LAH- MN regulations- health Flashcards
1
Q
free look period for life insurance ?
replacement policies?
A
10 days
30 days
2
Q
Commissioner of commerce duties:
A
elected by governor
can assist with making rules and regulations
examine records (must every 5 years)
CANT make laws, only enforce them
3
Q
commissioner orders:
- fine amount?
A
- restore deficiency
- cease and desist= 10,000$ fine for each day
4
Q
notice and hearings from insurer or agent from the commissioner
- amount of days to notice and appeal?
A
30 days to appeal at hearing
30 days for commissioner to hold hearing
5
Q
Forms and rates must be approved by commissioner before use or how many days have gone by without hearing from commish’s.?
A
60 days elapsed without hearing anything
6
Q
Reciprocal insurer
A
- UNincorporated group
- insure EACH OTHER and share losses with each other
- attorney in fact manages it
- no life insurance
7
Q
mutual insurer
A
owned by policyholders
can participate in dividends
- refund of premium = NOT taxed
board of directors = management
legal reserves (non assessable)
8
Q
stock insurers
A
general public and don’t have to be policy owners
-(subscribers)= shareholders/owners
board of directors
non participating policies (policyholders don’t get dividends)
- stockholders do
9
Q
fraternal insurers
A
lodge system
solely for the benefit of its members
member get certificates
10
Q
subrogation
A
legal right of insurance company to sue a third party who caused the loss to the insured
11
Q
LTC study requirements
A
8 study hours
4 ours of continuing education every 2 years
12
Q
annuity training
A
one time 4 hour course
13
Q
continuing education
A
24 credit hours per 2 years
3 hours in ethics
14
Q
license expiration
A
Last day of birth month every 2 years (3 years for first one)
15
Q
temporary license
A
180 days
surviving spouse
employee of the business entity
disgnee of a producer who is going into armed forces
16
Q
change of address days to notify?
A
10 days
17
Q
commissioner must notify agent of nonrenewable in writing as to why
- the agent has ___ days to respond?
- hearing must be held in ___ days after response from agent?
A
30 days
30 days
18
Q
revoked license for how long?
A
minimum 2 years and 20,000$ performance bond (filed with commissioner)
19
Q
amount fine per violation to a producer?
A
10,000$
20
Q
appointment of insured to the insurer rules?
A
must be appointed by insurer
or
permission to transact business on behalf of insurer AND obtains appointment within 15 days of first application
21
Q
insurer rules to appoint an agent?
A
file notice of appointment within 15 days of contract or first application of insured
22
Q
commissioner wil verify appointment in how many days if eligible?
if ineligible?
A
30 days
5 days
23
Q
termination of appointment:
1- if insurer terminates agent appointment, how many days to commissioner?
2- notice to agent from insurer?
3- agent file appeal of termination with commissioner days?
A
30 days
15 days
30 days
24
Q
penalty to insurer for not filing appointment is?
___ $ per offense (per sale of unappointed agent)
____$ max amount
days to pay fine to commissioner after notice?
A
25$ per
300$ total
10 days
25
agent administrative action must be notified to commissioner within___ days?
30 days
26
criminal PROSECUTION of agent must notify commish within ___days?
30 days
27
agent criminal CONVICTION/plea notify commish with ___ days?
10 days
28
reinstating a lapsed license must be done within how many months???
12 months (1 year)
29
rebating
- legal amount?
- fine amount for penalty?
offering or giving something in exchange for a sale
- anything over 25$ is considered rebating
- 60 to 200$ per violation
30
twisting
replacing one policy for another policy without benefit to insured
31
advertising material includes:
```
printer and published material
audio
descriptive literature
radio or television
billboard
circulars or leaflets
form letters
prepared sales talks/presentations
```
32
number of years loan records must be kept?
6 years
33
policies must be delivered with how many days to insured?
30 working days
34
financial and complaint records of agents must be held for how many years?
6 years
35
agent must request refund from insurer within how many days after receiving cancellation notification from insured?
how many days must refund be issued in once received by agent from insurer?
