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ACCIDENT &HEALTH

ACCIDENT & HEALTH NY INSURANCE EXAM

QuestionAnswer
Own Occupation An own occupation policy will provide benefits when the insured, because of sickness or accident, is unable to perform his/her own occupation
Own Occupation IS LIMITED TO limited to the first 24 months after the commencement of a loss, permitting claimants to receive benefits if, because of disablement, they cannot perform their normal or own occupation even though they might be able to earn income at a different occupatio
Own Occupation IS LIMITED TO CAN RECEIVE BENEFITS PERFORMING A SIMILAR JOB FOR UP TO 2 YEARS.
Medigap To buy a Medigap policy, the applicant must generally have both Medicare Part A and Part B.
Medicare Supplement Plan A • Part A coinsurance/copayment (NOT Part A deductible); • Part A hospital costs up to an additional 365 days after Medicare benefits are used up; • Part A hospice care coinsurance/copayment; • Part B coinsurance/copayment; • The first 3 pints of blood
CHILD HEALTHCARE ! New York law specifies that the insurer be notified within 30 days of the birth of a newborn.
The free-look provision allows for an insured to review his/her policy once it has been delivered; if the insured decides to return it within a certain time period, the premium will be refunded. In New York, the insured can review the policy from anywhere between 10 and 20 days
Under a prepaid plan, the health care providers are paid for services in advance, whether or not any services are provided. The amount paid to the provider is based upon the projected annual cost as determined by the provider.
Under the uniform required provisions how many days should a proof of loss be filed? , proof of loss under a health insurance policy normally should be filed within 90 days of a loss.
Under the uniform required provisions
The elimination period iThe elimination period s the time immediately following the start of a disability when benefits are not payable. This is used to reduce the cost of providing coverage and eliminates the filing of many claims.
If a non-member physician is utilized under the point-of-service plan, If a non-member physician is utilized under the point-of-service plan, then the attending physician will be paid fee for service, but the member patient will have to pay a higher coinsurance amount or percentage for the privilege.
The grace period is The grace period is 7 days if paid weekly, 10 days if paid monthly, 31 days for all other modes.
If a new employee is eligible, under HIPAA regulations, If a new employee is eligible, under HIPAA regulations, the new employer must offer coverage on a guaranteed issue basis.
2. Metal Levels 1. Under PPACA, plans are classified into 5 categories of coverage 1. Bronze: 60% 2. Silver: 70% 3. Gold: 80% 4. Platinum: 90%
Accidental BI vs Accidental Means definition A policy that uses the accidental bodily injury definition will provide broader coverage than a policy that uses the accidental means definition.
GROUP HEALTH All individual and group health insurance policies and contracts that provide coverage for a child of the insured must provide coverage for newborn children from the moment of birth.
STATE INSURANCE EXHCHANGES Annual open enrollment period is currently scheduled from November 1 through January 31.
A basic total disability plan ! A basic total disability plan protects a family or individual against the economic loss that would occur if the wage earner were totally disabled.
Medicare supplement insurance Insurers that issue Medicare supplement insurance policies are required to provide the disclosure statement to the applicant along with the application.
Waiver of premium benefit allows the insured, when disabled, to forego paying the premiums. Generally the insured must be disabled a specific number of days (could be 90 or 180 days) before the premium is waived.
Omnibus Budget Reconciliation Act of 1990 (OBRA Omnibus Budget Reconciliation Act of 1990 (OBRA), Congress passed a law that authorized the NAIC to develop a standardized model for Medicare supplement
Medicare supplement policies, The benefits in Plan A are considered to be core benefits and must be included in the other types.
Medicare supplement policies, the NAIC has developed standard Medicare Supplement benefit plans which are identified with the letters A through N. The benefits in Plan A are considered to be core benefits and must be included in the other types.
sickness or an injury (accident). While disability eligibility requirements may vary from company to company, normally a person becomes eligible for disability benefits due to either a sickness or an injury (accident).
The amount of disability benefits The amount of disability benefits that will be offered to an insured is stated in the policy. It is usually limited to a percentage of the insured’s income in order to prevent overutilization.
Dean has cancer and is covered under a major medical plan. Which of the following coverages, sold as a supplement to Dean's major medical plan, would help him pay the high out-of-pocket costs related to his cancer treatments? Specified Disease Insurance
Most health insurance policies exclude: cosmetic surgery expenses
Robert is He supplied the insurer with a proof of loss in January, 2014. Which of the following dates would be the approximate deadline for bringing legal action? December, 2016 2 years
In order to qualify for disability benefits through Social Security, a person must: In order to qualify for disability benefits through Social Security, a person must have a physical or mental condition that prohibits any type of work and is expected to last for at least one year or result in death.
Created by: Rosalynww