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IL Life and Health Insurance > IL Health Insurance Law > Flashcards

IL Health Insurance Law Flashcards

1
Q

Ads must be kept for…

A

4 years

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2
Q

Ads must disclose…

A

Elimination/waiting periods; exclusions for pre-existing conditions; source of stats; insurer’s name; any compensation paid for testimonials

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3
Q

Ads can’t…

A

Frame exclusions as positive; badmouth government insurance options; disparage the competition; frame a product as a “limited time offer” unless it’s true

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4
Q

Probationary periods for illnesses can’t last longer than…

A

60 days

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5
Q

Accident-only policies need to cover…

A

Accidents right away

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6
Q

If insurer cancels or non-renews, pregnancy benefits…

A

Ned to remain in effect for a reasonable time

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7
Q

Pre-existing conditions are those from as far back as…

A

2 years when applying

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8
Q

Most policies must be guaranteed renewable regardless of…

A

Deteriorating health

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9
Q

The cost of riders must be…

A

Disclosed

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10
Q

Applications need to determine if…

A

Policy is meant to replace another policy

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11
Q

Policies must include…

A

10 day free-look

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12
Q

Insurers must offer major medical insurance to…

A

All small groups (2-50) regardless of health

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13
Q

Group plans must be…

A

Guaranteed Renewable

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14
Q

Insurers that end group coverage must continue…

A

To cover disabled members for a limited time

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15
Q

Group replacements must carry over deductibles paid within…

A

90 days of the change

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16
Q

Major medical insurance for groups can’t reject or charge a member more because of…

A

Health

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17
Q

Pre-existing conditions are those within…

A

6 months before joining the group

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18
Q

Before the ACA, pre-existing conditions could be excluded for no more than…

A

1 year

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19
Q

IL Group Health Continuation Law

A

Employee can keep group coverage for 12 months after leaving group

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20
Q

IL Group Health Continuation Law applies to groups smaller than

A

20

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21
Q

IL MCR Supplements cannot sell…

A

Duplicate coverage, multiple policies or coverage that already exists under MCR

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22
Q

Producer compensation for replacing insurance can’t be more than…

A

Renewing existing coverage

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23
Q

IL MCR Supplement coverage must be…

A

Guaranteed Renewable

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24
Q

IL MCR Supplement coverage must include…

A

30 day free-look

25
Q

LTC Producers need an…

A

Accident/health license

26
Q

LTC producers must complete what before selling?

A

8 hour LTC course

27
Q

Every 2 years, LTC producers must take what to keep selling?

A

4 hour LTC course

28
Q

IL LTC insurance can’t be limited to…

A

Skilled care or require prior hospitalization

29
Q

IL LTC insurance must disclose whether policy is..

A

Tax-qualified

30
Q

IL LTC insurance must include…

A

30 day free-look

31
Q

IL LTC benefit triggers can’t be more restrictive than…

A

Inability to perform 3 ADLs or cognitive impairment

32
Q

IL LTC insurance must offer…

A

Inflation protection

33
Q

IL LTC insurance must include…

A

Non-forfeiture benefits

34
Q

IL LTC: If home care is covered…

A

Adult day care is covered

35
Q

IL LTC: Pre-existing conditions are those within…

A

6 months before applying

36
Q

IL LTC: Must be at least…

A

Guaranteed renewable

37
Q

IL LTC: Price increases based on age can only be until…

A

65

38
Q

IL LTC: Must have what grace period?

A

30 day

39
Q

IL LTC: Must be able to designate…

A

Third party who will receive cancelation notices

40
Q

IL Short-Term Health Insurance

A

Health insurance must be in place for less than 6 months

41
Q

IL STC is not…

A

Guaranteed renewable

42
Q

IL STC can’t be sold without…

A

First page disclosures

43
Q

First-Page Disclosures

A

Might not offer essential health benefits set by federal law; might not have consumer protections for pre-existing conditions

44
Q

IL HMO: Must cover out-of-network care and…

A

Ambulances in emergencies

45
Q

IL HMO: Must cover reconstructive surgery after…

A

Mastectomy

46
Q

IL HMO: Must cover mammograms but…

A

Can set limits on frequency

47
Q

IL HMO: Must provide certificates to members within…

A

30 days

48
Q

IL HMO: Need a what to deal with disputes?

A

Grievance committee

49
Q

IL HMO: Consumers can still…

A

Complain to the state

50
Q

Accident and health insurers can’t discriminate based on…

A

Disability, unless it’s actuarily justified

51
Q

Accident and health insurers can’t discriminate based purely on basis of…

A

Blindness

52
Q

IL Guaranty Association: For health insurer solvency, funds can pay up to…

A

$500K

53
Q

IL Guaranty Association: For disability and LTC, funds can pay up to…

A

$300K

54
Q

IL Guaranty Association: Ads can’t mention the fund to…

A

Reassure shoppers

55
Q

IL Guaranty Association: Doesn’t apply to…

A

Dental or vision insurance

56
Q

IL Limited Health Service Organizations provide…

A

Dental or vision care in manner similar to HMO

57
Q

IL Limited Health Service Organization rules are similar to those for…

A

HMO’s

58
Q

IL Limited Health Service Organization requires what to sell?

A

Accident and health license

IL Life and Health Insurance (29 decks)

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