- 10 days
| - 5 days
36
company complaint records must be kept on file for how many years?
4 years
37
policy forms, applications and advertisement and claim records:
must be kept on file for how many years?
3 years
38
flesch scale is what?
readability of insurance policies
39
after policy termination, all unearned premium must be returned within how many days after insurer receives request?
30 days
40
oral binders must be followed up in writing within how many days?
5 days
41
must have written or verbal communication(followed up in writing) of the agents?
name
company they represent
that they are in the business of selling insurance
42
sources other than the application that underwriters use with permission from potential insured?
driving records
medical records
credit reports from consumer reporting agency
43
fair credit reporting act says:
must notify consumer in BOTH verbal and writing when credit report is being done (and provide a copy if the consumer wants it)
44
adverse credit information stays on report for how many years?
7 years
10 years for bankruptcy
45
gramm leach billey act:
insurance companies must disclose their privacy policies
46
guaranty association
protects insured from the solvency or bankruptcy of an insurer
- association pays unpaid claims from the company
47
policyholders rights must be given at?
time of application or with 72 hours (3days) if not taken in person
48
if mailed, it is considered notified by when?
postmarker, properly addressed, prepaid postage
49
how many days until refund of free look period after insurer receives cancellation and policy?
10 days
50
if NO cancellation policy is described in a policy...how long do the insured have to cancel and still get a full refund?
days until refund is issued?
1 year
10 days
51
amount of credit insurance that can be issued
principal amount PLUS 1 monthly payment
52
after 63 months, the amount should not exceed what?
unpaid loan amount - interest unearned + 2 monthly payments
53
group life insurance COBRA (continuation)
- length of coverage?
- time to convert?
premiums payment?
- 18 months(or until other coverage is obtained),
- 60 days to elect conversion coverage
- can't exceed 102% of plan cost for premiums paid by individual
54
death of COBRA group life employee during the 60 day sign up/continuation period...what happens?
coverage is in force and death benefit is paid as normal minus the unpaid premiums
55
conversion of group life
allowed terminated employee and dependents to convert to INDIVIDUAL policy with NO insurability proof, paid by individual
- similar benefits as the group policy
- 30 days
56
settlement contracts of life insurance
- can't agree before or within first 4 years of contract
| - must not have knowledge of testing results within the 18months prior to policy effective date
57
change of ownership or beneficiary, insurer must respond within what time length? - life
- 30 calendar days written notice
58
notice regarding replacement must be issued by when?
- signed by both parties and left with who?
- copy submitted with what to replacing insurer?
at the time of application (taking application)
- signed by both parties and left with INSURED
- signed copy of notice and application must be turned in to insurer
59
replacing insurer must notify the existing insurer within how many days of receiving replacement notice and application?
written notice within 5 working days
60
ALL replacement life insurance information must be kept on file for how many years? (notice of replacement, application, existing insurer, agent signings)
6 years
61
replacement Exemptions are?
credit life
group life or group annuities
within same insurance company
policies still under receipt
62
coverage of health for physically disabled child must be notified to the insurer by when?
31 days before dependent child reaches policy age limits (every 2 years after that)
63
newborns and children coverage from when? (includes adoption)
- up to what age?
- covers what?
covered immediately at birth (no notice required)- additional premiums will be charged
- up to age 19, anything initiated before age 19
- medical and dental (orthodontic and surgery for ONLY cleft lip or palet)
64
health and accident conversion/continuation must be at least what for renewability?
guaranteed renewable
65
health and accident conversion/continuation must be the same for survivors until when??
surviving spouse becomes covered under new group plan OR coverage would have terminated as normal (without the death of insured)
66
survivor in H&A has how many days after notification to make premium or fee payments?
- how many days must insurer send written notice of cancellation?
- premiums now paid by survivor should not exceed?
90 days
- 30 days before cancellation
- 102% of plan cost
67
termination of employee COBRA continuation coverage in H&A
- length of coverage?
