Flash Cards for AD Banker Study Guide for Health Insurance
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| show | Both the insured and the insurer
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| One characteristic of life insurance is that the insurer is obligated to pay a claim in the event of the death of the insured, however, the insured is not contractually obligated to do anything other than keep the policy in force. This is a: | show 🗑
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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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| show | Self-insurance
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| show | Certificate of Authority issued by the state Insurance Department
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| In a reinsurance transaction, the company that wishes to transfer all or a portion of the financial risk of loss is known as the _______ company. | show 🗑
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| An applicant completes the application and submits it to the insurer along with a premium check. When is the applicant's offer considered accepted? | show 🗑
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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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| show | Speculative and pure
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| show | Marketing or Sales
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| show | Field underwriting
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| show | Political affiliation and religious preference
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| show | Workers' Compensation claims
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| show | Single Pay
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| For an accidental means policy to pay a claim, the injury must be an: | show 🗑
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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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| show | Due to the risk of a moral hazard
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| If a premium is collected at the time of the application, the producer will issue a: | show 🗑
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| show | The date of the conditional receipt
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| This type of policy covers the treatment and care of the insured's teeth. | show 🗑
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| show | Hospitalization in the Intensive Care Unit
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| Accident and Health insurers would use which of the following formulas in determining premium rates? | show 🗑
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| show | Only a comparison of benefits is required when insurers advertise by comparisons of like products
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| show | Mary
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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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| common exclusion in a medical expense plan: | show 🗑
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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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| An insured is covered for medical expense at work. A friend and the insured join the U.S. Army. How does this affect the insured's group medical insurance? | show 🗑
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| Which limitations is not included in most dental expense insurance plans? | show 🗑
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| show | They charge patients within the PPO less than those who are not in the PPO
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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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| show | Date of birth
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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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| Dental plans are normally written with a stated annual maximum on the number of: | show 🗑
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| show | Work related injuries are normally covered under Workers' Compensation
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| Between the ages of 19 and 65, a worker in America is more likely to be disabled rather than die. This is a comparison of: | show 🗑
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| show | Presumptive Disability involves the loss of two or more limbs.
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| show | Unable to perform one or more duties of his/her occupation
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| show | Workers' Compensation
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| show | Recurrent Disability Provision
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| show | Malingering
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| show | Elimination Period
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| show | Life
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| show | Transplant
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| Attaching a(n) ___________ rider excludes coverage for a condition that would otherwise be covered. | show 🗑
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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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| What type of disability income insurance pays a lump sum enabling certain businesses to cover the cost of purchasing a disabled business owner's interest in the business? | show 🗑
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| show | Hospital expenses
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| show | 30 days
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| Which will cover the cost of inpatient blood transfusions after the first 3 pints? | show 🗑
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| Which is not covered by Medicare Part A? | show 🗑
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| show | At the time of application
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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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| show | Hospitalization
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| What statement regarding Medicare is not true? | show 🗑
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| show | A through N
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| In order to purchase a Medicare Supplement, an eligible individual usually must have Medicare Parts __________. | show 🗑
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| If an individual is age ______ or over and continues to work, Medicare is usually the secondary insurer to any employer group health plan the individual participates in. | show 🗑
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| show | NAIC Model Law
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| show | Part A
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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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| The grace period for an individual health insurance policy being paid on a quarterly basis is: | show 🗑
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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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| show | Free Look Period
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| show | Continuation of the contract
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| If the insurer cancels an individual health plan, what happens to the unearned premium? | show 🗑
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| show | Premium or rate calculations
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| show | Reduce her normal benefits
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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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| show | 60
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| show | Overinsurance
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| show | 50
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| show | Each member of the group is covered regardless of his or her health history
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| An employee is considered full time and eligible for small employer medical expense insurance if he or she works a minimum of ________ hours per week. | show 🗑
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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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| show | Coordination of Benefits (COB)
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| Under HIPAA, coverage may be nonrenewed for all of the following reasons, except: | show 🗑
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| show | Adverse selection is not a concern for group contracts
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| show | In the event children are covered under two group plans, the insurer for the parent who is the oldest is primary, and the other parent's plan is secondary
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| What type of Language is permissible in advertising? | show 🗑
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| show | Group insurance normally covers occupational injury or disease
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| HIPAA defines a pre-existing condition as one for which the insured received medical advice, diagnosis, care, or treatment within the past _____ months. | show 🗑
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| show | ERISA
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| Which disability policies would be considered a deductible business expense? | show 🗑
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| show | They must be under age 26
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| show | The $1,000 is taxed as ordinary income, with an additional $200 penalty tax applied
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| show | $1,200 was subject to income tax
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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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| The benefits received from which of the following personal policies are received tax-free? | show 🗑
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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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| show | 60%
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| There are ____ different 'Metal Plans' offered through the health insurance exchanges. | show 🗑
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| A licensee may be required to wait for up to ______ years after license revocation before applying for a new license. | show 🗑
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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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| show | License
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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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| show | Unlicensed
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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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| show | 12
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| show | Age or health
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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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| A Certificate of Insurance or Outline of Coverage for a group policy must state the ___________ name on the cover. | show 🗑
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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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