Flash Cards for AD Banker Study Guide for Health Insurance
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| The policy conditions represent the obligations of: | show 🗑
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| show | Unilateral Contract
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| The Financial Privacy rule requires insurers to provide consumers with a privacy notice: | show 🗑
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| show | Admitted
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| ______is generally an option only for large corporations who may want to limit their risk up to a certain dollar amount, then buy insurance above and beyond that amount | show 🗑
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| show | Certificate of Authority issued by the state Insurance Department
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| show | Ceding
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| show | When the insurer issues a policy
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| show | Alien, admitted
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| show | Eliminate Risk
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| show | One party prepares the contract with little or no input or negotiation from the other party
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| What are the two types of risk? | show 🗑
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| show | Marketing or Sales
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| A producer gathers information about the applicant for the insurer in order to avoid adverse selection. This is considered to be: | show 🗑
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| show | Political affiliation and religious preference
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| Accident and Health policies provide coverages for all, except: | show 🗑
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| show | Single Pay
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| show | Unintentional in both the cause and the result of the injury
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| show | Mortality Table
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| show | Coverage would be as stipulated in the policy because the company issued the policy even though the question was left blank
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| Field underwriting is very important: | show 🗑
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| show | Conditional receipt
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| show | The date of the conditional receipt
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| show | Dental expense
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| show | Hospitalization in the Intensive Care Unit
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| show | Morbidity - Interest + Expenses
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| show | Only a comparison of benefits is required when insurers advertise by comparisons of like products
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| Howard talks to his agent Jane about buying a critical illness policy from the XYZ insurance company to cover his wife Deborah, and naming his daughter Mary as the beneficiary in case of death. Jane told him that she didn't need a signature from | show 🗑
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| The area of the dentistry profession dealing primarily with maintaining the functional use of natural teeth, is called: | show 🗑
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| show | Loss due to Workers' Compensation
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| show | Confined to the hospital
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| A procedure used by dental insurance carriers to determine the benefit to be paid is known as: | show 🗑
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| HMOs do not provide | show 🗑
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| show | It ceases immediately when the insured is sworn in
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| Which limitations is not included in most dental expense insurance plans? | show 🗑
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| How do PPOs save consumers money? | show 🗑
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| show | Usually after all other treatments have been exhausted
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| The main purpose of requiring a Gatekeeper is to: | show 🗑
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| Sandra owns a Plan that contains a 60/40 Participation (Coinsurance) Provision and a $200 deductible. How much will Sandra and the insurer each pay under the coinsurance provision if Sandra's first medical claim for the year totals $10,200? | show 🗑
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| If a policy requires the payment of an additional premium for the continuation of coverage for a newborn, the insurer must be notified within 31 days of the ______. | show 🗑
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| show | It provides specific benefits for specific injuries from specific causes
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| what is not correct concerning a Blue Cross and Blue Shield Plan? | show 🗑
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| show | Benefit dollars that will be paid
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| show | Work related injuries are normally covered under Workers' Compensation
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| show | Morbidity to Mortality
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| Presumptive disability means | show 🗑
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| A partial disability is defined as an individual: | show 🗑
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| Not possible business uses of Disability Income Insurance | show 🗑
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| Penelope received benefits from her disability policy and went back to work. After 30 days she found she was not able to work and began to immediately receive her disability payments. Which provisions made this possible? | show 🗑
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| Joan was told she could only expect about 70% of her weekly salary on a disability check if she was ever disabled. The reason for this is to reduce _________. | show 🗑
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| A Disability Income Policy has a period of deductibility immediately following a disability during which time benefits are not payable. This period is called a(n): | show 🗑
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| Which disability income benefit periods will result in the highest premium? | show 🗑
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| show | Transplant
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| show | Impairment
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| he optional guaranteed purchase option rider allows the insured to purchase additional coverage in all of the following situations, except: | show 🗑
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| show | Ole's personal lost income
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| show | Business disability buyout
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| Part A of Medicare pays for: | show 🗑
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| How long is the free look period for a Medicare Supplement policy? | show 🗑
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| show | A&B
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| Which is not covered by Medicare Part A? | show 🗑
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| When must an insurer provide a Medicare Supplement Buyer's Guide and an Outline of Coverage? | show 🗑
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| The Medicare Supplement Right of Return Provision (Free Look Period) allows the buyer a period of ________ to return a policy and receive a full refund. | show 🗑
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| If an individual starts receiving Social Security retirement benefits at age 62, when are they eligible for Part A benefits? | show 🗑
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| What is not covered by a long-term care policy? | show 🗑
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| What statement regarding Medicare is not true? | show 🗑
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| Which Medicare Supplement policies have Core Benefits? | show 🗑
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| show | A and B
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| show | 65
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| Which Act was implemented in order to protect consumers from questionable Medicare Supplement Policy marketing practices? | show 🗑
