Unit 29 Flashcards
All of the following statements about a health insurance application are correct EXCEPT:
(A) the application may request health history
(B) the application becomes a part of the insurance contract
(C) the agent can correct and sign an application form for the client
(D) the insurer can contested the application only when it is attached to the policy
(C) the agent can correct and sign an application form for the client
Which of the following applies to the 10-day free-look privilege in a health insurance contract?
(A) It permits the insured to reject the policy within 10 days of policy delivery and receive a full refund
(B) It allows the insured an additional 10 days to pay the initial premium
(C) It can be waived only by the insurance company
(D) It is granted only at the option of the agent
(A) It permits the insured to reject the policy within 10 days of policy delivery and receive a full refund
All of the following statements about the Outline of Coverage of health insurance policies are correct EXCEPT:
(A) it must be provided at time of application of delivery of policy
(B) principal benefits also shown on the policy need not be included
(C) it is to include a summary statement of principal exclusions
(D) it must include any right the insurer reserves to change premiums
(B) principal benefits also shown on the policy need not be included
A health insurance company can refuse coverage solely for which of the following reasons?
(A) Applicant’s past medical history
(B) Sickle-cell trait in applicant
(C) Sex of applicant
(D) Marital status of applicant
(A) Applicant’s past medical history
All of the following provisions are required by Florida law for group health insurance policies EXCEPT:
(A) coverage for mental and nervous disorders must be available to the group policyholder
(B) a newborn child is to be provided coverage from the moment of birth
(C) coverage must continue until age 25 for a handicapped child that is a family member
(D) a newborn child of a covered family member is to be provided coverage for 18 months
(C) coverage must continue until age 25 for a handicapped child that is a family member
All of the following statements regarding group health insurance are correct EXCEPT:
(A) coordination of benefits is required between group policies and Medicare supplement
(B) coordination of benefits helps to reduce costs
(C) duplication of benefits results in overpayment
(D) coordination of benefits is permitted so long as the insured is completely reimbursed for covered expenses
(A) coordination of benefits is required between group policies and Medicare supplement
Which of the following statements is CORRECT about a group health insurance policy?
(A) It cannot exclude coverage from an occupational accident
(B) It can exclude newborn children from coverage
(C) It cannot exclude coverage for VA hospital treatment
(D) It can provide coverage for handicapped children
(D) It can provide coverage for handicapped children
In which of the following situations is a group health insurance policy NOT required to provide coverage?
(A) Qualified services performed in an ambulatory surgical center
(B) Outpatient services that would have been paid if rendered for an inpatient
(C) Specified services by a licensed podiatrist
(D) Treatment for an occupational illness or injury
(D) Treatment for an occupational illness or injury
All of the following are correct about the required provisions of a health insurance policy EXCEPT:
(A) a grace period of 31 days is found in an annual pay policy
(B) the entire contract clause means the policy, endorsements, and attachments constitute the entire contract
(C) a reinstated policy provides immediate coverage for an illness
(D) proof-of-loss forms must be sent to the insured within 15 days of notice of claim
(C) a reinstated policy provides immediate coverage for an illness
The notice to the insurance company of a health insurance claim must include all of the following EXCEPT:
(A) name of policyowner
(B) estimated amount of claim
(C) nature of sickness or injury
(D) name of the person receiving treatment
(B) estimated amount of claim
Which of the following is NOT provided in a proof-of-loss form?
(A) A statement of the occurrence of accident or sickness
(B) The extent of the loss for which the claim is made
(C) A statement from the attending physician
(D) Information that identifies the claimant
(C) A statement from the attending physician
At what point in time can a policyholder file suit against a health insurance company for failure to pay a claim?
(A) 60 days from date of loss
(B) 120 days from date of loss
(C) 60 days after filing proof of loss
(D) 120 days after filing proof of loss
(C) 60 days after filing proof of loss
If a health insurance policyowner changes jobs to a more hazardous occupation, which of the following could apply?
(A) Benefits could reduced if the policy so provides
(B) Coverage would not change if all insureds are charged the same rate
(C) Coverage would not change if the insured has given notice and paid a higher premium
(D) All of the above could apply
(D) All of the above could apply
A health maintenance organization provides which of the following?
(A) Free health care for Medicare patients
(B) Preventive health care for its members
(C) A program of “pay as you go” medicine
(D) An extension of VA hospital treatment for veterans
(B) Preventive health care for its members
All of the following statements regarding maternity benefits are correct EXCEPT:
(A) hospital expenses are usually covered up to 10 times the room and board benefit
(B) individual health insurance policies can be written to include maternity benefits
(C) maternity benefits are optional to the policyholder of group insurance
(D) all health insurance policies must provide maternity benefits
(D) all health insurance policies must provide maternity benefits
