Nj Accident And Health Flashcards
Adam is an insured under a Major Medical policy written through an HMO. When he submits a claim, the policy would require him to do all of the following EXCEPT
Pay the medical vendor and then submit a claim for reimbursement
Olivia owns a Disability Income policy with a Change of Occupation provision that will pay a $4,000 per month benefit. When she changes from a high-riskoccupation to a low-risk occupation, spation, she fails to tell her insurance company. How will Olivia’s company respond to a covered loss six months later?
Pay $4000 per month and refund the unearned premium.
Which is considered a cost containment in health insurance?
Utilization Management
All of the following are requirements to qualify for social security disability benefits Except when
Unable to work in the occupation in which the worker was trained or educated.
Whitch statement about Cobra is False?
An insured person who quits their job forfeits their rights under cobra.
A preexisting condition under a Medicare supplement policy must have occurred and/or been treated within how many months of the effective date of the MSP?
6
Under a family Medical Expense policy without maternity benefits, when are newborns covered?
The moment of birth
An employee and his spouse are covered under Group Major Medical at XYZ Industries, and the spouse loses coverage following a divorce. How many months canthe spouse continue coverage under COBRA?
36
What happens when a major medical policy is reinstated on September 10th?
Accident coverage begins on September 10th, and sickness coverage begins on September 20.
Which health insurance benefits are taxable?
Benefits from an employer paid group disability income policy
The Additional Monthly Benefit Rider exists to pay income during a period of disability while the insured is waiting for benefits to be paid or denied by
Social security
A health maintenance organization (HMO) differs from a traditional insurer in that an HMO
Emphasizes preventive medicine
The life insurance policy will not be truly effective until all of the following except
The producer has explained the policy to the client
The agreement at which a child is no longer eligible for coverage under a parent’s medical expense policy is known as
Iimiting age
What does the health insurance time limit on certain defenses/incontestable clause state?
The company can only challenge the accuracy of statements made in an application for health insurance for up to 2 years.
Which health rider would not increase the cost of the policy?
Exclusion Rider
What does coinsurance mean?
The insurer and the insured share expenses over the deductible.
What does a life annuity protect against?
Outliving income
Which of the following is the most common method to supplement Medicare coverage?
Coverage offered by private insurers
Which is a source of underwriting information?
Attending physicians’ reports
If an insurance company obtains an investigative consumer report on a prospective insured, it MUST inform the prospect that it is permitted to do so under which of the following Federal laws?
The fair credit reporting Act
The uniform individual health policy provisions law requires a policy owner to wait at least how many days from submitting a claim before legal action?
60
Which level of long-term care must be provided occasionally by a skilled practitioner following doctor’s orders?
Intermediate care
In a Preferred Provider Organization (PPO), what is the primary financial benefit for an insured member to use only the services of a listed health care provider?
Lower cost sharing expenses
What is the primary qualifier for Medicaid?
Financial need
What is a conditional receipt intended to do?
Speed up coverage
Which is a cost containment feature stressed by HMOs?
Use of primary care physicians as gatekeepers.
What is an MBI report?
Medical information on an applicant for assessing life or health insurance risk.