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| In general, which of the following Medicare plans does not require additional premium? | show 🗑
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| Susan neglected to make her premium payment and she was injured in an accident. After she submitted the claim, she discovered that the insurer had subtracted $200 (the amount of the overdue premium) from the claim. This is allowed under which provision? | show 🗑
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| All states have adopted the Uniform Individual Accident and Sickness Policy Provision Law. If an insurer changes any of these provisions, they must make sure it does not: | show 🗑
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| Proof of loss is required within _____ days of loss. | show 🗑
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| show | The insured must notify the insurer of a change of occupation, or the policy will be cancelled
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| show | The insured can submit written proof of the loss
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| show | Insured
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| show | 31 days
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| Precertification, Mandatory Second Surgical Opinion, and Concurrent Review are provisions in health insurance policies known as: | show 🗑
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| Right to Examine is the same as: | show 🗑
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| Every Health and Disability Income Policy must express the conditions and provisions for _______. | show 🗑
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| show | It is refunded on a pro rata basis
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| The Insuring Clause under an individual A&H policy does not contain | show 🗑
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| Anna has a contract that includes the Non-Emergency Hospital Preauthorization Admissions Provision. For a scheduled hospital stay, she must first get preauthorization through her insurer. If she does not, the insurer may: | show 🗑
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| If the insurer cancels an individual health plan, what happens to the unearned premium? | show 🗑
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| If the insured is receiving regular disability income payments, the insurer can require notice of continuance of claim every ______ months. | show 🗑
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| A carrier replacing employer group coverage is not required to cover all employees and dependents covered by, or eligible for, coverage under the previous policy if the replacement takes place more than ___ days after of the previous policy's termination. | show 🗑
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| Coordination of Benefits is a provision designed to reduce ________ when an insured is covered under multiple health plans. | show 🗑
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| A Small Employer is defined as any person, firm, corporation, partnership, or association that is actively engaged in business and has ______ employees or less. | show 🗑
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| show | Each member of the group is covered regardless of his or her health history
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| show | 30
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| A third party administrator is utilized in which plans? | show 🗑
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| show | 20 or more employees
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| Which provision of group health plans is used to determine primary and secondary coverage when an insured is covered by more than one insurance plan? | show 🗑
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| Under HIPAA, coverage may be nonrenewed for all of the following reasons, except: | show 🗑
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| What is incorrect regarding the group underwriting process? | show 🗑
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| What is not true of the Coordination of Benefits Provision under a group plan | show 🗑
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| show | Stating that 'We have been in business for over 50 years, for more information contact a local agent.'
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| An example of an inaccurate statement is | show 🗑
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| show | 6
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| show | ERISA
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| show | A business overhead expense policy
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| show | They must be under age 26
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| Karen, age 50, withdraws $1,000 from her Health Savings Account (HSA) for a purpose other than a qualified medical expense. As a result of this action: | show 🗑
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| After Robert signed up for Medicare, he withdrew 2000 from his HSA. He used 600 for his Medicare Supplement premium, 200 for out-of-pocket medical expenses, and the remaining 1200 on a trip. Later, when he paid his taxes for the year, he discovered | show 🗑
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| show | Those who must pay less than 9.5% of their income for health insurance
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| show | The sole proprietor of a small firm buys an overhead expense policy
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| What regarding coverage for emergency care under the Affordable Care Act is correct? | show 🗑
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| show | 2,550The benefits received from which of the following personal policies are received tax-free?
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| show | Medical expense insurance, long-term care insurance, and disability income insurance
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| show | The benefits received from a group Disability Income Policy paid entirely by the employer are fully taxable as income to the employee
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| group long-term care insurance program through his employer, what percentage of his benefits would be taxable based on the premium structure? | show 🗑
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| show | Be self-insured
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| The Bronze plan covers _______ of medical expenses. | show 🗑
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| show | 4
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| show | 5
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| At least what percentage of the continuing education requirements for a producer or consultant must be classroom instruction? | show 🗑
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| A licensee must be at least ___ years of age. | show 🗑
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| A person must hold the appropriate ___________ to transact insurance business in Utah. | show 🗑
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| show | It fails to provide the producer's name, address, or business address, if for a basic policy or application (The producer's name and address is not found on any insurer's forms, policies, or applications.)
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| An insurance contract is valid even if purchased from a(n) _________ person. | show 🗑
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| A commission for selling insurance may not be paid to a person other than a licensed insurance: | show 🗑
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| Licensees must notify persons about privacy practices at least once every _____ months. | show 🗑
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| Insured risk classification may be based upon which criteria? | show 🗑
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| A person violating an insurance law must pay the Department ______ times the amount of any profit gained from the violation, in addition to any other penalty. | show 🗑
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| show | Insurer's
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| show | 2
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| show | Not a prohibited inducement or rebate
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| A person may not knowingly hire a person who is not: | show 🗑
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| show | Fellow chamber of commerce members
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