- preexisiting conditions, what is primary?
- child birth during continuation period?
- premium amount?
- time to elect coverage?
- 18 months (or new coverage is obtained)
- preexisting conditions MUST still be covered under old plan for 18 months if new plan doesn't cover them
- child is automatically part of new plan if there is one
- not more than 102%
- 60 days to elect coverage
68
CONVERSION of H&A from group to individual
- time to make conversion and premium payment?
- insurability?
- coverage amount?
- 30 days to convert after continuation period
- no proof of insurability
- minimum qualified plan benefits
69
divorced spouse and dependents
- continuation of coverage?
- conversion of coverage how many days to elect?
automatically continuation of coverage, and premiums paid by the dependent to the policyholder (who then pays the insurance company)
- 30 days after continuation coverage to elect and pay premium for conversion coverage to individual coverage
70
mental health and chemical dependency must be treated as such?
- same as any other patient in the hospital covered under the Affordable Care Act
71
grace periods length for premium payments in H&A?
- weekly
- monthly
- quarter, semi, or annual
- 7 days
- 10 days
- 31 days
72
grace periods length for LIFE policies?
31 days (1 month)
73
reinstatement for H&A?
- length until automatically covered?
- length of past premiums collectable?
- insurability and application?
- waiting (probationary period) length? for what?
- automatically reinstated if not rejected after 45 days
- up to 60 days of past premiums
- can (don't have to) require proof of insurability and new application
- 10 days for sickness, accident=immediately covered
74
notice of claim for H&A time length days?
| - for disability, continued notice every ?
- 20 days
| - every 6 months during disability after original notice
75
claim FORMS, how many days until issued from insurer?
- within 15 days after receiving notify of claim
76
proof of loss for H&A time to submit from insured?
- 90 days after date of loss
| - no later than 1 year from date of loss if reasonably incapable at time of loss
77
time of payments for H&A after proof of loss is furnished?
- immediately for medical after proof of loss
| - minimum monthly payments for disability
78
legal action in claims?
- length to wait for insured before sueing?
- max time to sue?
- 60 days after proof of loss
| - 3 years from proof of loss
79
change of occupation (optional provision)
- more hazardous = ?
- less hazardous = ?
more = reduced BENEFITS to what premium would cover
less= reduced PREMIUMS, returned pro rata excess unearned premiums paid
80
multiple insurance with SAME insurer (optional provision)
- one policy is picked by insured and other is cancelled (premiums refunded)
- claims made on policy that is picked
81
multiple insurance with DIFFERENT insurer (optional provision)
both companies pay pro rata amounts for their share of loss from the policies to equal a indemnity amount total for the claim
82
cancellation (optional provision)
| - days to notify in cancellable policy?
- 5 days written notice before cancellation
| - premiums unearned will be returned pro rata
83
CHIA- comprehensive health insurance act
| - under MCHA
allows for safety net...HIGH RISK pool of applicants that could still get some coverage
84
Medicare supplement policies standards:
| - pre existing conditions coverage length?
- must provide coverage for the first 6 months for any condition not diagnosed or treated in the 90 days prior to effective date
85
Medicare supplement policies standards:
- what two standards are there for policy types?
- mandatory offer of?
- Basic or Extended basic
| - BOTH must have written offer and explanations
86
Medicare supplement policies standards:
| - outline of coverage must be derived when?
at time of application and BEFORE premium payment
87
Medicare supplement policies standards:
- if insured become eligible for MA (medical assistance) they can suspend or pause supplement plan for up to how many months?
- notification time to supplement insurer?
- reinstatement of supplement policy?
- time to notify reinstatement?
- pause or suspend for up to 24 months (2 years)
- must notify insurer within 90 days of eligibility for MA
- reinstated immediately day MA is cancelled
- must notify proof of loss of MA within 90 days of cancellation to insurer
88
Medicare supplement policies standards:
| - guide to medicare supplement must be given to applicant when?
- At time of application (plus signed notice saying they issued this to applicant)
89
free look period of MEDICARE supplement policies?
