SC Health Regulations Flashcards
Someone is guaranteed issue under the Health Insurance Portability and Accountability Act if they have at least how many months of creditable coverage?
18 months
If a health insurance policy lapses and the insurer requires a reinstatement application, how much time after approval must an insured wait before the reinstatement becomes effective?
45 days
A small employer can deny health plan coverage for employees based on:
- Health status
- Gender
- Age
- None of the above
How much time is the right to return provision for a Medicare Supplement Policy?
30 days
How many parts must be included in the Outline of Coverage?
4
A group health insurance plan may impose a pre-existing condition exclusion if the condition occurred within how much time before the enrollment date?
6 months
How much time does someone have to return a health insurance policy for a full refund?
10 days
What happens if a health insurance policy conflicts with state law requirements?
The policy must be amended to conform
For how much time after the effective date of a person’s coverage under a SC Health Insurance Pool policy begins is a pre-existing condition excluded from coverage?
6 months
For how much time prior to the effective date of a person’s Medicare supplement policy coverage must a condition have to have occurred to be considered pre-existing?
6 months
What is the maximum commission as a percentage of the first year commission in relation to the second year commission for a Medicare supplement policy?
200%
Which of the following are the opening words to the statement that must be included on the first page of a Medicare supplement policy?
Notice to buyer: This policy may not cover all of your medical expenses
What does an insured have to do to keep their long-term care insurance policy guaranteed renewable?
Pay all premiums
If Sally has more than one group health plan, the coordination of benefits determines which plan is used without regard to the other?
Primary Plan
For non-direct response issuers, when must the Medicare Buyer’s Guide be delivered to an applicant?
At the time of application
In SC, what is the maximum age for a dependent child who is unmarried, a student and not disabled?
22
When must health insurance premium rates be filed with the Department?
Prior to their use
Once a handicapped child reaches the limiting age for a non-handicapped child on a health insurance policy, how much time do the parents have to provide proof of incapacity so the child can remain on the policy?
31 days
When does an individual health insurance policy become unavoidable (except for fraud)?
After 2 years
How is the Life and Health Insurance Guaranty Association mentioned when selling insurance?
The Life and Health Insurance Guaranty Association must never be mentioned.
The rate of any health insurance policy must be the same for people:
- Of the same gender
- Of the same geographic location
- ** Of the same class and same hazard
- All of the above
Who of the following is ineligible for coverage by the SC Health Insurance Pool?
- Someone eligible for COBRA coverage
- Someone eligible for Medicare
- Someone who is 65 years or older
- ** All of the above
If a policyholder becomes eligible for Medicaid, for how much time can they suspend their Medicare Supplement policy?
24 months
In the SC Health Insurance Pool high-deductible plan, what is the coinsurance percentage for in network?
80%
Who must approve a Medicare Select policy before it can be sold?
The Director
In the SC Health Insurance Pool’s 80/80 PPO plan, what is the copayment for non-network providers?
$100
Who pays if an insured has two health insurance policies with different insurers?
Each pays a proportion
In SC, how long after the effective date of coverage begins, may a pre-existing condition be excluded?
12 months
At what age can someone buy a Medicare Supplement policy?
There is no age requirement
What is the order of benefits of health plans for 2 parents who are divorced?
Parent with custody, then spouse of parent with custody, then parent without custody
The period of any pre-existing condition exclusion can be reduced by which of the following?
Creditable coverage
For what reason can a small employer health insurance provider not renew a policy?
- The insured failed to pay premiums
- Fraud is detected
- The insurer discontinues offering small employer health insurance plans
- ** All of the above
How much time after a loss covered by health insurance must a proof of loss be provided to the insurer?
90 days
How does the required inflation protection adjustment for long-term care insurance policies help with inflation?
There are automatic future increases in the level of benefits
