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WI Health Insurance
| Question | Answer |
|---|---|
| If a Medicare supplement policyholder cancels the policy midterm, which of the following is true regarding the premium? A) No further premiums must be paid, and a prorated premium refund must be offered. B) A fraction of the premiums that would have bee | A) No further premiums must be paid, and a prorated premium refund must be offered |
| Coverage for diagnostic procedures and medically necessary nonsurgical treatment for the correction of TMJ disorders may be limited to an annual amount of? | $1,250 |
| How often are insurers offering health benefit plans required to file for a grievance report with the OCI? | Every year |
| Disability (A&H) policies are incontestable once they have been in force for how long? | 2 years |
| What authority must approve an agents sale presentation? | The agent's insurer |
| Policies other than weekly and monthly payment require a grace period that last for how many days? | 31 days |
| When Oscar completes his health insurance application, he intentionally omits the fact that he has a heart attack 8 months prior to the application date. He has another heart attack three years after the policies effective date which of the following is t | C) The costs related to his heart attack can be denied |
| An applicant begins to fill out the medical history portion of his application but then forgets to complete it. Two months later, he is treated for a pre-existing condition which was not recorded on the application. To what extent will he receive benefits | Total, as limited by the policy. It was the insurer's fault that the application was accepted in incomplete state. |
| Who would be a good candidate for a short-term medical insurance? | An overall healthy individual who doesn't need coverage for pre-existing conditions |
| For an individual policy, and intermediary must furnish an applicant with an outline of coverage at what point? | When accepting the application |
| Policies that cover Hospital expenses must provide coverage for a minimum of how many days for skilled nursing care to patients to enter a licensed Skilled Nursing Care Facility? | 30 days |
| A long-term care policy holder request that his policy be cancelled. Which of the following is true? A)The policyholder will be assessed a cancellation penalty. B) The policy will be cancelled, and the policyholder will not be charged any additional fee | D) A pro-rated premium refund will be issued. |
| An insured has Medigap insurance and later becomes eligible for Medicaid. If the person elects to receive Medicaid coverage, for how many years can Medigap benefits and premiums be suspended? | 2 years |
| At what point during the policy application process must replacement forms be completed? | Prior to submitting an application |
| How many copies of replacement forms must be filled out and signed by the agent and the applicant during replacement of disability insurance? | 3 copies |
| If the payments of a specific premium or subscription fee is required to provide coverage for a child, the policy may require that notification of a child's birth and payment of the required premiums or fees be furnished to the insurer within how many day | 60 days |
| All of the following are considered autism spectrum disorders EXCEPT A) Severe depression B) Any pervasive development disorder C) Asperger's Syndrome D) Autism disorder | A) Severe Depression |
| If an insurer decides to discontinue providing group health insurance in general, how many days before the date of discontinuance must a notice be sent to the Commissioner and to each employer? | 180 days |
| If an insurer plan to stop providing a specific type of group health insurance plan to this state, the insurer must notify who? | Affected employers and employees |
| If the child of an insured is covered under the insured's health insurance plan, immunizations must be covered from birth to what age? | Age 6 |
| Which is a statement promoting an insurer and its policy made by an individual, group or individuals, Society, association association, or other organization, which makes no reference to experience under the policy? | Endorsement |
| People who have been insured for how many months under a group contract must be allowed to continue group coverage or convert to an individual contract if the group coverage ends? | 3 months |
| Revealing a specific charge level for procedure or a specific provider name are examples of information that might be construed as | Proprietary |
| Coverage of a dependent child who has now reached the maximum age limit cannot be ended while the child continues to be | Incapable of self-sustaining employment because of mental retardation or physical handicap. & Chiefly dependent upon the person insured under the policy for support and maintenance |
| Health insurance policies issued to small employers are allowed to charge rates that are higher than the average rate charged for all groups with similar characteristics and similar benefit design characteristics. What is the maximum allowance allowed rat | 30% |
| A disability insurance policy other than a Medicare supplement or Medicare replacement policy may require patients to enter a licensed skilled nursing care facility within what period of time after discharge from a hospital in order to receive continued c | 24 hours |
| Once an agent has met the requirements to sell long-term care insurance, how often must he or she complete the 4 hours of ongoing training courses? | Every 24 months |
| How long does the free-look period last for a Medicare supplement policy? | 30 days |
| How long was the agent keep copies of the disability insurance replacement forms on file? | 3 years |
| A policyholder may return (for a full premium refund) any individual Disability Policy within how many days of receiving it? | 10 days |
| When someone fills out a health insurance application, if they accidentally forget to include the fact they were once diagnosed with high blood pressure. Then later diagnosed 1 1/2 years after the policy begins. What can happen with the costs? | Treatment costs can be denied |
| When was the "Wisconsin guide for health insurance for people with Medicare" pamphlet be issued? | With every policy solicitation |
| Every disability insurance policy must cover hospital or Ambulatory Surgery Center charges incurred and anesthetics provided in conjunction with dental care if the individual is a child under the age of | 5 |
| A small employer can have a maximum of how many employees | 50 employees |
| Under what circumstances must an insurer provide benefits for adopted children? | When the policy provides coverage for dependent children of the insured |
| If an insurer decides to stop providing all group health insurance coverage. It must send notification of the discontinuance to all the following EXCEPT A) Affected employees B) the NAIC C) Affected employers D) Commissioner | B) the NAIC |
| An insurer must file advertisements of Medicare supplement policies with what Authority | Commissioner |
| In a disability policy, coverage for the cost of hearing aid coverage for children may be limited to | 1 hearing aid per ear per child every 3 years |
| The free look period for Long Term Care policy lasts for how long? | |
| Who does the Interstate Insurance Product Regulation Compact serve? | Insurers |
| Every disability insurance policy providing coverage of expenses incurred for inpatient hospital care must provide coverage for no less than how many Home Health Care visits per 12-month period? | 40 |
| Within how many days of receiving a request to use experimental treatment on an injured, the insurer must issue a decision on whether it will cover the experimental treatment? | 5 days |
| 5.5% per year | |
| 30 days | |
| A newborn is automatically covered under his/her parents' health insurance policy for 60 days. After that point, the coverage may be cancelled, unless within 1 year after the birth of the child the insured makes all past due payments plus interest applied | |
| Every disability insurance policy with weekly premiums must have a grace period of how many days? | At least 7 days |
| Disability insurance policy with monthly premiums must have a grace period of how many days? | At least 10 days |
Created by:
cruttner
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