- 30 days for full refund
90
commissions paid to an agent selling a medicare supplement policy must be?
level for the first 4 years
91
penalties under medicare supplement policies
- 5000$ per violation
| - felony
92
LTC: coverage minimum?
| - nursing facilities only care minimum?
25,000$ lifetime benefit (minimum)
one year (minimum)
93
LTC: pre existing conditions must be covered with what time frames?
- after effective date?
- screening before date?
- waiting days amount PER benefit period?
- exclusions?
cover pre existing conditions in the first 6 months
anything not treated or diagnosis in the 90 days before
180 days
CANT exclude mental disorders such as ahlzhimers or dementias
94
LTC; free look period length?
30 days
95
LTC: cancellation
- must notify at least one other person other than insured before cancellation
- can only cancel for non payment
- prior to cancellation of policy, must notify insured and others within how many days before cancellation?
30 days
96
qualified LTC; federal taxes
- premiums?
- benefits?
- premiums= Tax Deductible
benefits = not taxed as income
97
qualified LTC requirements:
-refer to 5 ADLs
- non forfeiture requirement
reduced paid up
extended term
shortened benefit period
98
LTC pre existing conditions
| - length before effective date to be consider pre existing?
6 months before effective date
99
LTC outline of coverage must be presented when?
before application is given
100
LTC claim denials must issue a formal written reason as to why within how many days?
60 days
101
LTC incontestability periods
| 3 of them...what are they?
less than 6 months= can deny a claim or cancel a policy if material misrepresentation is found
6 months- 2 years= can deny a claim or cancel a policy if material misrepresentation is found PERTAINING TO THE CLAIM being made at that time by the insured
after 2 years= only can be cancelled or non payment due to fraud from the insured
102
LTC inflation protection options:
3 of them
inflation protection is AUTOmatically included unless formally signed off by insured that it should be reject
- annual benefit increase of minimum 5%
- insured can periodically increase benefits without proof of insurability
- coverage for specified percentage of actual coverage
103
LTC acceptable exclusions:
- pre existing conditions
- mental disorders EXCEPT alzhemiers
- alcohol or drug addiction
- acts of war or self inflicted injuries
- treatment in government facilities (VA)
- benefits covered by medicare
- expenses for services provided by immediate family
- expenses reimbursable from SS
104
LTC group continuation and conversion
- time needed group plan to be in force to be eligible for continuation?
- how many days to convert?
- continuously for 6 months prior to termination of group
continuation= insured pays premiums and identical or similar benefits
conversion= application and premium due within 31 days after termination from group
- effective date is the date from termination of group
- original age of policy is used for conversion
105
LTC forms needed before application?
- shoppers guide
- LTC worksheet
- Things you should know about LTC buying
106
LTC penalty fines?
3x the commission amount up to 10,000$
107
LTC education requirements
8 hours initially
4 hours every 2 years after for CE
108
HMOs:
- what are people who are insured called and what do they pay?
- HMOs operate under what?
- what does HMO do (combines what?)
- how are health care providers paid under HMOs?
- subscribers (pay flat monthly fee- capitation fee paid to health providers)
- operate by providing a network
- combines the financial and delivery services part of health care
- providers are paid a flat monthly fee, regardless of the amount of care provided that month to subscribers
109
HMO subscribers receive what to show they are covered?
- issued when for individuals?
- issued when for group?
evidence of coverage
- immediately for individuals
- within 15 days for group
110
HMOs grace period?
31 days
111
HMOs free look period?
10 days
112
HMOs days to notify subscribers or groups of changes in fees?
30 days prior to changes
113
participating providers within the network distances?
30 miles or min for primary providers
60 miles or min for specialty providers
114
HMOs have what for cost sharing?
except for what?
co payments: flat fee for drugs and services
- NO co payment for preventative care
deductibles: per person or per family PER YEAR.
