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171 Cards in this Set

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