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171 Cards in this Set
- Front
- Back
On diagnostic or preventative care dental insurance has no _____
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deductible
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under dental insurance _____ includes bridgework
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prosthodontics
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Medical and dental expenses have the same deductible on what plan?
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integrated
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Health insurance policy that covers virtually all medical expenses
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comprehensive plan
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medicare covers skilled nursing but not ______
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custodial care
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when selling a MEDICARE SUPPLEMENT, agent must give out ____ no later than the time of _____ and must obtain ______ from the applicant
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Outline of coverage
application signed receipt |
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These plans are not required to be approved by Medicare
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medicare supplement
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after receipt of NOTICE OF CLAIM from insured, insurer must send out _____
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claim forms
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insurers to not have to pay _____ claims
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unsubstantiated
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when an insured has __________ they no longer have to prove that they meet the definition of total disability
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presumptive disability
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to be fully insured for social security disability benefits a worker must have contributed to social security for at least ______
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40 quarters
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___________ basis is based upon the geographic area where the insured resides
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usual, customary and reasonable
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HMOs wont cover out of network services unless it is _________
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emergency basis
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PPO subscribers who go out of network for services will receive ________
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reduced benefits
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applies to claims that occur during the last 3 months of the calendar year
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carry-over deductible
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for groups of 20 or more, employees remain eligible for group coverage even after _____
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age 65
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under HIPAA, ______ MAY NOT be considered a pre-existing condition
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pregnancy
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Medicare Part B co-insurance requirement is calculated as a percentage of Medicare's ___________, not the amount the doctor charges
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approved amount
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difference between what the doctor bills and what Medicare pays
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excess charge
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both insurance companies and HMOs may offer ________, a type of medicare supplement that limits the insureds choice of providers but has broader coverage for a lower price
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Medicare Select
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an older person with little income or assets who is concerned about custodial care may obtain coverage through _______
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Medicaid
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period of time that a Long Term Care policy will provide custodial care in a nursing home
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benefit period
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_______ group disability income benefits are taxable to the employee
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non-contributory
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under _______ clause benefits are adjusted to what the premium paid would have purchased if the correct age was known
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misstatement of age
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a ______ prior to performing surgery will result in fewer claims
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second opinion
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_____ one Medicare Supplement policy with another is permitted as long as it is not detrimental to the client
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replacing
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selling a client more than one medicare supplement is _____
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prohibited
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treatment of problems related to growth and development of jaw using appliances
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orthodontics
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limited policies cover limited ____ and have limited _____
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perils
coverage amounts |
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point of service HMO allows the subscriber to select to have their coverage provided by a provider that is ______
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outside the network
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workers compensation disability income eligibility is decided by the ____
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state
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losses sustained while under influence of drugs or alcohol are not covered unless administered on the advice of ______
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physician
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medicare supplement policies do NOT have to contain guidelines for ________
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medicare eligibility
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home health care coverage in a long term care policy will provide coverage for household chores, physical therapy and nurse visits but NOT _______
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wheel chairs and hospital beds
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sole proprietors are able to deduct _____ of the premium they pay for their medical expense insurance
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100%
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partners are able to deduct ____ of the premium paid for medical expense insurance, the benefits are also not taxable
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100%
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business overhead expense policy WILL cover ____, ____ & ____
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payroll
rent utilities |
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business overhead expense policy WILL NOT cover _______
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disability income
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an eligible individual can contribute up to ___ per year of the annual deductible of their individual policy to a Medical Savings Account
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65%
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insurers require a certain percentage of eligible ________ in a group policy to help reduce possibility of adverse selection
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employees enroll
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a group insurance contract is between the _____ and the insurance company
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employer
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employers who have 20 or more employees may not discriminate health benefits based on ____
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age
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if a group policy is issued and the certificates of insurance are delivered in mulitple states the policy provisions have to conform to the ___________
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state's jurisdiction
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from state to state COBRA will not be affected since it is a ________
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federal law
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Part A of medicare covers ____
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hospital services
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Part B of medicare covers ____
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physician services
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Part A of medicare covers skilled nurse care only after _____________
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3 day hospital stay
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Medicare supplements are required to cover medicare's part A _______
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co-insurance
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Physicians services 20% co-insurance and the first 3 pints of blood are basic benefits for ______
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medicare part B
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medicare supplements are sold by ________
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private insurance companies
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insured has to give the insurance company ____ days to investigate a claim prior to bringing legal action
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60
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in order to initiate a claim the insured must submit _______
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notice of claim
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covers the loss of income of the insured should they become unable to work because of injury or sickness
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disability income insurance
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the two perils covered by health insurance policies
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accidental injury and sickness
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a cause of loss
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peril
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insurance with other insurers provision will apply if the insured did not notify the insurer they had another policy covering the same loss prior to ______
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the loss
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when compared to an indemnity plan a ______ restricts the users choice of doctors and the coverage area
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HMO
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if an agent issues a conditional receipt and the underwriter issues the policy, the coverage begins when _________ was issued
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conditional receipt
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if the premium is going to be collected by the agent when the policy is issued, the agent must make sure the insured's ____ has no changed since the ________
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health
application |
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a health insurance application MUST be in ______ and becomes part of the policy when _____
