Coverage becomes effective when the company underwriter approves the application if the premium has been paid. -they are temporary insuring agreements -they guarantee the insurer will approve the application -they purchase temporary insurance, up to 6 months -they become part of the policy, they are temporary insuring agreements (with a conditional receipt, insurance coverage is effective as of the date of the receipt, so long as the application is approved) U2, A typical Accidental Death & Dismemberment policy covers all of the following losses EXCEPT: -limb -life -income -eyesight, Under a credit disability policy, until what point will payments to the creditor be made for the insured? Pete Rathburn What Is the Free Look Period? -have permanent kidney failure -be at least age 50 -have attained fully insured status -be disabled for at least 1 year, have attained fully insured status (although Social Security offers many benefits, such as retirement, survivors and Medicare, only those who have attained fully insured status are eligible for Disability Income benefits. Claims will be paid out even if the accident happens during the grace period. -an individual who was previously covered by group health insurance for 6 months is eligible -an individual who has used up COBRA continuation coverage is eligible -an individual who doesn't qualify for Medicare may be eligible -the gap of coverage for eligibility is a period of 63 days or less, an individual who was previously covered by group health insurance for 6 months is eligible (HIPAA requires that the individual have a previous continuous creditable health coverage for at least 18 months) U5, A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called: -reimbursement plan -fee-for-service plan -prepaid plan -indemnity plan. The amount of benefits that an insured receives is determined by the insured's earned income & is usually limited to a certain percentage of that amount) U2, What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided? -Disability Income -Major Medical -Dental Expense -Basic Medical Expense, Insurance that would pay for hiring a replacement for an important employee who becomes disabled is called: -Key employee disability insurance -Blanket disability insurance -Long-term disability -Business overhead expense disability insurance, What percentage of individually-owned disability income benefits is taxable? Under the Fair Credit Reporting Act, the producer or company is obligated to inform the client of the name and address of the reporting agency that furnished the report. Weekly: 7 Days Monthly: 10 Days All Other: 31 Days How soon after health insurance Reinstatement will accident and health claims be available? If the insured should die the insurer will pay the death benefit to the beneficiary if the policy is approved. -producer -insurer's executive officer -department of insurance -broker, insurer's executive officer (the insurer must have the insured's written agreement to the change) U3, What is the purpose of coinsurance provisions? Last March she forgot to mail her premium to the company. -2 examinations per week of the claim processing period -unlimited -none at all -1 examination per week of the claim processing period, An insureds purchased a noncancellable health insurance policy 1 year ago. -excessive benefits may be taxable -benefits may be taxable as ordinary income -premiums may be taxable as income -premiums are not deductible in any case, Under what condition are group disability income benefits received by an employee NOT taxable as income? What type of license should the producer obtain? -decrease -increase -remain the same -either increase or decrease, Which of the following is NOT a cost-saving service in a medical plan? Occupational injury is covered by Workers' Compensation insurance, not health insurance. A proportionate share of the loss should be paid by both insurance companies if? Her only options are to reject the policy or excepted as it is what contract feature does this describe, What an insured makes truthful statements on an application for insurance and pays the required premium it is known as which of the following, Which of the following information regarding an insured is not included in the investigative consumer report, And insured has a social Supplement rider in her disability income plan. The Insuring clause of a disability policy usually states that all of the following Except? Do years ago he suffered a head injury from an accident so we cannot river parts of his past but is otherwise competent. Casualty Overview Types Of Health Insurance Policies 18% Health Policy Provisions, Clauses, And Riders 27% Key Facts **** Study If All Else Falls Social Insurance 4% Other Health Insurance Concepts 5% Minnesota Laws, Rules, And Regulations 27% Minnesota Laws, Rules, And Regulations 7% Notes From Simulated Test Pricing Corporate Training D The identities of the insurance company and the insured. Disability Insurance Definitions and Terms | Guardian - Ch. 8 What kind of license with this require, To the following is an example of a producers fiduciary duty, They trust that a client places in the producer in regard to handling premiums, In instances where coordination of benefits provisions as necessary into relevant plans cannot agree on the order benefits they have the pay The claim in equal shares how long do they have to determine, If a telemarketer wants to make an unsolicited sales call to potential customer what is the earliest time a telemarketer can