Note 1 - Health Law PDF

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Health Law...

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A "reimbursement policy" pays what amount of covered Long-Term Care expenses? - Actual covered expenses up to the daily maximum

A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary? - Her group health plan

explanation: if the employer has more than 20 employees, the group health plan generally pays first

A Business Disability Buyout plan policy is designed to - to pay benefits to the Corporation or other shareholders

A Business Overhead Expense Policy would cover which of the following if a business owner becomes disabled - Utilities and Office rent

A CEO's personal assistant suffered injuries at home and as a result was unable to work for four months. Which type of policy will pay a monthly benefit for the personal assistance - Disability income

A CEO's personal assistant suffered injuries at home and as a result, was unable to work for four months. Which type of policy will pay a monthly benefit to the personal assistant? - Disability Income

A characteristic of Preferred Provider Organizations (PPOs) would be - Discounted fees for the patient

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered EXCEPT for: - experimental and investigative services

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered, EXCEPT for: - experimental and investigative services

A disability elimination period is best described as a - time deductible

A Disability Income policy owner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim? - Claim will be paid and coverage will remain in force

A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim? - Claim will be paid and coverage will remain in force.

After a policy has been in force for 2 (sometimes 3) years, it enters the incontestable period, in which the insurer may not deny a claim based on information not disclosed at the time of application.

A Disability Income policyowner suffers a disability which was due to the same cause as a previous disability. Both disabilities occurred within a five-month period. The insurer may cover the second disability without a new elimination period under the: - Recurrent Disability provision

A guaranteed insurability rider guarantees - the insured the option of purchasing additional amounts of disability income coverage at predetermined times without requiring the insured to provide evidence of insurability

A Health Reimbursement Arrangement (HMA) MUST be established: - by the employer

A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two

claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013? - 1,000

A life insurance policy would be considered a wagering contract WITHOUT - insurable interest

A long term care insurance contract shall provide coverage for a minimum of how many months? - 12

A major medical policy typically - provides benefits for reasonable and necessary medical expenses, subject to policy limits

A medical care provider which typically delivers health services at its own local medical facility is known as a - Health Maintenance Organization

A person who issues false written or oral statements that are maliciously critical of the financial condition of an insurance company may be found guilty of - defamation

A physician opens up a new practice and qualifies for a $7,000/month Disability Income policy. What rider would the physician add if he wants the ability to increase his policy benefit as his practice and income grow? - Guaranteed Insurability Option rider

A policy of adhesion can only be modified by whom? - The insurance company

A policyowner would like to change the beneficiary on an Accidental Death and Dismemberment (AD&D) insurance policy and make the change permanent. Which type of designation would fulfill this need? - irrevocable

A policyowner's rights are limited under which beneficiary designation? - Irrevocable

An irrevocable beneficiary designation requires the consent and signature of that named beneficiary before a change of beneficiary occurs.

A prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take? Send a notice to the MIB that the applicant was declined

A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will: - continue coverage but exclude the heart condition

A qualified Long Term Care policy requires the Free look provision to refund 100% of premiums paid within how many days of policy delivery? - 30 days

Accidental Death coverage is provided to commercial airline passengers in which of the following types of policies? - Blanket accident policy

Accidental Death coverage is provided to commercial airline passengers in which of the following types of policies? - Blanket Accident policy

According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid? - 31 days

According to the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, non-fraudulent misstatements first become incontestable - Two years from the date of the policy was issued

According to the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, nonfraudulent misstatements first become incontestable: - two years from the date of the policy was issued

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options? - Monthly

According to Virginia HIPAA regulations, a health insurance issuer of individual policies may discontinue coverage in each of the following situations EXCEPT - insured health status has declined

After a hearing, the State Corporation Commission may order an agent who willfully violates any provision of the insurance code to pay a MAXIMUM penalty per violation of - 5,000

Agent J takes an application and initial premium from an applicant and sends the application and premium check to the insurance company. The insurance company returns the check back to J because the check is made out to J instead of the insurance company. What action should J take? - Return to the customer, collect a new check made out to the insurance company, and send the new check out to the insurance company

Agents may combine business funds and insured's premiums: - when duly appointed and contractually authorized by an insurer

All of the following actions by a licensee may result in license suspension except when the licensee: - shares commission with a similarly licensed agent

All of the following are considered to by typical characteristics describing the nature of an insurance contract except - Bilateral

All of the following are limited benefit plans EXCEPT - life insurance policies

limited benefit plans: cancer policies, dental policies, critical illness policies

All of the following statements about Major Medical benefits are true, EXCEPT: - Benefits have no maximum limit.

explanation: they normally have a maximum limit

All of the following statements regarding group health insurance is true EXCEPT: - Group health insurance premiums are typically lower than individual health insurance premiums

All of these are considered sources of underwriting information about an applicant, EXCEPT: Rating Services...