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writing
issued |
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if a policy includes a waiting period for pre-existing conditions then the individual's pre existing conditions _______ be covered for the waiting period
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will NOT
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if a disability income policy has a 7 day elimination period and the insured is sick for 15 days they would receive benefits for ____ days
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8
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If an insured doesnt pay their $50 premium on the due date and has a $150 claim five days later, but their policy has an unpaid premiums provision and first dollar coverage, the insurer will pay _____
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$100
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if an individual jumps off a bus while exiting and breaks their ankle the injury was _____ and _____
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unintentional
unforeseen |
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a dental expense policy could have a ________ exclusion
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pre-existing condition
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person considered to be _____ has the capacity to enter into contracts
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sane
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counter-offers that modify the original application must be signed by the agent and _______
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applicant
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applicants should be aware that a misstatement of a material fact on the application could affect _______
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coverage
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an insurer _____ legally pay a commission to a person who is no longer licensed, as long as that person was licensed when they earned the commission
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CAN
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a ______ can void coverage
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breach of warranty
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it is NOT a violation of the _______ regulation to sell insurance in another state as long as the agent has a non resident license
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fraud and false statements
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a person who violates the fraud and false statements regulation is referred to as a _______ person and can only sell insurance in a state with written approval from the insurance commissioner of that state
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restricted
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insurers take the money from annuitants who die too soon and pay it to those who ______
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live too long
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the face amount decreases on a decreasing term policy, NOT the ______
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premium
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a policy written on the life of a child _______ pay benefits when a parent dies
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does NOT
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when an insured dies during the grace period without paying the premium due, the ______ is paid to the beneficiary, minus the _____
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face amount
premium |
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interest on a life insurance loan is added to the amount of the loan as it _____
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accrues
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under the misstatement of age clause, if the client understates their age, the ______ is reduced
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face amount
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403b tax sheltered annuities (TSAs) are owned by the _____, not the _____
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employee
employer |
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if the owner of a life policy doesn't designate a settlement option prior to death, the beneficiary may _________
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choose any option
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a trustee to trustee roll over will eliminate any _______ tax and defer _______ taxation on accumulated funds
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withholding
current |
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the owner of the annuity is responsible for paying the _____
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premium
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decreasing term is the type of life insurance policy provided in _______ redemption insurance
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mortgage
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the type of policy best suited to cover a 30 year mortgage is a _____ year ______ term policy
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30
decreasing |
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if a person purchases a whole life policy and adds a return of premium rider they will receive a _____ and ____ term amount of insurance
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level (whole life)
increasing (return of premium rider is a type of increasing term) |
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industrial life policies have ____ limit face amounts
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low
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whole life insurance will pay the face amount to the insured if they live to age ____
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100
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Equity Indexed Annuities have ____ inflation risk since their rate of return is based in part on _______
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equity index (S&P 500)
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annuities have many uses such as ____ payouts and ______ settlements
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lottery
structured |
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a corporation ______ use an annuity to build tax deferred growth on corporate assets
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cannot
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the waiver of premium rider ____ pay cash benefit to the insured.
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does NOT
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if the insured becomes disabled for a certain period of time the ________ rider will waive the insured's premium
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waiver of premium
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life insurance covers death due to ____ or _____
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sickness
accident |
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there _____ dollar limit on the amount that can be rolled over in a qualified plan
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is NO
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if an individual exchanges one annuity for another annuity there is ____ current tax due
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NO
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_____ and _____ plans have tax advantage to both the employer and employee
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pension
profit sharing |
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an employee covered in a group life insurance policy will receive ________ as their proof of coverage
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certificate of insurance
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if an outstanding policy loan plus interest exceeds the cash value of the policy, the policy will _____
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lapse
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in a modified endowment contract, any INCREASE in the DEATH BENEFIT is a _______
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material change
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an individual who is age 65 and is ready to retire may want to purchase a ______ annuity
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immediate
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if the beneficiary takes the policy proceeds in a lump sum, the ______ clause _____ apply.
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spendthrift
will NOT |
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the contingent beneficiary will receive policy proceeds if the primary beneficiary dies before the ________
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insured (policy owner)
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if an annuitant selects a payout option that will continue payments to their beneficiary for a set period of time should they die, they have selected a _______ annuity
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period certain
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a juvenile life policy is a life insurance policy written on the life of a ____
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minor
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the insurer must proved to all prospective life insurance purchasers a ______ and ______
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buyer's guide
policy summary |
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the HIV consent form must also state that the results of the test will only be shared with ______ individuals (such as the underwriter)
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certain
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the insurance agent is sometimes referred to as a ______ underwriter, since they get to meet the applicant in person
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front line
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in life insurance the incontestability clause lasts for a period of _____
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two years
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an irrevocable beneficiary cannot be changed without consent of both the _____ and the _______
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owner of the policy
irrevocable beneficiary |
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surrender penalties levied by the insurance company will reduce the amount the owner receives upon __________
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cash surrender
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a parent of a minor ______ need the minors consent in order to purchase life insurance on them
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does NOT
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if an annuitant selects a pay out option that will pay them $500 per month for an unspecified amount of time they have selected the _________ payout option
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fixed amount
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if an annuitant selects a pay out option that will pay them for a certain period of years they have selected the _______ pay out option
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fixed period
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under federal law, a ___________ policy must be guaranteed renewable
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qualified long term care
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HIPAA applies to group medical expense insurance written by insurers, HMOs and PPOs, but DOES NOT apply to _____ insurance
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disability income
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for an individual life insurance policy, the premium paid is or is not tax deductible?
