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What document describes an insured's medical history, including diagnoses and treatments? - ✔✔Attending physicians statement All of the following are true regarding Key Employment Disability Income Insurance except - ✔✔benefits are taxable to the employer An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. This results in a long hospitalization period. Which of the following is true? - ✔✔The group plan will not pay because the employee was injured at work A new employee who meets HIPAA eligibility requirements must be issues health coverage on what basis? - ✔✔guaranteed Insurance is the transfer of - ✔✔risk which of the following is an example of an unfair claims settlement practice? - ✔✔Failure to promptly settle a claim when liability has been clearly established An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blin. The blindness improves a month later. To what extent will he receive presumptive care? - ✔✔No benefits Which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial information? - ✔✔The Fair Credit Reporting act
one of the differences between group underwriting is that there is little or no medical information required regarding plan participants in groups of - ✔✔50+ An insured has a major medical policy with a $500 deductible and a coinsurance clause of 80/20. If he incurs medical expenses of 4000 the insurer would pay? - ✔✔ 2800 - > 80% Which if the follwing is an example of peril covered in accident and health insurance policy - ✔✔sickness What is the elimination period fo social security disability benefits? - ✔✔ 5 months Which insurence principle states that if a policy allows for greater compensation than the financial loss incurred, the insured may only receive benefits for the amount lost? - ✔✔indemnity What is the maximum civil penalty for violating the superintendents cease and desist order? - ✔✔ 10000 On a health insurance application, a signature is require from all of the following individuals except - ✔✔the spouse of the policy owner Adverse selection is a concept best described as - ✔✔risks with higher probability of loss seeking insurance more often than other risks Medicare Part A services do not include which of the following - ✔✔outpatient hospital treatment
What is the maximum amount that can be contributed to an MSA of the high-deductible plan for individuals? - ✔✔ 65 which of the following is one of the supplemental healht care services provided by a HIC on an outpatient-only basis and not in combination wiht other supplemental services - ✔✔specialty HIC Which of the following is not covered in Plan A in medigap insurance? - ✔✔the medicare part A deductible An insurer wishes to compare the information given in an insurance application with previous insurance applications by the same applicant but for different companies. What organization can help the insurer accomplish this - ✔✔the medical information bureau Which type of health care services are provided for unforeseen conditions of a kind that usually requires medical attention without delay but does not pose a threat to the life, limb, or permanent health of the injured or ill person - ✔✔urgent care An insured pays a $100 premium every month for his insurance coverage, yet the insurer promises to pay $10,000 for a covered loss. What characteristic of an insurance contract does this describe? - ✔✔aleatory under which condition would an employees group medical benefits be exempt from income tax
- ✔✔generally exempt from taxation as income all of the following are differences between individual and group health insurance except? - ✔✔individual insurance does not require medical examination,s while group insurance does
all of the following are covered by Part A of Medicare except? - ✔✔Physicians and surgeons services which of the following is not true regarding a flexible spending account - ✔✔it does not have limits on contributions under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain? - ✔✔a statement that sufficiently clear to identify the insured and the nature of the claim An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement - ✔✔cost-contaiment Which of the following is an eligibility requirement for all Social Security Disability Income benefits - ✔✔having attained a fully insured status An insurance company assures its new policyholders that their premium costs will not increase for a period of at least five years. However, due to increasing financial strain, they plan to raise premium costs for all insureds by 10% over the next two years. What term best describes this act - ✔✔fraud Your client has a Social Insurance Supplement (SIS) rider on his disability policy. After he becomes disabled, he receives payments from the company. Shortly thereafter, he also begins receiving Social Security benefit payments. Which of the following will happen - ✔✔The SIS payment will be reduced dollar-for-dollar by the Social Security benefit payment. An applicant is denied insurance because of information found on a consumer report. Which of the following requires that the insurance company supply the applicant with the name and address of the consumer reporting company? - ✔✔Fair Credit Reporting Act
Benefit periods for individual short-term disability policies will usually continue for - ✔✔ 6 months to 2 years on its advertisement a company claims that it has funds in its possession that are , in fact, not available for the payment of lossess or claims. The company is guilty of - ✔✔misrepresentation an insured pays a monthly premium of $100 for her health insurance. what is the duration of the grace period? - ✔✔10 days The Federal Fair credit reporting act - ✔✔regulates consumer reports Every subscriber of a health insuring corporation is entitled to a - ✔✔evidence of coverage An insolvent insurer is one who is unable to pay its obligations when they are due or has fewer assests that liabilities for a period of - ✔✔3 years peril is most easily defined as - ✔✔the cause of loss insured against in the event of a loss, business overhead insurance will pay for - ✔✔rent events in which a person has both the chance of winning or losing are classified as - ✔✔speculative risk who might receive dividends from a mutual insurer - ✔✔policy holders
How long is the an open enrollment period for medicare supplement policies - ✔✔ 6 months What is the elimination period for social security disability benefits - ✔✔ 5 months Under a nonscheduled plan, what portion of the balance could an insured expect to pay for basic services? - ✔✔20% How can a new physician be added to the PPO's approved list - ✔✔agree to follow PPO standards and charge appropriate fees Which of the following is true regarding limited health insurance policies? - ✔✔the only cover specific accidents or diseases Which document helps ensure that full and fair disclosure is provided to the recipient of a policy - ✔✔outline of coverage What type of information is NOT included in a certificate of insurance - ✔✔The cost the company is paying for premiums an insuere wants to advertise its new medicare supplement policy. Which authority must review the advertisiment prior? - ✔✔director What is the best way to change an application - ✔✔Start over with a fresh application
What documentation grants express authority to an agent - ✔✔agents contract with the principal What are the two types of flexible spending accounts - ✔✔health care accounts and dependent care accounts Occasional VIsits by which of the following professionals will not be covered under LTC's home health care? - ✔✔attending physician Under the Fair credit reporting act, if the consumer challenges the accuracy of the information contained in his or her report, the reporting agency must - ✔✔respond to the consumer's complaint Which provision states that the insurance company must pay medical expense claims immediately - ✔✔TIme of payment of claims What phase begins after a new policy is delivered - ✔✔free-look period When twin brothers applied for life insurance from Company A, the company found that while neither of them smoked and both had a very similar lifestyle, one of the twins was in a much stronger financial position than the other. Because of this, the company charged him a higher rate for his insurance. This practice is considered - ✔✔discrimination which of the following is an eligibility requirement for all social security disability income benefits - ✔✔having attained fully insured status Which of the folowing is true regarding examination of financial affairs of insurers - ✔✔examination expenses are the responsibility of the insurer
Which of the following is not true of disability buy-sell coverage - ✔✔benefits are considered taxable income to business which of the following do the standard and preferred risk categories share - ✔✔premiums are elevated an insured who has an accidental death and dismemberment policy loses her left arm in an accident. what type of benefit will she most likely receive from this policy? - ✔✔The capital amount in a lump sum Which of the following is NOT provided by an HMO - ✔✔patient care Following hospitalization because of an accient, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days? - ✔✔ 20 Which of the following is NOT a cost-saving service in a medical plan - ✔✔denial of coverage which of the following is incorrect concerning taxation of disability income benefits - ✔✔if paid by the individual, the premiums are tax deductible which of the following may be used when determining MEdicare advantage out of pocket costs? - ✔✔Medicare Part B premiums paid by the plan
An applicants resources and assets may be used when determining eligibility for a low income subsidy under medicare part D as long as - ✔✔the assets can be readily convered to cash within 20 days?
