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Insurance License MI

What do limited health policies cover? A specific accident or disease
If an applicant does not receive his or her insurance policy, who would be held responsible? The agent
In forming an insurance contract, when does an acceptance usually occur? When the insurer approves a prepaid application
What type of group health insurance is used to provide accident coverage on a group of persons that are participating in a particular activity, when the individual insureds are unknown, and are covered automatically? Blanket
What are the common exclusions in most health insurance policies? War, self-inflicted injuries, pre-existing conditions, elective cosmetic surgeries, injuries caused by participating in illegal activities, and workers compensation benefits
What is the term used for a written request for an insurer to issue an insurance contract based of the provided information? Application
What is the capital sum in Accidental Death and Dismemberment (AD&D) coverage? A percentage of the principal sum
What information are the members of the Medical Information Bureau required to report? Adverse medical information about the applicants or insured
What entities make up the Medical Information Bureau? Insurers
How can health insurance policies be delivered to the insured? Personally delivered by the agent or mailed
What entity provides underwriters with information concerning an applicant's health history? MIB - Medical Information Bureau
What type of health insurance plans cover all accidents and sicknesses that are not specifically excluded in the policy? Comprehensive plans
During which stage in the insurance process do insurers evaluate information that identifies adverse selection risks? Underwriting
In health insurance, what is considered sickness? An illness that first arises while the policy is in force
In health insurance, the policy itself and the insurance application form what? The entire contract
Whose responsibility is it to inform an applicant for health insurance about the insurer's information gathering practices? The agent
When must the Outline of Coverage be provided to the insurer? No later than policy delivery
What risk classification would require the highest premium for a health insurance policy? Substandard
What is the purpose of the Outline of Coverage in health insurance? To provide the insured full and fair disclosure about the policy issued
Whose responsibility is it to determine that all the questions on an insurance application are answered? The agent's
What are the three types of risk rating classifications in health insurance? Substandard, standard, and preferred
What type of hospital policy pays a fixed amount each day that the insured is in the hospital? Indemnity
Who is responsible for paying the cost of a medical examination required in the process of underwriting? Insurer
At what age do individuals qualify for Medicare? Age sixty five
What is adverse selection? People who are more likely to submit insurance claims are seeking insurance more often than preferred risks
If an agent makes a correction of the application for health insurance, who must initial the correct answer? The applicant
Who must sign the health insurance application? The policy owner, the insured (if different), and the agent
Health contracts are prepared by insurers and must be accepted by the insured on an 'as is' basis. This describes what aspect of a health insurance contract? Contract of adhesion
In health insurance contracts, the insured is not legally bound to any particular action; however, the insured is obligated to pay for losses covered by the policy. What contract element does this describe? Unilateral
During the application process for health insurance, a producer is trying to obtain creditable information about the applicant that would help underwriters determine if the risk is insurable. In what role is the producer acting? Field underwriter
In medical expense contracts, what is the term that describes the payment method when the insured is responsible for paying the medical expenses, and then the insurer pays directly to the insured? Reimbursement
What report is used to assess risk associated with a health insurance applicant's lifestyle and character? Investigative Consumer Report
If an insurer decides to obtain medical information from different sources in order to determine the insurability of an applicant, who must be notified of the investigation? The applicant
What characteristics would qualify an applicant for health insurance as a substandard risk? Poor health history or a dangerous occupation or avocation
What type of health insurance would be most appropriate for a group of children in a summer camp? Blanket
If an underwriter requires extensive information about the applicant's medical history, what report will best serve this purpose? Attending Physician's Statement
What are the two types of expenses that are covered by health insurance? Expenses related to health care, and expenses that compensate for loss of income
What is the term used for a condition for which the insured has received diagnosis, care, or treatment during a specific period of time prior to the health policy? Pre-existing condition
In insurance, what is the term for cause of loss? Peril
Who is a field underwriter? Agent/Producer
What are the four elements of an insurance contract? Agreement (offer and acceptance), consideration, competent parties, and legal purpose
What risk classification would typically qualify for lower premiums? Preferred risk
Health insurance contracts are unilateral. What does that mean? Only one party makes a legally enforceable promise
Under a credit disability policy, payments to the creditor will be made for the insurer until what point in time? Until the period disability ends or until the debt is repaid
What is the entire contract in health insurance underwriting? The application and the policy issued
When should an agent obtain a Statement of Good health from the insured? When the premium was paid upon policy delivery and not at the time of application
In insurance, when is the offer usually made on a contract? When the insurance application submitted
How is the information obtained for an investigative consumer report? Through interviews with the applicant's associates, friends, and neighbors
Most health policies will pay the accidental death benefits if the death is cause by an accident and occurs within how may days? Ninety days
What is a warranty in an insurance contract? An absolutely true statement upon which the validity of the insurance contract is based
