Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
72 Cards in this Set
- Front
- Back
|
What is the "own occupation" disabillity |
insured's inability to perform duties of his or her current job or an occupation for which the insured is educated and trained |
|
|
under what employer-sponsored plan are the benefits taxable to an employee in proportion to the amount of premium paid by the employer |
Disability income |
|
|
what health policy provision allows the insurer to non renew health coverage if certain events occur? |
conditionally renewable |
|
|
who decides which optional provisions would be included in a health policy? |
The insurance company |
|
|
what is the time requirment for terminated employees to convert the group health coverage to an individual plan without evidence of insurability |
31 days after termination of employee |
|
|
when must the outline of coverage be provided to the insured |
no later than policy delivery |
|
|
how are excess funds in an employee's health savings account (HSA) handled? |
the funds can be carried forward to the next year |
|
|
what medicare part will cover lab services or diagnostic tests |
plan b |
|
|
under an individual disability income policy, the benefits must be paid on at leas what schedule |
monthly |
|
|
in health insurance contracts, the insured is not legally bound to any particular action; however, the insurer is obligated to pay for losses covered by the policy. what contract characteristics does this describe |
unilateral |
|
|
what are the four types of worker compensation benefits? |
medical, income, rehabilitation, and death benefits |
|
|
according to the affordable care act, what are the cost sharing requirments for preventive care? |
no cost sharing |
|
|
how many consecutive months of coverage must long-term care insurance provide |
12 |
|
|
how is medicare part b funded |
federally and by monthly premiums |
|
|
if the insureds share in the cost of health insurance premiums with the employer, this would be known as what type of group health plan? |
contributory |
|
|
under what type of care do insurers negotiate contracts with health care providers to allow subscribers access to health care services at a favorable cost |
Preferred provider organization |
|
|
under the uniform required provisions for health insurance policies, proof of loss usually needs to be filed within how many days? |
90 days |
|
|
a waiver of premium provision may be included with what type of health insurance policies |
disability income |
|
|
which type of misrepresentation persuades an insured, to his or her detriment, to cancel, lapse, or switch policies from one to another? |
twisting |
|
|
if an underwriter requires extensive information about the applicant's medical history, what report will best serve this purpose |
attending physician's statement |
|
|
what is the primary purpose of disability income insurance? |
to replace income lost due to a disability |
|
|
how are individually owned disability income benefits taxed once received by the insured |
disability benefits are not taxed; they are received income tax free. |
|
|
who must be notified of a producer's change of address? |
commissioner/director/superintendent (The department of insurance) |
|
|
how long do short-term disability group plans pay benefits? |
for a period of less than 2 years |
|
|
When Can an irrevocable beneficiary be changed?
|
with written consent of beneficiary
|
|
|
which policy rider on health insurance policies allows an insured to purchase additional amounts of disability income coverage without evidence of insurability
|
Guaranteed insurability rider
|
|
|
in which medicare supplemental plans are the core benefits found
|
All plans
|
|
|
What are the two types of expenses that are covered by health insurance
|
Medical expenses and expenses that compensate for loss of income
|
|
|
what is the purpose of managed care health insurance plans
|
to control health insurance claims expenses
|
|
|
how do insurers determine the cost for a group health policy
|
the main variables are ratio of men and woman in the group and the average age of the group
|
|
|
What is the purpose of the impairment rider in health insurance
|
to exclude coverage for a specific impairment
|
|
|
What renewability provision will most likely appear on a travel accident policy
|
Period of time (short term- policy)
|
|
|
If medical caregivers are contractually obligated to provide services only to members or subscribers of a specific health organization, what is the name for this type of arrangement?
|
Closed panel
|
|
|
What are the two types of flexible spending accounts
|
Health care accounts and dependent care accounts
|
|
|
How can AD&D coverage be written
|
as a rider or as a separate policy
|
|
|
who qualifies for medicare coverage
|
individuals of 65 years of age, have been entitled to social security disability benefits for 2 years, or has chronic kidney disease
|
|
|
what is subrogation in health insurance
|
Legal process that gives the insurer the right to seek recovery from a third party responsible for the loss after insurer has paid insured for the loss
|
|
|
what are the tax implications for contributions to a health savings account by the individual insured
|
Contributions are tax deductible
|
|
|
who determines the eligibility and contribution limits of a health reimbursement account(HRA)
|
The employer
|
|
|
What information are the members of the medical information bureau required to report?
