Unit 5: Health Insurance Intro

Question 1

Health insurance policy renewability provisions and cancellations

Answer 1

• Optionally Renewable
• Conditionally Renewable
• Guaranteed Renewable
• Non-Cancellable
• Cancellation Clause

Question 2

_________ – non-renewal at expiration; policy is not cancellable during the term.

Answer 2

Optionally Renewable

Question 3

_______ – non-renewal for policy stated reasons only; no other reasons can apply.

Answer 3

Conditionally Renewable

Question 4

_______ – renewable to a stated attained age of the insured (i.e. 65) – premiums can be increased by age or class.

Answer 4

Guaranteed Renewable

Question 5

– renewable to a stated attained age of the insured (i.e. 65) – premiums cannot be increased by age or class.

Answer 5

Non-Cancellable

Question 6

• A 20 day written notice to the insured required by Florida Law

Answer 6

Cancellation Clause

Question 7

______ - provision waives the required payment of premiums if the insured becomes totally disabled AND the policy remains in force.

Answer 7

Waiver of Premium

Question 8

____________ – this provision places a two year limitation to defenses an insurer may raise to deny a claim or void a policy.

Answer 8

Limitations on Insurer Defense

Question 9

_____________ provision – simply states the time period after a policy has gone into effect before benefits begin.

Answer 9

Waiting or Elimination Period provision

Question 10

_______ – this provision increases the policy benefit to double the death benefit for a stated number of incidents.

Answer 10

Double Indemnity

Question 11

There is a ___ year limitation to defenses or reservations an insurer may raise to deny a claim or void a policy.

Answer 11

2

Question 12

____________ policies protect against catastrophic losses; most policies have –

deductibles (the portion the insured is responsible for in a policy year).
maximum limits (normally quite high).
coinsurance up to a maximum stop loss limit.

Coverages Include -
Hospital room and board.
Physicians and surgeons fees.
Operating room and Medical expenses including lab work.
Transfusions, drugs, and other medicines.
X-rays, anesthetics, nursing services.

Answer 12

Major medical insurance

Question 13

Common exclusions in a __________ policy include –

Injury or disease payable under Workers Compensation.
Childbirth and pregnancy.
Treatment in a VA or government hospital.
Intentionally self-inflicted injury.
Dental expenses (except resulting from an accident).
Mental illness.
War.
Cosmetic surgery (except as required following an accident).

Answer 13

Major Medical policy Exclusions

Question 14

Medicare Supplement Insurance covers the gaps, deductibles, exclusions, and coinsurance of __________ Medicare.

Answer 14

Federal

Question 15

____________ (HMO) provide the insured with comprehensive health services with a focus on preventative activity –

HMOs employ medical care providers as direct employees.
have small if any deductibles.
include coinsurance provisions.
have minimal exclusions.
include broad coverage.

Answer 15

Health Maintenance Organizations (HMO)

Question 16

________ (____) provide the insured with comprehensive health services with a focus on managed care, cost containment, and flexibility.

PPOs are organized by physicians and hospitals that contract with an insurance company; services are provided via a negotiated scheduled contract.

Answer 16

Preferred Provider Organizations (PPO)

Question 17

Insurance providing payment if the insured’s death results from an accident, if the insured accidentally severs a limb above the wrist or ankle joints, or totally and irreversibly loses eyesight.

Answer 17

Accidental Death and Dismemberment Insurance

Question 18

Number of days Florida Statutes (F.S. 627.67 1-675) requires Medicare Supplement Insurance to be returnable within for full premium refund.

Answer 18

30 days

Question 19

Health insurance provision which states how a lapsed policy may be reactivated.

Answer 19

Reinstatement Provision

Question 20

Type of service provider which employs medical care providers as direct employees; has small if any deductibles; coinsurance provisions; minimal exclusions; and offers broad coverage.

Answer 20

HMO- Health Maintenance Organizations

Question 21

Provides coverage for gaps, deductibles, and exclusions in Federal Medicare.

Answer 21

Medicare Supplement Insurance

Question 22

The Health insurance continuation provision in which the insurer reserves the right to terminate the coverage at any anniversary or, in some cases, at any premium due date, but does not have the right to terminate coverage between such dates.

Answer 22

Optionally Renewable

Question 23

The Health insurance continuation provision which permits the insured may renew the contract from period to period, or continue it to a stated date or an advanced age, subject to the right of the insurer to decline renewal only under conditions defined in the contract.

Answer 23

Conditionally Renewable

Question 24

Pays benefits for nonsurgical doctors’ fees commonly rendered in a hospital; sometimes pays for home and office calls.

Answer 24

Medical Expense Insurance

Question 25

Which Health insurance provision waives premiums if the insured becomes totally disabled but the policy remains in force?

Answer 25

Waiver of Premium

Question 26

Which Health insurance provision provides a period of time after a premium is due and not paid that an insurer must keep the policy in force and accept a late payment?