- except for preventative care
annual out of pocket limits
cost sharing does not apply to medical assistance programs or medicare
115
HMOs Open enrollment period is how many days minimum per year?
any underwriting restrictions must be applied for doing this period with who?
-how many days until approval?
14 days
- commissioner of health
- approval within 30 days
116
HMOs continuation or conversion
continuation last until covered under another plan or medicare or date it would have stopped originally before continuation
continuation must not exceed 102% of plan cost for premiums
conversion = have 30 days from termination of continuation to elect conversion and pay premium
117
HMOs dependent coverage when enrollee become enrolled in medicare
- how many months of continued coverage for dependents?
- age for dependent kids?
continuation is stopped when dependent become enrolled in another plan or medicare
- 36 months
| - 26 years old under ACA
118
HMO must provide replacement coverage for cancellation of non qualified reason (anything but failure to make payments, fraud, moving out of area)
within how many days?
-replacement coverage has no what?
90 days before cancellation takes effect
- no waiting period
no preexisting conditions exclusion
no proof of insurability
no interruption in coverage
119
penalties under HMOs
- for the company?
- for agents first offense?
- second offense?
corporation= max 5000$
agent 1st= 1,000$ and/or 90 days jail
agents 2nd= 3000$ and/or 1 year jail
120
small employers in MN must have how many employees?
1 - 50 (not including the sole proprietor)
121
small employer who is leaving small employer benefits must notify the commissioner within how many days prior to leaving?
must cover all employees for renewals within how many days from notice to commissioner?
commissioner notice be made 180 days prior
renewal coverage for employees for 120 days after notice
122
reinsurance
- primary company?
- secondary company?
- ceding
| - assuming
123
examination of records every how many years by commissioner?
5 years
124
cease and desist penalties $$?
10,000$ per day
125
minimum suspension amount of agent license?
3 months
126
minimum revoked license?
2 years and 20000$ performance bond
127
violation fine to agent for suspension/revocation?
10,000$ per violation
128
- unappointed agent penalties to company $$$?
| - how many days to pay?
25$ per sale up to 300$
- 10 days
129
license of agent valid for how many years? (after the first one)
-expires when?
2 years
-expires last day of birth month
130
reinstatement of lapsed agent license within how many months?
- fees paid?
- 12 months
| - 2x renewal fees
131
military personnel can reinstate policy after how many days when finished active duty?
- 90 days after active duty
132
oral binders length?
5 days
133
loans must be on file for how many years?
6 years
134
days to deliver a policy?
30 days
135
financial and agent complaint records kept for how long?
6 years
136
agent must notify insurer (once notified by insured) of cancellation of policy within how many days?
- how many days to deliver refund after initiation?
- 10 days
| - 5 days
137
complaint records of company on file for?
4 years
138
forms, apps, advertising, claims file length?
3 years
139
unearned premium refunds length to return?
30 days
140
false statement or fraud penalty length?
10 years (15 if destroying)
141
embezzlement penalty length?
10 years (15 if damaging)
142
length to continue calling after initiating contact?
3 months
143
length to call after last purchase?
18 months
144
fine amount for calling someone on National do not call list>
11,000$
145
gramm leach billy act is what?
| - how often to issue?
privacy policies
| - time of policy and 1 every year after
146
policy must be delivered to insured after approval within how many days?
30 days
147
HMO open enrollment period length?
30 days
148
grievance period to solve complaints in HMO
180 days (6 months)
149
time until reinstatement is automatically in force?
45 days to notify insured
150
notice of claim days?
20 days from loss date
151
claim forms days after notice of claim?
15 days
152
proof of loss days?
90 days FROM DATE OF LOSS
153
claims paid when?
immediately after receiving proof of loss
154
legal actions to be taken on claims after how many days?
| - up to how long?
must wait 60 days
| - must happen within 3 years
155
```
free look periods for:
- health and accident?
- life?
-medicare?
-LTC?
replacement policies?
```
- 10
- 10
- 30
- 30
- 30
156
recurrent disability for disability income is considered the same disability period if readmitted within how many days?
