Basic Health

What document describes an insured's medical history, including diagnoses and treatments?

When is the insurability conditional receipt given?

What statement best describes the free look provision?

In an optionally renewable policy, the insurer has which of the following options?

When Ken purchased his health policy he was a window washer. He has since changed occupations and now manages a library. Upon notifying the insurer of his change of occupation the insurer should

All of the following are correct about the required provisions of health insurance policy EXCEPT A) Proof-of-loss forms must be sent to the insured within 15 days of notice of claim B) A grace period of 31 days is found in an annual pay policy C) The entire contract clause means the signed application, policy endorsements, and attachments constitute the entire contract D) A reinstated policy provides immediate coverage for an illness

Which health insurance provision describes the insureds right to cancel coverage

Under the Physical Exam and Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending?

Which of the following is not true regarding uniform mandatory provisions concerning claims? A. If the insured is several days late in filing proof of loss form, the claim cannot be denied if the insured can show good cause B. The insured is customarily required to give notice of claim within 20 days C. If the insured is 2 years late in filing proof of loss, the claim can be denied D. An insured must notify the insurer of a claim on forms prescribed by the insurer

Rose bought three policies from the same insurer. Her benefits have exceeded the max allowed by the insurer. Which of the following will happen?

The free-look provision allows for which of the following?

While a claim is pending the insurance company may require

Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date?

A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?

An insurer would like to add a provision to its individual health insurance policies. This particular provision would be consistent with uniform provisions. Which of the following is true?

Under a disability income policy, the insurer pays a monthly benefit that is less than the insured's income. What is the reason for that?

All of the following statements concerning workers compensation are correct EXCEPT A. Benefits include medical, disability income, and rehabilitation coverage B. A worker receives benefits only if the work related injury was not his/her fault C. Workers compensation laws are established by each state D. All states have workers compensation

Income benefits in a disability income policy are characterized by all of the following EXCEPT

What is the shortest possible elimination period for group short-term disability benefits provided by an employer?

Which of the following are the main factors taken into account when calculating residual disability benefits?

Any occupation disability typically means that an individual is unable to perform the duties of the occupation for which he/she is suited by all of these EXCEPT

After the elimination period, a totally disabled insured qualified and started receiving benefits from his disability income policy that has a waiver or premium rider. What will most likely happen to the premiums paid into the policy during the elimination period?

Of the following choices, which of the statements about occupational versus nonoccupational cover is true?

Alden is involved in a small plane accident that renders him permanently deaf, although he does not sustain any other major injuries. Alden is still able to perform his current job. To what extent will he receive Presumptive Disability benefits?

Bethany studies in England for a semester. While she is there she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives?

John owns a medical expense policy that he purchased for his family. John's employer purchased a Group Disability Income policy for John and all eligible employees. John subsequently suffered an accident on the job that left him unable to work for four months. If John receives benefits from his disability income policy, which of the following would be true?

In which of the following cases would an "any occupation" disability income policy pay the benefits?

A business wants to make sure that if a key employee becomes disabled, the business will be protected from any resulting loss. Which kind of insurance will protect the business?

Which of the following conditions would a disability income policy most likely NOT require in order to qualify for benefits? A. The insured must be under a physicians care B. The insured must be confined to the house C. The insured must provide proof of disability D. A specified income status prior to the disability

An employee is injured in a construction accident, rendering him unable to work for a year. Which of the following plans would provide him with medical expense coverage and income assistance?

Which is true regarding HMO coverage?

Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?

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

The HMO Act of 1973 required employers to offer an HMO plan as an alternative to regular health plans if the company had more than 25 employees. How has this plan since changed?

Under which provision can a physician submit claim information prior to providing treatment?

Can an individual who belongs to a POS plan use an out-of-network physician?

All of the following are ways in which a Major Medical policy premium is determined EXCEPT A. The stop loss amount B. The average age of the group C. Amount of the deductible D. Coinsurance percentage

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as

What would a physician utilize if he/she wanted to know if a treatment is covered under an insured's plan and at what rate it will be paid?

To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?

