Insurance

Question 1

Broker

Answer 1

Represents the insured

Works with many insurers

Question 2

Agent

Answer 2

(captive) Represents the insurer

Binds the principal insurer

Question 3

Types of Authority

Answer 3

Express-specifically conferred
Not expressly granted-but assumed
Apparent

Question 4

Participating Policies

Answer 4

Sold by Mutual Companies (and to Stock Companies)

Question 5

Non-Participating Policies

Answer 5

Sold by Stock companies

Question 6

NAIC

Answer 6

National Association of Insurance Commissioners
Not Regulatory Body (but powerful)
Creates Model Laws

Question 7

Universal Insurance

Answer 7

Premium Unbundled

Question 8

Tax Treatment of Insurance

Answer 8

FIFO-Withdrawals as Ord Income, amt above basis

DB is income tax free

Question 9

MEC Contract

Answer 9

Fails 7 pay test
Only in Unbundled Policy-UL and VUL
SPLI
LIFO
10% of all withdrawals pre 59.5

Question 10

Per Capita-Beneficiary

Answer 10

By head

Question 11

Pricing Factors of Life Insurance

Answer 11

Mortality
Interest Options
Expenses

Question 12

Annuity Taxation

Answer 12

LIFO

pre August 14, 1982- FIFO

Question 13

1035 Exchange

Answer 13

Cannot go Anuity to Life Insurance
Life to Life, Life to Annuity
Endowment to Endowment

Question 14

HMO

Answer 14

Gatekeeper, need permission for specialist, staff model most restrictive, then Group Practive, then IPA, Indeoendent Practice Association model

Question 15

PPO

Answer 15

Fairly liberal, larger deductible and coinsurance out of network. Can have gatekeeper

Question 16

POS

Answer 16

Point of Service

Question 17

EPO

Answer 17

Smaller version of PPO, Exclusive Provider Organization

Question 18

HSA (health savings account)

Answer 18

Requires HDHP-minimum 1,200/$2,400 single vs family
Max out of pocket (12) $6,050/12,100
Max Annual Contribution: 3100/6,250
$1000 Catch up after 55
20% Penalty

Question 19

HIPAA

Answer 19

Cannot apply coverage exclusion for pre-existing conditions for more tan 12 months
No loss of coverage for prex conditions
not ancillary benefits-DI, dental etc

Question 20

Medicare Part A

Answer 20

Some Health Services: Hospice, Skilled Care
Very Limited LTC
40 quarters, no premium

Question 21

Medicare Part B

Answer 21

Physician, outpatient and ambulance

Question 22

Medicare Part C

Answer 22

Combines A,B, D

Question 23

Medicare Part D

Answer 23

Prescription Drug Benefit
Total out of Pocket $4,700
320 deductible,
25% copayment of next 2,600
3,700 donut hole
then 5% co-insurance

Question 24

Medigap Plans A-N

Answer 24

Fill in Deductible and co-pay gaps with medicare

No substantial LTC benefits

Question 25

Noncancellable

Answer 25

Premium and renewal guaranteed

Question 26

Guaranteed Renewable

Answer 26

No premium increase for individuals, but can change for entire policyholder class

Question 27

ADL’s

Answer 27

Dressing
Transferring
Toileting
Eating
Bathing
Continenece 
(plus cognitive impairment/dementia)

Question 28

Skilled Nursing Care

Answer 28

24 hr registerd nurse, supervision of Dr

Question 29

Medicare LTC Benefits

Answer 29

Must spend 3 days in hospital
Must enter Nursing facility within 30 days
Benefits- First 20 days paid in full
21-100 paid with a deductible of $144.50
100+ no benefit

Question 30

Homeowners Insurance: Open Peril

Answer 30

Covers everything (except exclusions), floods not covered