|
adverse medical information about applicants or insureds
|
|
|
what are the common exclusions in most health insurance policies?
|
war, self-inflicted injuries, elective cosmetic surgeries, injuries caused by illegal activities, and workers compensation benefits.
|
|
|
What is the name of the act by the insured to voluntarily give up insurance?
|
cancellation
|
|
|
how is medicaid funded
|
state and federally funded
|
|
|
what is a probationary period in group health insurance
|
period of time that must lapse before an employee is eligible for group health coverage
|
|
|
how does someone qualify for social security benefits?
|
the insured must have proper insured states, meet definition of disabled, and satisfy waiting period
|
|
|
how will changing ones occupation to be more hazardous affect the health insurance policy in force
|
claim benefits will be reduced to what the premium would have bought for a more hazardous occupation
|
|
|
what benefit is based on a primary insurance maount (PIA)
|
social security disability benefit
|
|
|
what are the activities of daily living
|
mobility, bathing, dressing, eating, transferring, toileting, and continence
|
|
|
what is the purpose of insurance guaranty assoications
|
to protect policyowners, insureds and beneficiaries from loss caused by insolvent insurers
|
|
|
what health policy renewability provision allows the insurer to terminate coverage for any reason, and to increase the premiums for any class of insureds
|
optionally renewable
|
|
|
what health policy provision defines the insured's duty to provide the insurer with reasonable notice in the event of a loss
|
notice of claim
|
|
|
in what type of health plans are providers paid for services in advance, regardless of the services provided?
|
prepaid plans
|
|
|
what is the tax advantage of the employer paying premiums for its employees for disability income insurance
|
premiums are deductible as a business expense
|
|
|
what health policy provision states to whom the claim benefits must be paid
|
payment of claims
|
|
|
what are the tax implications for employer contributions to health reimbursement accounts
|
employer contributions are tax deductible as business expenses
|
|
|
what is the purpose of the coinsurance provision in health insurance policies
|
to prevent overutilization of the policy benefits
|
|
|
an agent offers a client free tickets to a sporting event in exchange for the purchase of an insurance policy. what is the agent guilty of?
|
rebating
|
|
|
what is the capital sum in accidental death and dismemberment coverage
|
a percentage of the principle sum
|
|
|
when should an agent obtain a statement of good health from the insured
|
when the premium was paid upon policy delivery rather than at the time of application
|
|
|
when are LTC benefits received tax free by an individual
|
they are always tax free
|
|
|
what report is used to assess risk associated with a health insurance applicants lifestyle and character
|
investigative consumer report
|
|
|
what is the purpose of respite care in long term care insurance
|
to provide relief for a major caregiver
|
|
|
what health policy provision describes the insured's right to cancel coverage
|
renewability provision
|
|
|
what type of licensee represents the insurance company
|
the agent
|
|
|
what is the purpose of a buy-sell aggreement for health insurance policies
|
to specify how the business will pass between owners when one of them dies or becomes disabled
|
|
|
what illegal act does a producer commit when the producer represents a policy in a more favorable light than the policy really is
|
misrepresentation
|
|
|
what are agents/producers required to do in order to renew their license
|
complete continuing education hours and pay a renewal fee
|
|
|
how are the benefits of a group accidental death and dismemberment policy received
|
income tax free
|
|
|
what is a fee-for-service health plan
|
providers receive payments for each service provided.
|
|
|
who must be a member of a state insurance guaranty association
|
any authorized insurer within a state
|
|
|
what health policy provision prevents the insured from bringing a lawsuit against the insurance company for at least days after proof of loss is provided
|
legal actions
|
|
|
whose responsibility is it to determine that all of the questions on an insurance application are answered
|
the agenst
|