A new employee who meets HIPAA eligibility requirements must be issued health coverage on what basis?

A child of the insured is incapable of self support because of a physical handicap. The child has reached the limiting age for dependent. When can coverage continue under the health insurance policy?

What process will the insurance company use to monitor the insured's hospital stay to make sure that everything is proceeding according to schedule?

What is Concurrent Review process?

Under which of the following organizations are the practicing providers compensated on a fee-for-service basis?

Which of the following are responsible for making premium payment in an HMO plan?

A husband and wife are insured under group health insurance plans at their places of employment. Because their employers pay for their plans, each is covered as a dependent under their spouse's coverage. If the husband is hospitalized, how are the medical expenses likely to be paid?

What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?

Which of the following statements concerning group health insurance is CORRECT?

What is the period of coverage for events such as death or divorce under COBRA?

An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75 for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?

An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1500 of medical expenses. What amount, if any, would be paid by the secondary insurer?

When employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles?

Which of the following is true regarding METs?

All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT

Which of the following factors would be an underwriting consideration for a small employer carrier?

COBRA applies to employers with at least

A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim

Kevin and Nancy are married, Kevin is the primary breadwinner and has a health insurance policy that covers both him and his wife. Nancy has an illness that requires significant medical attention. Kevin and Nancy decide to legally separate, which means that Nancy will no longer be eligible for health insurance coverage under Kevin. Which of the following options would be best for Nancy at this point?

All of the following can qualify as a trust EXCEPT

In a group policy, who is issued a certificate of insurance?

what clause allows both the insured and the dentist to know in advance which benefits will be paid?

under most dentist plans what limitations are posed for denture replacement?

which of the following is not applied toward the deductible under a nonscheduled plan>?

most scheduled plans provide first dollar benefits without

under a nonscheduled plan what portion of balance could an insurance expect to pay for basic services?

Which of the following is not considered a basic service under a nonscheduled plan

All of the following are usually provided under an employer group dental insurance plan EXCEPT

A dental plan that provides coverage based upon a specified max scheduled amount for each procedure and pays on a "first dollar" basis with no deductible or coinsurane is a

Julie must have orthodontic work performed on her incisors. Which type of service would this be called, under a nonscheduled plan?

What two types of services are under nonscheduled

An insured does not have to pay coinsurance or deductibles on a full-series mouth x-ray, but does have to pay a deductible to get his cavities filled. Which dental plan does he have?

In order for costs to be covered under a dental plan, what is the minimum interval that must pass between routine dental exams?

Which of the following statements is not true of a Combination Dental Plan? A. A combo plan is also known as "superimposed plan" B. Combo plan is basically a combo of a schedule and nonschedule plan C. Combo plan covers diagnostic and preventive care on the usual customary and reasonable basis D. Combo plan uses a fee schedule for other dental services

Combination plans are comprised of two types of plan featuers: basic and

Which of the following statements is NOT true concerning medicaid? A. Intended to provide medical assistance for needy B. It consists of 3 parts: Part A: Hospitalization Part B: doctor's services, Part C: disability income C. State program D. Paid for by state taxes

What option allows the insured to periodically increase benefit levels without providing evidence of insurability?

OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage

Which law was passed to authorize the NAIC to develop a standardized model for Medicare supplement policies?

A man is enrolled in Part A of Medicare and not Part B. Three months into coverage, he applies for a Medicare supplement policy Which of the following is true?

Medicaid provides all of the following benefits EXCEPT A. Family Planning Services B. Income assistance for work-related injury C. Home health care services D. Eyeglasses

Following an injury, Jill, age 66 and covered under Medicare Parts A and B, was treated by her physician on an out-patient basis. How much of her doctor's bill will Jill be required to pay out-of-pocket?

Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?

Medicare Advantage is also known as

Medicare Part A =

Medicare Part B =

Medicare Part C =

Medicare Part D =

When an employee is still employed upon reaching age 65 and eligibility for Medicare, which of the following is the employee's option?

In group insurance, what is the policy called?

Which of the following is NOT an activity of daily living (ADL)?