90 days
157
short term disability:
- elimination period?
- benefit period?
- own or any occupation?
30 days
- 6 months to 1 year
- own occupation
158
Long term disability:
- elimination period?
- benefit period?
- own or any occupation?
90 days to 6 months
- 2 -5 years
- any occupation
159
guaranteed insurability time frames:
- how often?
during what ages?
every 3 years
| 25 - 40 years old
160
BOE time tables:
- elimination period?
- benefit period?
taxes:
- premiums
- benefits
15-30 days
1-2 years
- tax deductible
- taxed
161
key person time tables:
- elim?
benefit?
taxes:
- 30 - 90 days
1-2 years
- premiums= not deductible
benefits= tax free
162
buy sell time tables:
- elim?
benefit?
taxes:
LONG 1-2 years
payments done in 5 years
not tax deductible premiums
tax free benefits
163
conversion from group policy to an individual policy the insured has how many days to elect conversion?
31 days (usually after continuation ends)
164
dependent child covered until what age?
| - must provide how many days before for disability extension for age expiring child?
26 years old
| -31 days prior to 26
165
Hipaa: switching jobs
- remain covered if you were covered for ___ months continuously before switch?
- how many days to make the switch while still being covered?
12 months
-63 days
166
HIPAA mandated benefits for pregnancy:
- normal birth time?
- seas sextion time?
48 hours
| 96 hours
167
COBRA
- how many employees must employer have?
- length to continue benefits?
- non termination length?
minimum 20 employees
18 months
36 months
168
notification of COBRA from employer to employee time?
| - days to elect/accept continuation?
14 days to notify
60 days to elect
169
OBRA. how long is continuation length if disabled at time of trigger event under cobra?
- or disabled within how many days from event?
29 months instead of 18
60 days
170
eligible for medicare on what day?
first day of the month turning 65 years old
covered under SS disability for 2 years
child disabled after 18 but before 22
171
part b enrollment period if not done initially?
- plan start when if enrolled in this window?
January 1 - march 31
- July 1
172
Part A benefits:
- inpatient care full coverage days?
- deductibles paid every what?
- coinsurance days?
- lifetime reserve days and coinsurance does what?
admittance period for one claim?
full coverage after deductible for 1-60
61-90 coinsurance
every benefit period
lifetime reserve days with co insurance going up from insured portion 60
day admitted - 60 days after discharge (if back in that time, same benefit period)
173
```
Part A medicare benefits:
skilled nursing facility
- full coverage for how many days?
coinsurance coverage for how many days?
days in hospital before eligblity?
```
1-20
21-100
must be in hospital for minimum of 3 days prior
174
medicare part A exclusions:
first 3 pints of blood
private room
private nursing
conveniences
175
medicare part B
- deductible length?
coinsurance amont?
covers what?
annual deductible
80 20 coinsurance
physicians expenses and outpatient services
176
ADLs for LTC
```
continuance
transferring
dressing
bathing - least impaired
toileting
eating - most impaired
```
177
LTC eligibility ages
min range?
max range?
50 -60
69-89
178
HIPAA federal ADLs to qualify for LTC plans
must be incapable of minimum TWO ADLs for at least 90 days
179
Health policies tax- individual policy
premium?
benefits?
not deductible
tax free
180
Health policies tax- group policies (anything but disability)
premium?
benefits?
tax deductible to business
not taxed to employee
tax free
181
Health policies tax- group policies DISABILITY
premium?
benefits?
tax deductible to employer
not taxed to employee
benefits = TAXED (unless premiums paid by insured)
182
Health policies tax- group policies AD&D
premium?
benefits?
tax deductible to employer
not taxed to employee
tax free
183
Health policies tax- self employed
premium?
benefits?
spouse can NOT claim you on their plan
tax deductible
tax free
184
Health policies tax-business policies - BOE
premium?
benefits?
tax deductible
TAXED benefit
185
Health policies tax-business policies - key person or buy/sell
premium?
benefits?
not deductible
tax free
