MT Laws and Regulations for Accident and Health Insurance only Flashcards
All disability insurance policies must provide the insured with full ______ of _______ in selecting a licensed physician or other practitioner
Freedom of choice
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
Montana state institution
Disability policies cannot deny or reduce benefits because the insured is eligible for _____ ______ _______
Public medical assistance
Insurer must received proof of the incapacity of a dependent child within ___ days of the date the child reaches the limiting age
31
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
Well-child
Well-child care coverage must include:
-a history, physical exam, developmental assessment, anticipatory guidance, and lab tests
-routine immunizations
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
48; 96
Disability insurers must make benefits for ___ ___ care available under group insurance policies
Home health
The transfer of the insured’s rights of recovery against others to the insurance company
Subrogation
The subrogation provision states that insurance companies have a legal right to:
Sue a third party that has caused an insurance loss to the insured
The primary plan must pay its benefits as if the secondary plan or plans did not _____
Exist
Employers with ___ or more employees must continue group medical expense coverage for terminated workers for up to ___ months
20; 18
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
One year
All group disability policies must provide group members who have been insured for at least ____ _____ with the right to convert to individual policies
Three months
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
90
If an insurer discontinues a particular coverage in the group market, it may not offer the same coverage in that market for ____ _____
Five years
Except as authorized by the commissioner, insurers cannot cancel or refuse to renew Medicare supplement policies for any reason other than:
Material misrepresentation or nonpayment of premium
Health service corporations (such as BCBS) are nonprofit corporations that establish plans for:
Furnishing prepaid hospital health care services to members or beneficiaries
A health maintained organization (HMO) furnishes:
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
HMOs must acknowledge complaints within ___ days of receiving them and complaints must be maintained for ___ years
10; 3
An HMO can limit services for pre-existing conditions at the time of _______
Enrollment
As used in a long-term care insurance policy, activities of daily living shall mean
Eating, toileting, transferring, bathing, dressing, and continence
A long term care insurance policy in Montana shall not require the inability to perform more than ____ ADLs
Three
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
30
An individual may not sell or solicit long-term care insurance unless he:
-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