Which of the following is not an enrollment period for Medicare Part A applicants?

A Medicare supplement policy must provide coverage for pre-existing conditions after the policy has been in force for

According to OBRA, what is the minimum number of employees required to constitute a large group?

S is a sole business proprietor who owns a medical expense plan. What percentage of the cost of the plan may he deduct?

Which of the following is incorrect concerning taxation of disability income benefits?

An individual is insured under his employer's group Disability Income policy. The insured suffered an accident while on vacation that left him unable to work for 4 months. If the disability income policy pays the benefit, which of the following would be true?

Lisa and Lena own a shop together. They are partners in their business of 2 years. Lisa is a designer, Lena is a seamstress. Lisa worries that if Lena becomes disables, that would affect their business. She inquires about purchasing disability buy-sell insurance. What does her agent tell her about that type of policy?

Under a Key Person disability income policy, premium payments

Which of the following is true regarding the taxation of the premium in group accidental death and dismemberment policies?

Which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner?

In an individual long-term care insurance plan, the insured is able to deduct the premiums form taxes. What income taxation will be imposed on the benefits received?

When may an insured deduct un-reimbursed medical expenses paid under a long-term care policy?

The proprietors of a business may deduct the cost of a medical expense plan because they are considered to be self-employed individuals instead of employees. What is the highest percentage that may be deducted?

Which of the following is not true of the tax deductibility of medical expense coverage for sole proprietors and partners?

Under what condition are group disability income benefits received by an employee NOT taxable as income? A) When the employer makes all the premium payments B) When the employee is 59 1/2 C) When the amount of the benefit is equal or less than the amount of contributed by the employer D) When the benefits received are equal or less than the employee's percentage of the contribution

Under which of the following employer provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer?

How are excess funds in an employee's HSA handled?

Which of the following is not true of Disability Buy-Sell coverage?

Willy has a history of heart disease in his family, so he would like to buy a health insurance policy that strictly covers heart disease. What type of policy is this?

An insurance agent proposed an individual health insurance policy that is guaranteed renewable. If the applicant accepts this policy, the insurere agrees that

Most insurers issue health insurance policies for delivery in many states. Because each state regulates and mandates the requirement for policies delivered to their residents, instead of having a policy form for each stat, the insurer attaches

An employee becomes insured under a PPO plan provided by his employer. If the insured decided to go to a physician who is not a PPO provider, which of the following will happen?

Can a group that is formed for the soul purpose of obtaining group insurance qualify for group coverage?

Which of the following would require an individual to stop participating in a specific activity if the commissioner believes to be violating the insurance code

What is the term used for an applicants written request to an insurer for the company to issue a contract, based on the information provided

If an insurer terminates a producer, the Commissioner must be notified. How many days does the insurer have to deliver this notice?

All of the following events will terminate a producer's certificate of appointment EXCEPT a)A producer's license expires and is not renewed.b)A termination issued by the appointing insurer.c)A producer's license is suspended or revoked by the Department of Insurance.d)A new Commissioner or Director is put into office. An appointment by an insurer is based upon the person maintaining a valid insurance license. Although the appointment is made by the head of the Insurance Department, that person leaving the office does not terminate existing appointments.

Health insurance plan which involves financing, managing, and deliver ofhealth care services and involves a group of providers who share in the financial risk of the plan or who have an incentive to deliver cost effect service

An insurance contract requires that both the insured and the insurer meet certain conditions in order for the contract to be enforceable. What contract characteristic does this describe?

Which of the following is required to be licensed as an insurance producer

Which of the following answers does

Jason is insured under his employer's group health insurance. He splits the cost of the premiums with his employer. THis is an example of

When health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost, it is called

Which of the following occupations would have the lowest disability insurance premiums

What is NOT a benefit of a POS plan?

What is a material misrepresentation?

Which of the following factors does an insurer use the most to determine the extent to disability benefits that it will promise in a contract?

Which of the following is excluded in a dental insurance plan?

Which act amended the National Labor Relations ACT

When may an insurer require an insured to provide genetic information?

