
Q

What is the Idaho Health Carrier External Act?

A

Ensure uniform application of external review, all people have the opportunity for an independent review for an adverse benefit determination

32
Q

If a person requests an expedited external review, how long will the review be made?

A

72 hours