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95 Cards in this Set
- Front
- Back
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An individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received |
No tax |
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An African is considered to be high risk but not so much that the insurer wants to decline coverage. What can the insurance company do |
1. Rate up the policy 2. Increase the premium 3. Add exclusions to the policy |
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If a consumer request additional information concerning an investigative Consumer Report how long does the insurer or reporting agency have to comply |
5 days |
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What is franchise insurance |
It is health coverage for small groups whose numbers are too small to qualify for True Group Insurance |
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How often must a specialty healthcare insurance provide current company information, providers list, operating and other reports to be insured |
Biannually |
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MEWA |
Can be sponsored by insurance companies and the employees retainers full responsibility for unpaid claims and can be self-insured |
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How do employer contributions to health savings account affect the insured's taxes |
The employer contributions are not included in the individuals taxable income |
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Which of the following is the term for a specific dollar amount that must be paid by a health insurance company number for service |
Co-payment |
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Which of the following terms coverages would be allowed MSA |
Long-term care insurance |
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Under the Affordable Care Act, a special enrollment period allows an individual to enroll in a qualified Health Plan within how many days of a qualifying event |
60 days |
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Occasional visits by which of the following medical professionals will not be covered under long-term care |
The attending physician |
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When may an insured deduct unreimbursed medical expenses paid under a long-term care policy |
When the expenses exceed a certain percentage of the insureds adjusted gross income |
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In franchise insurance premiums are usually |
Lower than individuals but higher than group policy |
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How are premiums and benefits taxed on business overhead policies |
Premiums are deductible and benefits taxed |
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A participating insurance policy May |
Pay dividends to the policy |
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Medicare part A Services include |
Post Hospital skilled nursing Hospitalization Hospice care |
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What makes you eligible for a health savings account |
An individual must be covered by high-deductible Health Plan, must not be covered by other health insurance except for specific injury and must not be eligible for Medicare or claimed as a dependent |
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To be eligible for tax credits under the Affordable Care Act, individual must have that is what percentage of the federal poverty level |
100 and 400 percent |
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An employee becomes insured under a PPO plan provided by his employer. If the insured decides to go to a physician who is not a PPO provider what will happen |
The PPO will pay reduced benefits |
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The limits of a health reimbursement account are set by |
The employer |
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Solicitation documents |
Contains all the information necessary to ensure consumer to make an informed Choice as to whether or not to enroll in the Health Insurance Corporation |
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A man bought an individual health insurance policy for himself. Which of the following roles does he now legally have |
He is both a subscriber and the insured |
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How are commissions regulated |
Commissions are negotiated between the insurer and agents |
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And insured is receiving Hospice Care. Isn't sure will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement |
Cost Containment |
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What are two types of flexible spending accounts |
Healthcare accounts and dependent care account |
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Does basic medical expense plans cover for catastrophic medical expenses |
No |
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When an insurer offer services like pre-admission testing, second opinions regarding surgery, and preventive care which term would best apply |
Case management provision |
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Specialty Healthcare Services |
Any the supplemental health care services that are provided by the insurer on an outpatient only basis and not in combination with other Healthcare Services |
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How many hours of pre-licensing Education are required for applicants seeking a resident agent license for single line of insurance |
20 |
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Under a disability income policy, the insured does not pay a monthly benefit that is equal to the insured's previous income. The reason for paying a benefit amount that is less than the insurance income is to |
Prevent overutilization and Malin gineering |
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Business overhead expense insurance |
Sold to small business owners for the purpose of reimbursing the policy holder for business overhead expenses during a period of total disability period premiums are tax-deductible for a business, but any benefits received your taxable income. Overhead expenses, including equipment and employee salaries, are covered by the plan. |
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Issuing or circulating any sales material that is false or misleading |
Misrepresentation |
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How many members do you have to enroll for a group insurance |
At least 100 members |
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MEWAs |
Are groups of at least two employers who pull their wrists to self insure |
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Medicare Supplement Plan a |
Provides the core or basic benefits established by law |
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When May and insured deduct unreimbursed medical expenses paid under a long-term care policy |
When the expenses exceed a certain percentage of the insured's adjusted gross income |
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Specialty HIC |
One of the supplement Healthcare Services provided by a health insurance corporation on an outpatient only basis and is not in combination with other supplement Health Care Services |
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Healthcare provides coverage for expenses related to |
Healthcare, loss of income, and disability income |
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Continuation provision |
The renewal provision must be included on the first page of the Medicare supplement policy. This provision explains the right of the insurer to alter premium amount |
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Within how many days of requesting an investigative Consumer Report must an insurer notify the consumer in writing that the report will be obtained |
Three days |
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The maximum amount that can be contributed to an MSA is what percent of the family deductible for those with family coverage |
75% |
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Under workers compensation which of the following benefits are not included |
Legal benefits |
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An insurance long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged $100 per day. How much will the insurance company pay |
$120 a day |
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Will an HMO or PPO pay for service and not usually covered by Medicare or Medicare supplement policies |
Yes |
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In a non-contributory health insurance plan, what percent is eligible employees must participate in the plan before the plan can become effective |
100% |
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Every subscriber of the Health Insurance Corporation is entitled to |
Evidence of coverage |
