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Health Insurance Exam Questions 2
Terms in this set (49)
What act requires that insureds must be advised that reports and/or medical reports on them are being requested?
Fair Credit Reporting Act
proof of loss
has been furnished, periodic benefit payments must be made
not less frequently
Partial Disability Payments
-Often made as a result of
-Usual partial disability benefit is
50% of total disability benefit
When an insured changes to a less hazardous occupation, the insurance company...
with due proof, will
reduce the premium
Elimination or Waiting Period
after a disability commences
before you may begin receiving benefits
Applicants' rights to information
- With proper identification,
applicants must be told everything a reporting agency has in its files
on individuals except medical info
- Applicants entitled to know
to whom reports have been made
Inaccurate or unverified information
discovered by applicant
must be removed from the files
If an insured is receiving continuing disability claims, the insurance company can require notice of continuance of claim every...
If an A&H policy provides any periodic payments contingent on continuing loss, written proof of loss must be furnished by the insured
within how many days of the termination of the period
for which the insurer is liable?
in a HMO is...
An insured can, by written request to the insurance company,
have benefits under a policy paid to
A hospital, physician, or a surgeon
A Recurrent disability is a...
Disability; which is due to the same or a related cause of disability
An insured has an A&H policy which the insurance company declines to renew
at the policy anniversary date
. The policy is...
Optionally Renewable Policy
The benefit paid for
is usually called the...
Once a policy has been reinstated, there is normally...
a 10-day waiting period for
For a misstatement made on an application to affect the validity of the policy, the misstatement must be...
contain a material fact
An A&H policy which excludes coverages for injuries arising out of the insured's job
In an HMO
any person who engages in solicitation or enrollment of persons
for profit or gain in the organization
What is twisting?
Through misrepresenting the facts, inducing an individual to lapse a policy with one company and buy from another
A company licensed to sell insurance in a state is called... (the other name for it)
an admitted company
What benefits are usually provided by a Hospital Policy?
-Hospital and room board
Functions of Accident Insurance
-Provide benefits for accidental loss of life, limb, or sight
-Provide benefits for the accidental loss of time away from work as a result of an accident
-Provide benefits for the payment of hospital, surgical, and medical expenses incurred in the treatment of accidental injuries
refers to the...
Policy, its endorsements, a copy of the application, if attached, and a copy of any other attached papers
The basis on which
Health Maintenance Organizations provide health care
When an insurer
reduces the premium rates in order to persuade the client to purchase insurance
A company chartered *in Indiana* is referred to as a ?????? company
artered *in Indiana* is referred to as a ?????? company *in Indiana* and a ?????? company
in all other states
Domestic ; Foreign
What does the
"Conformity with States Statute"
any provision in conflict with state statutes in the state in which the insured resides
on the effective date of the policy is
automatically amended to conform with the minimum requirements of the statutes
of a policy of H&A insurance...
The sum specified in the policy
payable for loss of life caused by accident
Premium amounts that cover the time
for which protection has not yet been provided
, are called...
Proof of loss
must never be received later than...
One year from the date otherwise required
, unless the insured suffers legal incapacity
Medical Information Bureau (MIB)
supported by insurance companies
aid in underwriting
Supplies member companies with insurability information
Must be authorized by the applicant
to give info to member companies
Benefits shall be made available for
Home Health Care
by HMO providing what?
Hospital, Medical, or Surgical Expense benefits
may contract for or own annuities or insurance upon his or her own life, health, property,
if not less than what age
15 Years Old
A prospect for insurance has a
somewhat dangerous lifestyle
. The company would say that this individual poses...
Purpose of the
Uniform Provisions Law
To provide each state with a law that will permit the use of
Uniform Standard Provisions
, resulting in some
standardization of policy forms
Joan has been disabled by sickness covered in her individual A&H policy, and has
been collecting disability benefit payments from her insurance company
. She is also
receiving disability benefits from Social security
. If she received an
increase in Social security benefits
, her insurance company...
continue to make full benefit payments to joan
as though she had received nothing additional
Duties of an agent where
-Leaving a copy or original of all solicitation material used for presentation to the applicant
-Submitting to the replacing insurer a copy of all solicitation material
-Submitting to the replacing insurer a statement signed by the applicant as to whether or not he has existing life insurance
What plan has a
Supplemental Major Medical Policies
In A&H insurance policies, if a policy is
, it pays
when the event is...
For loss by "accident"
What policy covers a loss which is classified as the
Disability Income Policy
Payment amount for
loss of life by accident
Difference between "traditional" insurers and an HMO
An HMO provides both the health insurance services and the health care coverages
HMO's must operate where?
Only in designated service areas
Which "typical structure" of
maximum freedom to choose physicians and locations?
Independent Practice Association Model (IPA)
Primary Care Physicians are sometimes referred to as...
PPO's and HMO's are often lumped together and referred to as...
Managed Health Care Systems
When does the "free look" period begin?
When the insured receives the policy
in health care policies
Used to encourage insureds to renew their policies successively
Optional Provisions 3, 4, 5, and 6, respectively, have which common purpose?
to avoid the insured from becoming over-insured
When an insurance company considers risk, everyone is said to start at what rate?
100% is standard
THIS SET IS OFTEN IN FOLDERS WITH...
Health Exam Questions
Life Exam Practice Questions
Health Insurance Exam Questions 3
Life Exam Practice Questions 2
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