call the prospects, A producers license has been revoked a second time for violating the insurance code when can the producer apply for a new license, And insured pays $100 premium every month for his insurance coverage yet they ensure promises to pay $10,000 for a covered loss. D) The insurance company accepts the risk. -if the total of benefits paid meets the minimum state taxation standard -whether the premiums were tax deductible -state statutes -contract provisions, whether the premiums were tax deductible (the taxation status of benefits is often determined by whether the premium has been tax deducted) U8, If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply? Clause defines type of coverage, as well as identifies the rights and duties of each party of the contract, identities of both the insured and insurer? -apparent -express -implied -fiduciary, apparent (the appearance or the assumption of authority based on the actions, words or deeds of the principal or because of circumstances the principal created). What is the benefit is based on the insurance loss of earnings after recovery from disability, All of the following long term coverages would allow an insured to receive care at home except, The rider that may be added to disability income policy that allows for an increase in the benefit amount under certain conditions is called, An insured has Been injured in an accident. when a claim is pending, the insurance company may require, an independent examination as often as reasonably required. Notice of Claim and Proof of Lossa What are the insurer's duties during the claim? Health Comprehension Test: CH6 Flashcards | Chegg.com -a person's total loss of income -a person's inability to qualify for insurance coverage -a person't ability to work is significantly reduced or eliminated for the rest of his/her life -a person's inability to perform one of the regular duties of his/her occupation, a person't ability to work is significantly reduced or eliminated for the rest of his/her life U4, The relation of earnings to insurance provision allows the insurance company to limit the insured's benefits to his/her average income over what period of time? What type of agent authority does this describe, For an individual who is eligible for Medicare at age 65, and who is still employed and covered under employers plan which of the following is true, The employer plan is primary coverage and Medicare is secondary coverage, A waiver of premium provisions may be included with which kind of health insurance policy, Which is the contact provision that allows the insured to nonrenew health coverage if certain events occur, Which is not true regarding an insured who is considered to be a standard rest, The insured may have to pay slightly higher premiums, Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policy owner, And insured has mistakenly failed to enroll in her husbands health plan what would happen following a major health expense, If the insured under disability income insurance policy changes to a more hazard occupation after the policy has been issued and a claim is filed the insurance company should do which of the following, I just the benefit in accordance with the increased risk. $1000 Health insurance policy May cover all of the following risks except War related injuries If a business wants to buy a disability income policy on a key employee which of the following is considered the applicant Employer Which of the following is an eligibility requirement for all Social Security disability income benefits Definitions - Disability Specialists -if paid by the individual, the premiums are tax deductible -if the employer paid the premiums, income benefits are taxable to the insured as ordinary income -if the insured paid the premiums, any disability income benefits are tax-free -if the benefits are for a permanent loss, the benefits paid to the employee are not taxable, if the employer paid the premiums, income benefits are taxable to the insured as ordinary income (if an individual purchases his or her own disability insurance with before-tax dollars, any benefits paid are tax free, but the premium is not tax deductible. when the insured initiates the cancellation of a policy, the unearned premium will be refunded on a ______ _____ basis? The method of premium payment is in another section of the policy called the Mode of Premium, which may be annual, semiannual, quarterly or monthly. whats it called when Insurer cannot cancel or raise premiums beyond amount stated in the policy? 2003-2023 Chegg Inc. All rights reserved. -in long-term plans, monthly benefits are limited to 75% of the insured's income -there are no participation requirements for employees -short-term plans provide benefits for up to 1 year -the extent of benefits is determined by the insured's income, the extent of benefits is determined by the insured's income U4, A business wants to make sure that if a key employee becomes disabled, the business will be protected from any resulting loss. -the cost the company is paying for monthly premiums -the policy benefits and exclusions -the procedures for filing a claim -the length of coverage, the cost the company is paying for monthly premiums U6, Which statement best defines a Multiple Employer Welfare Arrangement (MEWA)? What provision states that claim must be paid immediately upon written proof of loss, A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as, Which of the following is a statement that is guaranteed to be true and if untrue Maybridge