Note 10 - Health Law PDF

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Health Law...

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In an insurance contract, the insurer is the only party who makes a legally enforceable promise. What kind of contract is this? - unilateral

In Major Medical Expense policies, what is the intent of a Stop Loss provision? - Limits an insured's out-of-pocket medical expenses

In order to act as an insurance agent, a person MUST be - duly licensed

In regards to representations or warranties, which of these statements is TRUE? - If material to the risk, false representations will void a policy

In Virginia, a small group is comprised of not more than - 2 to 50 members

In Virginia, if an agent misappropriates insurance funds held in a fiduciary capacity, the Commission may - Suspend or revoke license

Insurance agents MUST maintain premiums in a fiduciary capacity and remit them - in the ordinary course of business

Insurance agents who must maintain premiums in a fiduciary account may withdraw funds from the account to pay all of the following expenses EXCEPT - personal medical expenses

Insurance companies and agents must implement an information security program to accomplish each of the following EXCEPT - provide policyholder lists to the Commissioner of Insurance

Insurance contracts are known as ____ because certain future conditions or acts must occur before any claims can be paid. - Conditional

Insurance policies are considered aleatory contracts because - performance is conditioned upon a future occurrence

Insurance policies are offered on a "take it or leave it" basis, which make them - contracts of adhesion

is NOT a limited benefit plan? - life insurance policies

J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to? - Health Maintenance Organization

K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered - guaranteed renewable

Licensed agents are NOT required by the Virginia Code to keep - records of premium quotations that are not accepted by the insured

Life and health insurance policies are - Unilateral contracts

Long Term Care policies will usually pay for eligible benefits using which of the following methods? - Expense incurred

M completes an application for health insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect EXCEPT - free-look period has expired

M purchased an Accidental Death and Dismemberment (AD&D) policy and named his son as beneficiary. M has the right to change the beneficiary designation at anytime. What type of beneficiary is his son? - Revocable

Medicare - is a hospital and medical expense insurance program

Medicare is intended for all of the following groups EXCEPT - Those enrolled as a full-time student

Medicare Part A and Part B do NOT pay for - dental work

Medicare Part B does NOT cover - inpatient care services

Minimum standards apply to policy definitions as well as to benefits - make reasonable insurance rules and regulations

N is covered under an individual Disability policy with a 30-day Elimination period and a monthly benefit of $500. N is totally disabled for 3 1/2 months. N's total benefit received on this claim is - $1,250

need animal of who if changed info - applicant

On an Accidental Death and Dismemberment (AD&D) insurance policy, who is qualified to change the beneficiary designation? - POLICY OWNER

P is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period? - Sign an enrollment card

P received Disability income benefits for 3 months then returns to work. She is able to work one month before her condition returns, leaving her disabled once again. What would the insurance company most likely regard this second period of disability as? - A recurrent disability

S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations? - 36

Stranger Originated Life Insurance (STOLI) has been found to be in violation of which of the following contractual elements? - Legal Purpose (Insurable Interest)

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called - time limit on certain defenses

T has Disability Income policy that pays a monthly benefit of $5000. If T becomes partially disabled, what can he likely expect? - Less than $5,000 per month benefit regardless of the cause

T is covered by an Accidental Death and Dismemberment (AD&D) policy that has an irrevocable beneficiary. What action will the insurance company take if T requests a change of beneficiary? - Request of the change will be refused

T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. Under the Model Group Coordination of Benefits provision, when T files a claim, his employer's plan is considered the - PRIMARY CARRIER

T was insured under an individual Disability Income policy and was severely burned in a fire. As a result, T became totally disabled. The insurer began making monthly benefit payments, but later discovered that the fire was set by T in what was described as arson. What actions will the insurer take? - The insurer will rescind the policy, deny the claim, and recover all payments made

Taking receipt of premiums and holding them for the insurance company is an example of Fiduciary responsibility

Testimonials used in Accident & Health insurance must meet all of the following requirements EXCEPT - They must be approved by the Virginia Commissioner of Insurance

The Accident and Health Insurance Replacement Notice states that the failure to include material medical information on the application may provide a basis for the insurance company to - deny any future claims and to refund the premium

The act of offering an applicant something of value as an inducement to purchase a policy of insurance is - rebating

The benefits under a Disability Buy-Out policy are - payable to the company or another shareholder

The Bureau of Insurance may deny an insurance license for which of the following? - Failure to submit a Criminal History Record Report

The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the - Insuring clause

The Commission in Virginia has the power to - Examine insurer solvency

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers (and their families) whose employment has been terminated the right to

(COBRA) - continue group health benefits

The Coordination of Benefits provision - prevents an insured covered by two health plans from making a profit on a covered loss

The difference between group insurance and blanket health policies is - Blanket health policies do not issue certificates

The federal income tax treatment of employer-provided group Medical Expense insurance can be accurately described as - Employee's premiums paid by the employer is tax-deductible to the employer as a business expenditure

The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the - initial deductible

The Health Insurance Portability and Accountability Act (HIPAA) gives privacy protection for health info

The health insurance program which is administered by each state and funded by both the federal and state governments is called - Medicaid...