Unit 37: Health Insurance Candidates

Question 1

Page 559
How do individual health policies treat newborn children?

Answer 1

The health insurance benefit shall be payable for a baby from the moment of birth.

Question 2

What happens if a specific premium/fee is required to provide coverage for a child?

Answer 2

Policy or contract may require notification of birth and payment of required premium/fee paid to insurer within 30 days after birth (if you want coverage to continue beyond 31-day period

Question 3

When does a claim need to be given to the insurer after an occurrence or commencement of loss covered by the policy?

Answer 3

written notice within 60 days after occurrence/loss (or as soon as possible after, within reason)

Question 4

What is the insured right if not satisfied with policy he/she purchased?

Answer 4

Person to whom policy was issued has 10 days of its delivery to have a refund of the premium

Question 5

Is the insurer liable for loss due to intoxication, under influence of narcotic/hallucinogenic drugs?

Answer 5

No. Unless administered on the advice of a physician

Question 6

Page 568
For a Medicare supplement policy, is there a pre-existing condition exclusion?

Answer 6

No.
(David, read the top highlighted sentence. As usual, it is word vomit. I want to make sure I asked the correct ?)

Question 7

How many days does an applicant of a medicare supplement policy have to return the policy and get a refund if not satisfied?

Answer 7

30

Question 8

Does the same 30 day return policy apply to long term care policies?

Answer 8

yes

Question 9

Page 570
What must insurers provide to insurers of Medicare age?

Answer 9

A Medicare Supplement Buyers Guide (Guide to Health Insurance for People with Medicare)

Question 10

Page 572

Question 11

What happens to time periods regarding preexisting conditions, waiting/elimination/probationary periods if one Medicare supplement policy replaces another?

Answer 11

Replacing insurer must wave these.

Question 12

Page 574
What is the permitted compensation arrangement for the first year commision for the sale of a medicare supplement policy?

Answer 12

Can not be more than 200% of the commission paid for selling/servicing policy in second year.

Question 13

Page 577
Long-term care policy definitions in KY:

Define “activities of daily living”

Answer 13

bathing, bathroom, dressing, transferring

Kind of obvious

Question 14

Define adult day care

Answer 14

programs for groups of 4 or more provided in the day for socializing, getting heath-related services, support for frail, impaired or disabled adults

Question 15

Define acute condition

Answer 15

person is medically unstable
frequent monitoring needed

Question 16

Define personal care

Answer 16

provision of hands-on services to help with daily living activities

Question 17

Page 578
What are the limitations and exclusions of a long-term care policy

(As usual, word vomit in the way sentence is written. Not sure I’m asking correct ?)

Answer 17

A. Preexisting conditions
B. mental or nervous disorders
C. Alcoholism and drug addiction
D. All of the above

David, person wrote in book to answer letter D on test. All of the above.

Question 18

Page 579
The premium for a long-term care policy can not increase as a result of?

Answer 18

A. increasing age beyond 65
B. duration the insured has been covered under policy.

Then someone wrote:
C . Both A + B
D. Neither A or B

(Guess answer would be C)

Question 19

Page 583
What does a “prohibition against postclaims underwriting mean?”

Answer 19

Handwritten note…
No underwriting is allowed to be done when a claim has been filed.

Question 20

Page 584
Before issuing a long-term care policy/certificate to an applicant 80+ years old insurer must obtain ONE of the following:

Answer 20

• a report of a phys. exam
• assessment of functional capacity
• attending physician’s statement
• copies of medical records

Question 21

Page 584 again
The handwriting says
…applicant 80+ years old insurer must obtain WHICH of the following:

Answer 21

The handwriting says:
Possible answer is “some form of medical records”

Question 22

How much coverage must a long-term care policy pay for home health or community care services?

Answer 22

A dollar amount = to at least 1/2 of one year’s coverage available for nursing home benefits under the policy.

Question 23

Page 585
All that is highlighted is the headline:
Requirement to Offer Inflation Protection

Answer 23

not sure what to do here

Question 24

Page 586
Application forms must include questions designed to determine what?

Answer 24

• whether applicant has another long-term policy/certificate already in force
• a long-term policy/certificate is intended to replace other accident/sickness policy in force

Question 25

Page 589
What happens to time periods regarding preexisting conditions, waiting/elimination/probationary periods if one long-term care policy/certif replaces another?

Answer 25

Replacing insurer waives any time periods

Question 26

Page 590
How much compensation can the replacing insurer (of long-term care polic) pay it’s agents?

Answer 26

nothing greater than 200% of the renewal compensation paid…
(David, look at this sentence on the page. Another word vomit sentence.)

Question 27

Page 591
In group health insurance paragraph, does the term “employees” include retired employees?

Answer 27

yes

Question 28

Page 592
What is blanket health insurance?

Answer 28

a form of health insur covering groups

Question 29

What are some of the groups covered by blanket health insurance?

Answer 29

religious, charitable, recreational, educational or civic organizations

volunteer fire dept, first aid, civil defense, or other volunteer org.

Question 30

Page 596
When a group policy is replaced by a succeeding insurer, who has a right to continued health insurance coverage?

Answer 30

• surviving spouse
• a child who has aged out as a dependent
• a former spouse and children spouse has custody of

Question 31

Page 611
What is a Health Maintenance Organization (HMO)?

Answer 31

an indiv or entity that provides healthcare to individuals who VOLUNTARY (circled on page) enroll

Question 32

Page 613
An agent of a health maint organization must be licensed in what?

Answer 32

must be licensed as an agent with a health line of authority

Question 33

Page 615
health maintenane organizations issuing policies in KY have to make available home health care

How many visits does the policy have to cover in any calendar year or 12 continuous months?

Answer 33

No less than 60

Question 34

What are the deductibles and copays for home health care coverage?

Answer 34

same as the other services covered by the health mainten. orgainzaitons (hospital, medical, surgical)