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Sickness and Accident Basics
Terms in this set (54)
According to PPACA metal levels classifications, if a health plan covers 90% and the participant covers 10%, what type of plan is it?
Platinum (Platinum=90%, Gold=80%, Silver =70%, and Bronze= 60%)
In franchise insurance, premiums are usually:
Lower than individual insurance, but higher than group insurance
In what case would a credit disability policy be issued?
If an individual is in debt to a specific creditor. Payments will be made for the individual until they return to work
Which is not a metal level classification?
What is a peril covered in an accident and health insurance policy?
Who may not be covered under an individual health insurance policy?
Applicant's house help
Health coverage begins when:
1st premium is paid and the application is approved
Health insurance policies may not cover:
What is not true of health insurance premiums?
Substandard risks are never insured and are always rejected
A health insurance plan that covers all accidents and sicknesses that are not specifically excluded from the policy are referred to as:
Medicaid is sponsored by what kind of sources?
Both state and federal
What would an accident policy NOT cover?
Surgery to repair a wrist damaged by tendinitis (tendinitis is a sickness, not an accident)
When is the insurability conditional receipt given to the insured?
When the premium is paid at the time of application
An insured is upset that her policy was delivered by mail, not in person by the agent. What is true?
There is nothing wrong with this form of policy delivery
In a replacement situation, what is not considered?
What is true about requirements for HIV exams?
The applicant must give prior informed written consent
What is franchise insurance?
It is health coverage for small groups not able to qualify for true group insurance
What group could be covered by a blanket accident policy?
Students at a public school
What loss will be covered by a group medical expense policy?
A pre-existing condition
What phase begins after a new policy is delivered?
Free look period
Most policies will pay accident death benefits as long as the death is caused by an accident and happens within:
90 days of the accident
The patient protection and affordable care act does not include:
Individual tax deduction for premiums paid
What would not be an underwriting consideration for a health insurance applicant?
When benefits are paid directly to the insured under a health insurance policy, the police provides benefits on what type of basis?
What document is used to asses rick associated with their lifestyle and character?
Investigative consumer report
If an insurance company says their policies are guaranteed by the Insurance Guaranty Association, that would be considered:
An unfair trade practice
What is true of underwriting for a person with HIV?
The person may not be declined solely based on the HIV status
When is it illegal for an insurer to disclose information about an insured?
A researcher for marketing purposes
Which type of hospital policy will pay a fixed amount each day the insured is hospitalized?
Who is involved in completing the agent's report?
Only the agent
What is not included in an investigative consumer report?
What is true of limited insurance policies?
They only cover specific accidents or diseases
The insurance policy with the application is known as:
The entire contract
What is not correct of accidental death and dismemberment coverage?
Death benefits are paid only if death occurs within 24 hours of the accident
A person steps off of a street car and trips and breaks his ankle. What type of injury is this?
Sudden and unforseen
What is not required of a producer to tell a prospect?
What requirements the producer needed to meet to obtain an insurance license
In underwriting a substandard risk, what is incorrect?
A discounted premium would be charged
Who must pay for the cost of a medical examination required in the process of underwriting ?
What is the best way to change an application?
Start over with a frwsh application
What benefit would a disability plan most likely pay?
Income lost by inability to work
What is the maximum age for qualifying for a catastrophic plan?
30 years old
What is not a significant consideration in the underwriting of individual health insurance risks?
Applicant's geographic location
An insured looses her left arm in an accident covered. What kind of benefit will she receive?
Capital amount in a lump sum
What is true of an insured who is a standard risk?
The insurer may have to increase premium amounts
Hospital indemnity/ hospital confinement indemnity policies will provide payment based on:
the number of days confined to a hospital
Health insurance companies can refuse coverage solely based on:
Past medical history
If an applicant for health insurance is a substandard risk, the insurance company is likely to:
Charge an extra premium
A group blanket policy is best suited for
a summer camp
An agent is replacing an old policy with a new one. What is the proper action?
The old policy stays in force until the new policy is issued
An insurer wants to compare an application with an old application from the same applicant. Who can provide this information?
The medical information bureau
An insurer hires a representative to advertise the company. The representative lies about the coverage to get more business. Who is responsible?
Where would long term care services be rendered?
Nursing home or one's own home
Who is eligible for coverage on the health insurance marketplace?
A permanent resident lawfully present in the US
What does the accidental death and dismemberment policy not cover?
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