SC Health Regulations Flashcards

1
Q

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

A

18 months

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2
Q

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?

A

45 days

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3
Q

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

A
  • Health status
  • Gender
  • Age
  • None of the above
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4
Q

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

A

30 days

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5
Q

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

A

4

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6
Q

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

A

6 months

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7
Q

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

A

10 days

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8
Q

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

A

The policy must be amended to conform

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9
Q

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?

A

6 months

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10
Q

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?

A

6 months

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11
Q

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?

A

200%

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12
Q

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

A

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

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13
Q

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

A

Pay all premiums

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14
Q

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

A

Primary Plan

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15
Q

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

A

At the time of application

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16
Q

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

A

22

17
Q

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

A

Prior to their use

18
Q

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?

A

31 days

19
Q

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

A

After 2 years

20
Q

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

A

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

21
Q

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

A
  • Of the same gender
  • Of the same geographic location
  • ** Of the same class and same hazard
  • All of the above
22
Q

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

A
  • Someone eligible for COBRA coverage
  • Someone eligible for Medicare
  • Someone who is 65 years or older
  • ** All of the above
23
Q

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

A

24 months

24
Q

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

A

80%

25
Q

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

A

The Director

26
Q

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

A

$100

27
Q

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

A

Each pays a proportion

28
Q

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

A

12 months

29
Q

At what age can someone buy a Medicare Supplement policy?

A

There is no age requirement

30
Q

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

A

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

31
Q

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

A

Creditable coverage

32
Q

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

A
  • The insured failed to pay premiums
  • Fraud is detected
  • The insurer discontinues offering small employer health insurance plans
  • ** All of the above
33
Q

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

A

90 days

34
Q

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

A

There are automatic future increases in the level of benefits