Answer 26

Grace Period

Question 27

This Health insurance provision increases policy payout to double the death benefit for a stated number of fortuitous events.

Answer 27

Double Indemnity

Question 28

Health insurance policies may contain any one of a wide range of renewability provisions, which define the rights of the insurer to cancel the policy at different points during the life of the policy. There are five principal renewability classifications: cancellable, optionally renewable, conditionally renewable, guaranteed renewable, and non-cancellable.

Answer 28

Renewability Provisions

Question 29

This joint federal-state program provides medical care for the needy.

Answer 29

Medicaid

Question 30

This Federally sponsored health insurance and medical program covers persons age 65 or older; and is administered under provisions of the Social Security Act.

Answer 30

Medicare

Question 31

Health insurance policies that provide daily indemnity benefits for extended care confinement.

Answer 31

Long-Term Care Policies

Question 32

An illness or medical condition that existed before a policy’s effective date; usually excluded from coverage, through the policy’s standard provisions or by waiver.

Answer 32

Pre-Existing Conditions

Question 33

Health insurance contract that the insured has the right to continue in force by payment of premiums set forth in the contract for a substantial period of time, during which the insurer has no right to make unilaterally any change in any contract provision.

Answer 33

Non-Cancellable Renewability Provision

Question 34

The Health insurance continuation provision which states the insured has the right to continue in force by payment of premiums for a substantial period of time during which the insurer has no right to make unilaterally any change in any provision, other than a change in premium rate for classes of insureds.

Answer 34

Guaranteed Renewable Provision

Question 35

Policy covers fees of physicians for performing surgery by listing covered surgical procedures in a schedule with applicable dollar amounts of coverage.

Answer 35

Surgical Expense Policy

Question 36

Major Medical Insurance
A type of Health insurance intended to provide protection against catastrophic losses. These policies cover hospital room and board; operating room expenses; and nursing services.

Answer 36

Major Medical Insurance

Question 37

Health insurance designed to indemnify the insured for basic hospitalization expenses of room and board in the hospital, nursing care, lab fees, operating room, medical supplies, and related items.

Answer 37

Hospitalization Expense Insurance Policy

Question 37

This type of service provider is organized by physicians and hospitals who contract with an insurance company who offers their services via a negotiated scheduled contract?

Answer 37

PPO- Preferred Provider Organizations

Question 38

Health insurance that pays a flat amount per day of hospitalization, regardless of expenses or other insurance. Its primary purpose is to supplement other coverage that may be inadequate due to rising costs.

Answer 38

Hospital Indemnity Insurance Policy

Question 39

A type of Health insurance that reimburses the insured for non-surgical care provided by a physician.

Answer 39

Physicians Coverage Policy

Question 40

Insurance policy that includes coverages that are designed to protect the insured against a loss of income resulting from injury or sickness.

Answer 40

Disability Income Insurance Policy

Question 41

The ‘limitations on insurer defense’ provision limits an insurer’s defenses or reservations by which an insurer may deny a claim or void a policy.

What is the time limit for the ‘limitations on insurer defense provision?

Answer 41

2 years

Question 42

Major Medical Insurance policies typically have all of the following EXCEPT:

Answer 42

death benefit

Question 43

Major Medical Health Insurance policies typically cover:

• hospital room and board
• physicians and surgeon’s fees
• operating room expenses
• all of the above

Answer 43

all of the above;

Major Medical Health Insurance policies typically cover: hospital room and board; physicians and surgeon’s fees; operating room expenses; medical expenses including lab work, drugs, medicines and anesthetics; and transfusions, X-rays, and nursing services.

Question 44

Florida Statutes require Medicare Supplement Insurance to:
A) have easy read policy language
B) be returnable within 90 days of purchase for full
premium refund
C) both A and B
D) neither A or B

Answer 44

Florida Statutes require Medicare Supplement Insurance to: have easy read policy language; be returnable within 30 days of purchase for full premium refund; provide an outline of coverage with a Medical Supplement Buyers’ Guide; and limit coverage limitations for pre-existing conditions to six months.

Question 45

All of the following statements are correct concerning Hospitalization Indemnity Insurance EXCEPT:
- payments are made directly to the hospital
- benefits are paid on a maximum daily room rate
- benefits are paid on a maximum daily room rate
- Hospitalization Indemnity Insurance is used as
supplement to other coverage

Answer 45

payments are made directly to the hospital

The Hospitalization Indemnity Insurance policy features include: payments made directly to the insured; benefits paid on a maximum daily room rate; benefits limited to a maximum number of days; and the policy is used as a supplement to other insurance coverage. Hospitalization Indemnity Insurance narrowly cover only room and board at a hospital.

Question 46

Florida law requires a Florida health insurance company to provide ___ days written notice of cancellation of a Florida health insurance policy.

Answer 46

not less than 20 (days)

Question 47

The most stringent ‘total disability’ definition in a Disability Income Insurance policy is:

Answer 47

complete inability to do any work