In group insurance, who is issued a certificate of insurance? Individual insured
In group insurance, what is the name of the policy? Master policy
A waiver of premium provision may be included with what type of health insurance policies? Disability income
When are newborns covered in individual health insurance policies? From the moment of birth
What type of health insurance would pay for hiring a replacement for an important employee who becomes disabled? Key-person disability insurance
Who are the parties in a group health contract? The employer and the insurer
What is the purpose of COBRA? To allow continuation of health insurance coverage for terminated employees
If the insureds share in the cost of health insurance premium with the employer, this would be known as what type of health plan? Contributory
What are the two types of Flexible Spending Accounts? Health care accounts and dependent care accounts
Who chooses a primary care physician in an HMO plan? The individual member
What is the primary purpose of disability income insurance? To replace income lost due to a disability
How do insurers determine the cost for a group health policy? The main variables are the ratio of men and women in the group, and the average age of the group
What is the purpose of a buy-sell agreement for health insurance policies? To specify how the business will pass between owners when one of them dies or becomes disabled
What is the purpose of managed care health insurance plans? To control health insurance claims expenses
What is the term for a period of time immediately following a disability during which benefits are not payable? Elimination period
What percentage, if any, of the individual disability income policy benefits are taxed to the insured? Benefits are not income taxable
What is the 'own occupation' disability? Insured’s inability to perform duties of his or her current job or an occupation for which the insured is educated and trained
What is the time requirement for terminated employees to convert the group health coverage to an individual plan without evidence of insurability? Thirty one days after termination of the employment
Under what type of care do insurers negotiate contracts with health care providers to allow subscribers have access to health care services at a favorable cost? Preferred Provider Organization (PPO)
What is the main principal of an HMO plan? Preventive care
What term is used to describe a situation when a medical caregiver contracts with a health organization to provide services to its members, but retains the right to treat patients who are not members? Open panel
How are HMO territories typically divided? Geographic areas
What is a presumptive disability provision? Provision found in most disability income policies that specifies the conditions that will automatically qualify for full disability benefits
How many members must an association have to qualify for group insurance? one hundred members
When a business receives benefits from its key person disability insurance, how are those benefits taxed? The key person disability insurance benefits are received tax free
What does the amount of disability benefit that an insured can receive depend on? The insured's income at the time of policy application
What is a fee-for-service health plan? Under a fee-for-service plan, providers receive payments for each service provided
What is the main purpose of HIPPA regulations in group health plans? To limit exclusions for pre-existing conditions
What the three types of basic medical expense insurance? Hospital, surgical, and medical
With key person disability insurance, who pays the policy premiums? The business (employer)
How can an HMO member see a specialist? Referral by the primary care physician
Who determines the eligibility and contribution limits of an HRA? The employer
Can an insured who belongs to a POS plan use and out-of-network physician? Yes, but the co-pays and deductibles may be higher
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
After elimination period, a totally disabled insured qualified for benefits from a disability income policy that has a waiver of premium rider. What will happen to the premium that was paid into the policy during the elimination period? Premium will be refunded
How can an AD&D policy be written? As a rider to a health insurance policy, or as a separate policy
How do HMOs encourage members to get regular checkups? To help catch health problems early when treatment has the greatest chance for success (i.e. preventive care)
In what type of health plans are providers paid for services in advances, regardless of the services provided? Prepaid plans
To be eligible under HIPPA to convert group health coverage to an individual policy, the insured must apply for the individual plan within how many days of losing the group coverage? Sixty three days
In order to be eligible for coverage by an HSA, an individual must also be covered by what type of health plan? High Deductible Health Plan (HDHP)
Does group health insurance require medical examinations? No, the underwriter evaluates the group as a whole, rather than each individual member
What types of injuries and services will be excluded from major medical coverage? Injuries caused by war, intentionally self-inflicted injuries, injuries covered by worker compensation, regular dental/vision/hearing care, custodial care, and elective cosmetic surgery
What types of groups are eligible for group health insurance? Employer-sponsored and association-sponsored groups
What are the tax implications for contributions to a Health Savings Account by the individual insured? Contributions are tax deductible
What do individual insureds receive as proof of their group health coverage? Certificate of Insurance
If a group health policy covers individuals that reside in more than one state, which state has the jurisdiction over the group policy? The state in which the policy was delivered
What are the tax implications for employer contributions to Heath Reimbursement Accounts? Employer contributions are tax deductible as business expenses
What is the role of the gatekeeper in an HMO plan? To control costs for the services of specialists
What is the purpose of respite care in long-term care insurance? To provide relief from a major caregiver (usually a family member)
If an employee covered under a health reimbursement account changes employers, what happens to the HRA? It remains with the originating employer
Created by: iesha3692
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