Life and Health 1 Flashcards
Utilization review includes all of the following EXCEPT
A. projected data for release of the patient
B. Continuous analysis of accident-prone individuals.
C. cost-effective ways of handling patients with catastrophic illnesses.
D. intermittent analysis of the reasons for the patient to remain in the health care facility.
A
lf agent Sue completes an application for an insurance policy on behalf of Phil’ and the company agrees to Insure him, which party made the offer?
A. Sue, when she made the initial appointment
B. Phill, when he completed the application
C. The company, when it issued the policy
D. Phill, when he received the policy
C
Insurance plans that are terminated for an entire group, generally allow an extension of
benefits to which type of employee?
A. temporary
B. disabled
C. full time
D. laid off
D
Which of the following is a primary consideration in replacing a health insurance policy？
A. shorter elimination periods
B. the commission schedule of the proposed insurer
C. the limitations and exclusions in the new policy
D. the doctor’s recommendation to the proposed insured
C
The following statement refers to which type of clause? “We have issued the policy in consideration of the representations in your applications and payment of the first-term premium.
A. A contestability clause
B. A consideration clause
C. A concealment clause
D. A whole contract clause
B
How long can an insurer exclude coverage for preexisting condition on a Medicare Supplement Policy?
A. 6 months
B. 12 months
C. 18 months
D. 24 months
A
Which of the following is an example of an unfair claim settlement practice
A. Delaying the settlement of claims submitted in which liability has become clear
B. Replacing a policy when it is in the best interest of the insured.
C. Adopting and implementing standards to settle claims in a timely manner.
D. Disclosing the settlement terms and provisions of the contract of insurance
A
Someone who sells, solicits, or negotiates insurance contracts for compensation is called
A. an independent insurance adjuster
B. an insurance producer
C. an insurance adviser
D. a life insurer
B
Which of the following is a mechanism to ensure a policy does NOT lapse A. reinstatement period B. elimination period C. waitinq period D. grace period
D
With regard to Disability Insurance the waiting period is to
A. exclude payments for a short-term illness
B. determine severity of illness
C. accurately calculate medical expenses
D. determine policyowner’s eligibility
D
Under the Affordable Care Act, an insurer may place dollar limits on coverage for
A. laboratory services
B. mental health services
C maternity and newborn care
D routine adult dental services
C
When managing a health insurance plan for a group, the insurer’s administrative cost for each insured person
A. varies among all group members
B. equals the cost of insuring each member individually
C. is less than the cost if each member was individually insured
D. is more than the cost of if each member was individually insured
C
In a hospital indemnity plan, an elimination period refers to the number of days
A. for which the insured can receive benefits for each hospital visit
B. for which the insured can receive benefits for the term of the plan
C. an insured must wait before becoming eligible to receive benefits for the term of the plan
D. an insured must wait before becoming eligible to receive benefits for each hospital stay
C
All of the following preventive care services are provided by health insuring corporation (HIC) primary care physicians EXCEPT
A. Well-baby checkups
B. immunizations for children
C. Hearing screenings for adults
D. Physical examinations
C
According to the Affordable Care Act, an insurer may rescind coverage under a health benefit plan when
A. the insured attempts to add more than 3 additional dependents.
B the insured makes an intentional misrepresentation of a material fact
C an insurer adds benefits to a plan offered on another tier at a comparable price
D. more than 30% of individuals covered under the plan qualify for additional tax credits.
B