an insurance contract, Events in which a person has both the chance of winning or losing are classified as, Pertaining to insurance what is the definition of fiduciary responsibility, Probably forwarding premiums to the insurance company, Medicare supplement renewal commission paid in the third year must be as high as the commission of what year, The authority granted to an agent through the agent contract is referred to as, Who must pay for the cost of a medical examination required in the process of underwriting, In long-term care insurance what type of care is provided with intermediate care, Which of the following is not required to be stated in the outline of coverage provided with the long-term care policy, Basic information about the supplementary policies, Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. -10 -20 -30 -60, A producer's license may be renewed every -year -2 years -3 years -5 years, The primary purpose of licensing is to: -ensure high standards to the insuring public -protect the policyowners against insolvent insurers -generate income for the insurance department -satisfy a federal requirement that all persons involved in insurance be licensed, ensure high standards to the insuring public U9, An out-of-state producer wants to start selling insurance in this state. -look at the applicant's medical history to decide what premium to charge -send the applicant to a doctor for a physical. This acknowledgement is on the application. How does his major medical policy handle the payment of his claim? Warranties are sworn statements of truth, but are not required on insurance applications. What is a Disability Clause? - Definition from Insuranceopedia An insuring clause is a part of insurance policies that defines how much risk will be taken on by the insurance company. The larger the percentage that is paid by the insured, the lower the required premium will be. -Medicare -Blue Cross -Blue Shield -Medicaid, Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care? -partial benefits -full benefits until the blindness lifts -no benefits -full benefits, Which of the following types of agent authority is also called "perceived authority"? -an insurer with a home office in another country -an insurer with licensed agents doing business in other countries -an insurer with licensed agents who are citizens in more than one country -an insurer with a home office in another state, an insurer with a home office in another state U1, The authority granted to an agent through the agent's contract is referred to as: -apparent authority -implied authority -absolute authority -express authority, On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are: -not taxable since the IRS treats them as a return of a portion of the premium paid -paid at a fixed rate every year -taxable as ordinary income -guaranteed, not taxable since the IRS treats them as a return of a portion of the premium paid U1, An applicant knowingly fails to communicate information that would help an underwriter make a sound decision regarding coverage. Death due to sicknessc. Upon reaching age 65 in eligible for Medicare which of the following is the employees option, Remain on the group health insurance plan and defer eligibility for Medicare until retirement, Which of the following options depicts How eligibility of members for group health insurance is determined, Which statement best defines a multiple employer welfare arrangement, A joining together by employers to provide health benefits for employees, Which writer when added to a disability income policy provides for changes in the benefits payable based on consumer price index, A long term care shoppers guide best be presented at which point, When an insurer offers services like Pred mission testing, second opinions regarding surgery, and preventative care which term best applies, Not all losses are insurable and there are certain requirements that must be met before a risk is a proper Subject for insurance. -race -age -medical history -sex, What is the minimum grace period required in health insurance policies in this state? Policies subject areas of insuring clause of a disability policy loan agreement by way to employees. When the complete policy is delivered, the Free Look starts. Choose the most correct answer. -Medicare Part A -Medicare Supplement -Medicare Advantage -Medicare SELECT, Which of the following must be present in all Medicare supplement plans? The producers birthday is on October 17 the producer last renewed her license in 2012 by what date was the producer renew her license again, Insurance policy specifies that it will be $600 for the Specific loss. A limited health insurance policy that will pay a lump-sum to the insured if they are diagnosed with life-threatening cancer, stroke, heart attack or Alzheimer's disease is known as: A) Critical Illness insurance B) Hospital Confinement Indemnity C) Accidental Death and Dismemberment D) Dread Disease insurance A) Critical Illness insurance The insuring clause is the section of an insurance policy that outlines the risks assumed by the insurer. 2 years to age 65. -licensed practical nurses -community-based organization professionals -attending physician -registered nurses, attending physician (home health care is care provided in ones home and could include occasional visits to the persons home by registered nurses, licensed practical nurses, licensed vocational nurses, or community-based organizations like hospice.
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