MT Laws and Regulations for Accident and Health Insurance only

Question 1

All disability insurance policies must provide the insured with full ______ of _______ in selecting a licensed physician or other practitioner

Answer 1

Freedom of choice

Question 2

Disability insurance policies delivered in Montana cannot exclude coverage or decrease benefits for services rendered in a _____ _____ _____, if the policy would have covered the same service otherwise

Answer 2

Montana state institution

Question 3

Disability policies cannot deny or reduce benefits because the insured is eligible for _____ ______ _______

Answer 3

Public medical assistance

Question 4

Insurer must received proof of the incapacity of a dependent child within ___ days of the date the child reaches the limiting age

Answer 4

31

Question 5

All individual and group disability insurance plans issued in Montana that cover insureds’ family members must provide coverage for ___-____ care from the moment of birth through 7 years of age

Answer 5

Well-child

Question 6

Well-child care coverage must include:

Answer 6

-a history, physical exam, developmental assessment, anticipatory guidance, and lab tests
-routine immunizations

Question 7

Any policy that covers maternity services, including benefits for childbirth, must provide coverage for at least ___ hours of inpatient care after vaginal delivery and at least ___ hours after delivery by c-section

Answer 7

48; 96

Question 8

Disability insurers must make benefits for ___ ___ care available under group insurance policies

Answer 8

Home health

Question 9

The transfer of the insured’s rights of recovery against others to the insurance company

Answer 9

Subrogation

Question 10

The subrogation provision states that insurance companies have a legal right to:

Answer 10

Sue a third party that has caused an insurance loss to the insured

Question 11

The primary plan must pay its benefits as if the secondary plan or plans did not _____

Answer 11

Exist

Question 12

Employers with ___ or more employees must continue group medical expense coverage for terminated workers for up to ___ months

Answer 12

20; 18

Question 13

A person covered by a group disability policy may, for a period of ___ ____, continue to be covered even though hours worked are less than the minimum required to qualify for membership

Answer 13

One year

Question 14

All group disability policies must provide group members who have been insured for at least ____ _____ with the right to convert to individual policies

Answer 14

Three months

Question 15

If an insurer discontinues its particular type of coverage, it must notify each plan sponsor, participant, and beneficiary at least ___ days before the date the plan will terminate

Answer 15

90

Question 16

If an insurer discontinues a particular coverage in the group market, it may not offer the same coverage in that market for ____ _____

Answer 16

Five years

Question 17

Except as authorized by the commissioner, insurers cannot cancel or refuse to renew Medicare supplement policies for any reason other than:

Answer 17

Material misrepresentation or nonpayment of premium

Question 18

Health service corporations (such as BCBS) are nonprofit corporations that establish plans for:

Answer 18

Furnishing prepaid hospital health care services to members or beneficiaries

Question 19

A health maintained organization (HMO) furnishes:

Answer 19

Basic health care services to enrollees on a prepaid or other financial basis, either directly through provider employees or through contractual or other arrangements with a provider

Question 20

HMOs must acknowledge complaints within ___ days of receiving them and complaints must be maintained for ___ years

Answer 20

10; 3

Question 21

An HMO can limit services for pre-existing conditions at the time of _______

Answer 21

Enrollment

Question 22

As used in a long-term care insurance policy, activities of daily living shall mean

Answer 22

Eating, toileting, transferring, bathing, dressing, and continence

Question 23

A long term care insurance policy in Montana shall not require the inability to perform more than ____ ADLs

Answer 23

Three

Question 24

An applicant or person insured under a long-term care policy shall have the right to examine and return the policy within ___ days of delivery

Answer 24

30

Question 25

An individual may not sell or solicit long-term care insurance unless he:

Answer 25

-is a licensed producer for life or disability insurance
-has completed an approved one-time, 8 hour training program
-has completed at least 4 hours of approved on-going training every 24 months thereafter