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The insured and insurance company will share the cost of covered losses under which health policy feature? ANSWERV V Payment of Claims provision M applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional reccipt is left with the applicant. The insurance company's underwriting department request's M's medical records and determines that M has had asthma for many years. All of the following are probable underwriting outcomes, EXCEPT: ANSWERY V Changing the policy's provisions M applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional receipt is left with the applicant. The insurance company's underwriting department request's M's medical records and determines that M has had asthma for many years. All of the following are probable underwriting outcomes ANSWERV ¥ 1. Deny coverage 2. Approve with higher premiums 3. Attach a rider excluding specified coverages Which type of policy would pay An employee salary if the employer was injured in a bicycle accident and out of work for six weeks ANSWER ¥ Business overhead expense Which of the following types of organizations are prepaid group health plans, where members pay in advance for services of participating physicians and hospitals that have agreements ANSWERV ¥ A Health Maintenance Organization (HMO) is a prepaid group health plan, where members pay in advance for the services of participating physicians and hospitals that have agreements. Which of these is not considered a preventative service in a dental plan ANSWERV V Fillings (A Restorative Service. Oral Examinations, teeth cleaning, and fluoride treatments are preventative services). R becomes disabled and owns an individual Disability Income policy. When is R eligible to receive disability benefits? ANSWERV V Upon satisfying the elimination period requirement The health insurance program which is administered by each state and funded by both the federal and state governments is called ANS WERV V Medicaid- is funded by both the federal and state governments and administered by individual states. A(n) of benefits of a health policy transfers payments to someone other than the policyowner ANSWERV V assignment Which type of plan normally includes hospice benefits? ANSWERV V managed care plans Which of the following is covered by a basic dental indemnity plan ANS WERV V Non- surgical periodontal treatment Health providers are compensated by a preferred provider organization (PPO) for normal dental procedures by what means? ANSWERV V Decreased fee schedules XYZ Company pays the entire premium for its group health plan. The MINIMUM percentage of eligible employees that must be covered is ANSWERV ¥ 100% T applied for a Disability Income policy and has a history of back injuries. The insurer issued the policy with a statement that excludes coverage for back injuries. This statement is called a(n) ANSWERY ¥ Impairment Rider Insurer may request a hearing within ___ if their policy is rejected ANSWERV V 20 days M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in foree? ANSWERV V 45 days Health insurance will automatically be placed back in force if the insurer fails to notify an applicant within 45 days that the reinstatement application was denied. Which type of policy pays bencfits to a policyholder covered under a Hospital Expense policy? ANSWERV ¥ Reimbursement- ‘When benefits are paid to a policyowner covered under a Hospital Expense policy, the policy is known as reimbursement. All of the following statements about major medical benefits are true, except ANSWERV ¥ Benefits have no maximum limit All of the following statements about major medical bencfits are true ANSWERV V 1. The deductible can be expressed as a fix dollar amount 2. the benefit period begins only after a specified amount of expensive have accrued 3. benefits are generally expressed as a percentage of eligible expenses An insured must notify an insurer of a medical claim within how many days after an accident? ANSWERV ¥ 20 Jhas an Accidental Death and Dismemberment policy with a principal sum of $50,000. While trimming the hedges, J cuts off onc of his fingers. What is the MAXIMUM J will receive from his policy? ANSWERWV V The maximum sum payable would be the capital sum, or $25,000. Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business? ANS WERV V Business owner becoming disabled A Business Disability Buy-Sell policy is designed to assist in the sale of a business when one of the owners becomes disabled. An accident policy will most likely pay a benefit for a(n) ANSWERY ¥ off-the-job accident The provision in a group Health Policy that allows the insured to post pone coverage for a covered illness 30 days after the policies affect that day is referred to as the ANSWERV ¥ Waiting period And insured pays premiums on an annual basis for an individual health insurance policy. What is the minimum number of days for the grace period provision ANSWERV ¥ 31 Long term care policies will Usually pay for eligible benefits using which of the following methods ANSWERV V Expense incurred Most long-term care policies pay on a reimbursement (or expense-incurred) basis, up to the policy limits. Which of the following reimburses it's insureds for a covered medical expenses ANSWERV V Commercial insurers And insured must notify and insurer of a medical claim within __ days aficr an accident ANSWERV V¥ 20 days Periodic health claim payment must be made at least ANSWERV/ ¥ Monthly The first portion of a Covered major medical insurance expense that the insured is required to paid is called the ANSWERV V Initial deductible Which of the following is not a limited benefit plan ANS WERV V life insurance policy List some limited benefit plans ANSWERY ¥ 1. Dental policies 2. Critical illness policy 3. Cancer policy A catastrophic Illness would be best covered by which of the following health insurance plans ANSWERV ¥ major medical Common exclusions to continuation of group coverage include ANSWERV V Dental care, other prescription drugs Most prepaid dental plans cover ANSWERV ¥ Oral examinations Which of the following best describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that uses the "accidental means" definition ANSWERV Vv Less restrictive a policy that uses the "accidental bodily injury" definition of an accident is less restrictive than one that uses the "accidental means" definition The insured and insurance company will share the cost of covered loss is under which health policy feature ANSWERV V Payment of claims provision When does a Probationary Period provision become effective in a health insurance contract? ANSWERV Vv At the policy's inception M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for? ANSWERV V Determined by the terms of the policy The policy provision that entitles the insurer to establish conditions the insured must me while I claim is pending is ANSWERV ¥ Time limit on certain defenses Generally, how long is a benefit period for a major medical expense plan ANSWERV V 1 year An Insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the ANSWERV ¥ insurer dates the policy Which of the following does restorative dental treatment cover ANSWERV ¥ crowns Group dental plans will frequently place a limit on annual benefits in order to minimize ANSWERV ¥ adverse selection What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? ANSWERV V Dread disease insurance K is the insured and P is the sole beneficiary on a life insurance policy. Both are involved in a fatal accident where K dies before P. Under the Common Disaster provision, which of these statements is true? ANSWERY ¥ Proceeds will be paid to P's estate Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care ANS WERV ¥V Obtain prior approval from the insurer for the medical service 