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is NOT
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amount of time the insured has to return a policy and get a full refund
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free look
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when does free look start?
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the date of policy delivery (if mailed, the date of mailing)
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first policy provision to apply if the premium is not paid on time
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grace period
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grace period on ordinary individual life insurance (whole life, endowment, term)
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30 days
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grace period on group life insurance
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31 days
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grace period on industrial life insurance
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28 days
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nonforfeiture provisions apply when a policy _______
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lapses with cash value
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nonforfeiture option where you take your money, no more coverage and can never reinstate coverage
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cash surrender
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nonforfeiture option where the insurer takes your cash value and uses it as a single premium for a term policy with same face amount as original policy.
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extended term
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if policy lapses and insurer does not hear from you in 60 days, automatic option is ______
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extended term
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nonforfeiture option where the insurer takes your cash value and buys you a single premium whole life policy, face amount is reduced
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reduced paid up to 100
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period of time where a newly issued policy claim can be contested
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incontestability clause
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period of time after buying a policy where suicide is excluded (maximum 2 years in arizona)
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suicide exclusion
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ways that a beneficiary can select to receive the proceeds from the insureds life insurance policy
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settlement options
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settlement option where insurance company pays the beneficiary the face amount in cash
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cash option
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settlement option where insurance company keeps the money and pays the beneficiary interest on it (TAXABLE)
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interest option
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settlement option where company pays the beneficiary a fixed amount monthly until proceeds are exhausted
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fixed amount option
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settlement option where company pays the beneficiary for a specific period of time
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fixed period option
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settlement option where beneficiary selects to take monthly payments for his or her life
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annuity option
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the amount of risk that a client poses to the insurance company
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risk classification
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risk associated with client that may have a health problem or dangerous hobby/occupation-would have to pay a higher premium
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substandard
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risk associated with average person paying average premium
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standard
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risk associated with someone who is in excellent shape and likely to live a long life-premium would be at a discount
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preferred
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for group health insurance, the portion paid by the employer is tax deductible as a ________
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business expense
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business overhead expense is tax deductible as a ________
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business expense
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for an individual, disability income insures ______ after _____
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net income
tax |
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for an group, disability income insures ______ before _____
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gross income
tax |
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for AD&D insurance, what pays for death and sever dismemberment?
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principal sum
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for AD&D insurance, what pays for dismemberment only?
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capital sum
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part of social security only available to a person 65 or older
|
medicare
|
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what medicare supplement will fill in all the gaps in medicare?
|
NONE
|
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how many uniform medicare supplements?
|
12 (A-L)
|
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medicare supplement with the least coverage and cheapest
|
part A
|
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sometimes referred to a the preexisting condition exclusion
|
probationary period
|
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what is the probationary period used for?
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to prevent adverse selection on medical expense and disability income policies
|
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maximum preexisting condition exclusion on reinstatement of an individual policy
|
10 days
|
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preexisting conditions have been treated prior to coverage ___ months for group and ___ months for individual
|
6
12 |
|
federal regulation that permits the insured and dependents to continue in the group
|
COBRA
|
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COBRA insures group members up to ___ months after termination of employment
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18
|
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COBRA insures dependents of a group member for ___ months upon death or divorce
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36
|
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under COBRA the insured must pay _____ including employer's share
|
entire premium
|
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under COBRA at the end of 18 months, insured may still convert to an individual policy without evidence of insurability. true or false?
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true
|
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requires that every insurer who offers individual health make available at least two plans for certain "eligible" individuals on a guaranteed issue basis
|
HIPAA
|
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under HIPAA an individual is eligible if they have at least ___ months of prior creditable coverage
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18
|
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under HIPAA an individual is eligible for coverage if they have no lapse in coverage greater than ___ days
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63
|
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under HIPAA individual is eligible for coverage if they have elected and exhausted ______
|
COBRA
|
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always contestable on health insurance
|
fraud
|
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______ in health insurance are tied to mode of payment (how often you pay your premium)
|
grace periods
|
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health insurance grace period if premium is paid weekly
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7 days
|
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health insurance grace period if premium is paid monthly
|
10 days
|
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health insurance grace period for all other payment modes besides weekly/monthly
|
31 days
|
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insured must give notice of claim within ___ days
|
20
|
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insurer must provide claim forms within ___ days of notice of claim
|
15
|
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insured must give proof of loss within ___ days of having claim forms
|
90
|
|
insurer must pay claim within ___ days of proof of loss
|
60
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