Idaho Health/ Disability Flashcards
What does Newborn Coverage cover?
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.
What must a Newborn Coverage cover?
Congenital abnormalities of infants from birth
What reasons are not valid to deny Newborn Health Coverage?
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
Within how many days of being placed must an adopted child be covered under Newborn Coverage?
60 days
Who is a dependent?
Unmarried child under 25 who receives more than half of income from parent
Unmarried child of any age who is medically disabled and dependent
Within how many days of a child reaching maturity under a Handicapped Dependent policy must the insurer receive proof in order to continue coverage?
31 days
How often is proof needed under the Handicapped Dependent Policy?
No more than once a year after reaching the 2 year limit after reaching the limit age.
How long is the free look period for health insurance?
10 days
If a policy is paid weekly, what is the grace period?
Not less than 7 days
If a policy is paid monthly, what is the grace period?
Not less than 10 days
If a policy is paid less frequently than monthly, what is the grace period?
Not less than 31 days
When must losses caused by pre-existing conditions be covered?
If they aren’t specifically excluded
Happen 12 months from effective date of policy
Simplified application with no questions regarding health
Policies where the insurer reserves the right to refuse renewal must begin with a statement providing at least how many days advance?
30 days
No Medicare supplement policy can be delivered in Idaho if it limits/ excludes coverage by what?
Type of illness
Treatment
Medical conditions
Accident
No Medicare supplement policies may be more restrictive than what?
Medicare or duplicate benefits
What is the free look period on Medicare Supplement Insurance?
30 days
How long must Long Term Care last?
At least 12 consecutive months
When is the only time that the waiting period for Long Term Care be increased?
If policyholder increases benefits
Long-Term Care must provide a protection option against what?
Inflation
Long-Term Care Partnerships
Those who have exhausted/ partially exhausted private LTC benefits can apply for Medicaid without having to meet same means-testing requirements
In order to sell Long-Term Care insurance an agent must be licensed with what?
Life and disability
Continuing Education Requirements for Long-Term Care Insurance?
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
How many employees must an employer have to be considered a small employer?
At least 2
No more than 50
Who is an eligible employee under the Small Employer Health Insurance Availability Act?
Full-time at least 30 hours per week unless there’s an agreement with employer and carrier, then between 20 and 30 per week
Every small employer carrier must offer small employers what health benefit plans?
Basic
Standard
Catastrophic
The restrictions placed on premiums in order to prevent insurers from charging excessive rates is due to what act?
Individual Health Insurance Availability Act
For Disability Income Protection Coverage, after what age may the payments be reduced and to what amount?
62
At least 50% of what was paid before 62
What is the elimination period for disability income for a benefit of 1 year or less?
No more than 90 days
What is the elimination period for disability income for a benefit of 1 - 2 years?
No more than 180 days
What is the elimination period for disability income for a benefit lasting longer than 2 years?
365 days
What is the Idaho Health Carrier External Act?
Ensure uniform application of external review, all people have the opportunity for an independent review for an adverse benefit determination
If a person requests an expedited external review, how long will the review be made?
72 hours
