SC Health Regulations

Question 1

Someone is guaranteed issue under the Health Insurance Portability and Accountability Act if they have at least how many months of creditable coverage?

Answer 1

18 months

Question 2

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?

Answer 2

45 days

Question 3

A small employer can deny health plan coverage for employees based on:

Answer 3

• Health status
• Gender
• Age
• None of the above

Question 4

How much time is the right to return provision for a Medicare Supplement Policy?

Answer 4

30 days

Question 5

How many parts must be included in the Outline of Coverage?

Answer 5

4

Question 6

A group health insurance plan may impose a pre-existing condition exclusion if the condition occurred within how much time before the enrollment date?

Answer 6

6 months

Question 7

How much time does someone have to return a health insurance policy for a full refund?

Answer 7

10 days

Question 8

What happens if a health insurance policy conflicts with state law requirements?

Answer 8

The policy must be amended to conform

Question 9

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?

Answer 9

6 months

Question 10

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?

Answer 10

6 months

Question 11

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?

Answer 11

200%

Question 12

Which of the following are the opening words to the statement that must be included on the first page of a Medicare supplement policy?

Answer 12

Notice to buyer: This policy may not cover all of your medical expenses

Question 13

What does an insured have to do to keep their long-term care insurance policy guaranteed renewable?

Answer 13

Pay all premiums

Question 14

If Sally has more than one group health plan, the coordination of benefits determines which plan is used without regard to the other?

Answer 14

Primary Plan

Question 15

For non-direct response issuers, when must the Medicare Buyer’s Guide be delivered to an applicant?

Answer 15

At the time of application

Question 16

In SC, what is the maximum age for a dependent child who is unmarried, a student and not disabled?

Answer 16

22

Question 17

When must health insurance premium rates be filed with the Department?

Answer 17

Prior to their use

Question 18

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?

Answer 18

31 days

Question 19

When does an individual health insurance policy become unavoidable (except for fraud)?

Answer 19

After 2 years

Question 20

How is the Life and Health Insurance Guaranty Association mentioned when selling insurance?

Answer 20

The Life and Health Insurance Guaranty Association must never be mentioned.

Question 21

The rate of any health insurance policy must be the same for people:

Answer 21

• Of the same gender
• Of the same geographic location
• ** Of the same class and same hazard
• All of the above

Question 22

Who of the following is ineligible for coverage by the SC Health Insurance Pool?

Answer 22

• Someone eligible for COBRA coverage
• Someone eligible for Medicare
• Someone who is 65 years or older
• ** All of the above

Question 23

If a policyholder becomes eligible for Medicaid, for how much time can they suspend their Medicare Supplement policy?

Answer 23

24 months

Question 24

In the SC Health Insurance Pool high-deductible plan, what is the coinsurance percentage for in network?

Answer 24

80%

Question 25

Who must approve a Medicare Select policy before it can be sold?

Answer 25

The Director

Question 26

In the SC Health Insurance Pool’s 80/80 PPO plan, what is the copayment for non-network providers?

Answer 26

$100

Question 27

Who pays if an insured has two health insurance policies with different insurers?

Answer 27

Each pays a proportion

Question 28

In SC, how long after the effective date of coverage begins, may a pre-existing condition be excluded?

Answer 28

12 months

Question 29

At what age can someone buy a Medicare Supplement policy?

Answer 29

There is no age requirement

Question 30

What is the order of benefits of health plans for 2 parents who are divorced?

Answer 30

Parent with custody, then spouse of parent with custody, then parent without custody

Question 31

The period of any pre-existing condition exclusion can be reduced by which of the following?

Answer 31

Creditable coverage

Question 32

For what reason can a small employer health insurance provider not renew a policy?

Answer 32

• The insured failed to pay premiums
• Fraud is detected
• The insurer discontinues offering small employer health insurance plans
• ** All of the above

Question 33

How much time after a loss covered by health insurance must a proof of loss be provided to the insurer?

Answer 33

90 days

Question 34

How does the required inflation protection adjustment for long-term care insurance policies help with inflation?

Answer 34

There are automatic future increases in the level of benefits