The classification "small employer" means any person actively engaged in a business that during the preceding year employed

Which of the following is not true of basic medical expense plans

Q was treated for hypertension prior to applying for a major medical policy. As the producer who is writing the replacing policy, what should you tell Q?

In order for an insurer to legally transact insurance, it must obtain which of the following?

Workers compensation insurance covers a worker's medical expenses resulting from work related sickness or injuries and covers loss of income from A) Work-related disabilities B) Job termination C) Plant or office closings D) Temporary job layoffs

According to the PPACA rules, what percentage of the health care costs will be covered under a bronze plan?

Which of the following would be a typical max benefit offered by major medical plans

Insured's disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payment from the insurer before Social Security benefits begin?

An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles how much will the excess plan pay?

HIPAA applies to groups of

Underwriting is a major consideration when an insured wishes to replace her current policy for all of the following reasons EXCEPT A) Premiums always stay the same B) Due to age or health, the policy may change dramatically C) Pre-existing conditions that were previously covered may not be covered under the replacing policy D) Benefits may change A) Premiums always stay the same

The PPACA includes all of the following provisions except a) Coverage for preventive benefits. b) Individual tax deduction for premiums paid. c) Right to appeal. d) No lifetime dollar limits.

An underwriter must review an applicant with an extensive medical history. Which document would give the underwriter a better understanding of how the insured was treated for various illnesses?

Which of the following statements concerning group health insurance is CORRECT

Which of the following options best depicts how the eligibility of memebers for group health insurance is determined

Which type of hospital policy pays a fixed amount each day that the insured is in a hospital?

An insurer hires a representative to advertise its company at a local convention. The representative lies about the details of some of the policies, in an attempt to secure more business for the company. Who is responsible for the representative's claims?

In a group prescription drug plan, the insured typically pays what amount of the drug cost

What is the major difference between a stock company and a mutual company

insurance companies may be classified according to the legal form of their ownership. the typeof company organized to return any surplus money to their policyholders is a:

Maximum benefits for a major medical plan are usually lifetime

Premium payments for personally-owned disability income policies are

An applicant is discussing his options for Medicare supplement coverage with his agent. He is eligible for the Medicare supplement plans. What is the insurance company obligated to do?

All of the following statements about Medicare supplement insurance policies are correct EXCEPT

Which of the following groups seeknig group health insurance would represent a bad risk for underwriters

If an insurer meets the state's financial requirements and is approved to transact business in the state, it is considered to be

After a person's employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true

Which of the following is not covered under a "core" policy, Plan A in Medigap insurance

Which of the following is true regarding health insurance

Under which plan does preventative dental not apply toward the deductible

All of the following are difference between individual and group health insurance EXCEPT

What is the goal of the HMO

When a group health insurance plan is terminated how long is an extension of benefits provided for any totally disabled employee or dependent

According to the Time Limit on Certain Defenses provision, non-fraudulent misstatements made on the health insurance application may not be used to deny a claim after the policy has been in force for

The purpose of managed care health insurance plans is to

If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within a specified period of time?

A producer misrepresents the details of an insured's new insurance contract that will be replacing the current contract. Which of the following is the producer violating

Which of the following is not true regarding partial disability a) An insured would qualify if he couldn't perform some of his normal job duties. b) This is a form of insurance that covers part-time workers. c) The insured can still report to work and receive benefits. d) Benefit payments are typically 50% of the total disability benefit.

How many pints of blood will be paid for by Medicare Supplement core benefits?

A married couple is covered under a group health insurance plan at the husband's place of employment. When the wife gave birth to their first child, what must the husband do in order to have coverage for the child?

In individual health insurance coverage, the insurer must cover a newborn from the moment of birth, and if additional premium payment is required, allow how many days for payment

How is emergency care covered for a member of an HMO

A _____ policy covers all members of the insured group without requiring individual applications or without issuing individual policies

Which of the following is not provided by an HMO

Which type of information is not included in a certificate of insurance

An insured pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would

What type of care is Respite care

A participating insurance policy may do which of the following