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What is the difference between the medicare-approved amount for a service or Supply and the actual charge |
Excess charge |
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To comply with The Fair Credit Reporting Act when must a producer notify an applicant at the credit report may be requested |
At the time of application |
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Does the owner have right to renewal in a term Health policy |
No |
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Do Medicare supplement insurance policies cover the cost of extended nursing home care |
No |
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What is the period of coverage for events such as death or divorce under cobra |
36 months |
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Who must Medicare supplement plans be available to |
Supplement plans must be available to qualifying applicants regardless of their age |
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What provision concerns the insured's duty to provide the insurer with reasonable notice in the event of loss |
Notice of claim |
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The HMO Act of 1973 required employers to offer an HMO plan as an aternative plan to regular health insurance plans if the company had more than 25 employees. How was the plan changed since |
Employers are no longer forced to offer HMO plans |
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The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as |
Legal actions |
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Employer Health Plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months |
30 months |
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In insurance policies, the insured is not legally bound to any particular action in the insurance contract, but the insurer is legally obligated to pay losses covered by the policy. What contract element does this describe |
Unilateral |
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Blank is a state program funded by state and federal taxes that provide medical care for the needy including Parts a through C of Medicare |
Medicaid |
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According to PPACA rules, what percentage of healthcare costs are covered under a bronze plan |
60% |
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Under HIPAA regulations, how lond should an individual converting to an individual plab have been covered by the previous plan? |
18 months |
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A policy owner is reading on the the first oage of his health insurance policy, whixh says "Limited Policy". What is the name of this statement |
Limited Policy Notice |
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Provided by HIC |
Services Financing Patient care |
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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 consumers complaint |
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Which of the following Provisions must be included in the first page of Medicare supplement policy, which did the insurer is right to change the premium amount |
Continuation provision |
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Medical expense policy that establishes the amount of benefits paid based on the prevailing charges which fall within the standard range of fees normally charge for specific procedure by dr. Of similar training and experience in that geographic area is known as |
Usual customary and reasonable |
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What best describes the type of care provided by HIC |
Preventative |
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What is the elimination period for Social Security disability benefits |
5 months |
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An insured purchased a policy to provide coverage on himself his wife and their two children. All of them we need to prove insurability except |
Any children born after the Inception of The Contract |
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Policy requires insured to use Pacific healthcare providers in hospitals, except in emergency situations and in return the insured pays lower premiums |
Medicare select |
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Which type of Hospital policy pays a fixed amount each day that the insured is in the hospital |
Indemnity |
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How is emergency care covered for a member of an HIC |
A member of an HIC can receive care in or out of the service area of the carrots preferred in the service area |
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Which of the following is the errors and omission to occur on the part of the insurer |
Policy delivery |
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Employer Health Plans provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months |
30 months |
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Which state has jurisdiction over a group policy that covers individuals that reside in more than one state |
The state in which the policy was delivered |
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How is the amount of Social Security Disability Benefits calculated |
It is based upon the workers primary Insurance amount which is calculated from the average indexed monthly earnings over their highest 35 years |
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A health insurance policy that pays a lump sum at the insured suffers a heart attack or stroke is known as |
Critical illness |
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To sign up for Medicare prescription drug plan individuals must be enrolled in |
Medicare part A |
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HIPAA applies to groups of |
Two or more |
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An insurance disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payments in the insurer before Social Security benefits begin |
One year |
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Falling hospitalization because of an accident bill was confined in a Skilled Nursing Facility. Medicare will pay full benefits in his facility for how many days |
20 days |
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Most scheduled plans provide first-dollar benefits without |
Coinsurance and deductibles |
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Who has authority to make changes to an insurance policy |
Only the executive officer of the company has authority to make changes to the policy |
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A medical insurance plan in which the health care provider is paid regular fixed amounts of providing care to the insured and does not receive additional amount of compensation dependent upon the procedure performed is called |
A prepaid plan |
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If a business wants to buy a disability income policy on a key employee which of the following is considered the applicant |
The employer |
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How many pints of blood will be paid for by Medicare supplement core benefits |
The first three pints |
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And insured Miss stated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. Insurance company will take which of the following actions regarding the claim |
They will adjust the claim benefit to reflect the insured's true age |
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When an employee is still employed upon reaching age 65 and eligibility for Medicare what should the employee do |
Remain on the group health insurance plan in defer eligibility for Medicare until retirement |
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Every subscriber of Health insurer and corporations are entitled to |
Evidence of coverage |
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Long-term care insurance policies must cover which of the following |
Alzheimer's disease |
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What is the maximum amount that can be contributed to an MSA of a high-deductible plan for individuals |
65% |
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Workers comp benefits are regulated by which entity |
State government |
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Which of the following insurance providers must be non profit and sell insurance only to its members |
Fraternal |
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What is the maximum age for qualifying for a catastrophic plan |
30 |
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An employee group with which of the following number of employees would qualify for a medical savings account |
Less than 50 |
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In order to collect Social Security disability benefits to claim it must be able to demonstrate that the disability will last at least |
12 months |
