Note 3 - Health Law PDF

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Summary

Health Law...

Description

- applicant's signature on applications

Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without required to provide evidence of insurability - Guaranteed insurability rider

C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000? - 720

400 + 20% of remaining bill

Comprehensive Major Medical policies usually combine - Major Medical with Basic Hospital/Surgical coverage

Consumer reports requested by an underwriter during the application process of a health insurance policy can be used to determine: - probability of making timely premium payments

D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits? - Residual Benefit clause

A residual amount benefit is based on the proportion of income actually lost due to the partial disability, taking into account the fact that the insured is able to work and earn some income.

Deductibles are used in health policies to lower - overuse of medical services

Disability policies do NOT normally pay for disabilities arising from which of the following? War

During the appeal period, an agent may successfully appeal license termination due to continuing education requirements if - proof of compliance is provided

E and F are business partners. Each takes out a $500,000 life insurance policy on the other, naming himself as primary beneficiary. E and F eventually terminate their business, and four months later E dies. Although E was married with three children at the time of death, the primary beneficiary is still F. However, an insurable interest no longer exists. Where will the proceeds from E's life insurance policy be directed to? - F

Each agent shall complete all continuing education requirements by no later than November 30, and shall be given a final opportunity to complete such requirements by - December 31 every even year

Each applicant for an agent's license in VA MUST - be of good character and have a good reputation for honesty

From what authority derives the requirement that an insurance application contains a disclosure stating that an investigative consumer report may be obtained on an applicant? - Fair Credit Reporting Act

G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern is - Business Overhead Expense

G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's policy - Insured

Group/voluntary long-term care policy premiums are typically deducted from the employee's income and, - are less costly as compared to individual long term care coverage

Health coverage provided under the Affordable Care Act (ACA) shall be made available for dependents until the child attains the age of: - 26

Health insurance benefits NOT covered due to an act of war are: - excluded by the insurer in the contract provisions

How does group insurance differ from individual insurance? - premiums are lower

How long is the typical free look period for Long Term care insurance policies? - 30 days

How often must an insurance consultant license be renewed - Every year

Must submit a renewal application to the Commission along with a renewal application and $50 fee

How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment (AD&D) policy? - if the insured died of accidental causes

If a contract of adhesion contains complicated language, to whom would the interpretation be in favor of? - Insured

If a licensed resident insurance agent moves out of state, which of the following will occur? The agent's license shall terminate immediately

If a retiree on Medicare required five hospital stays in one year, which policy would provide the best insurance for excess hospital expenses? - Medicare Supplement

If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all these situations EXCEPT: - When the state prohibits this by law

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called: noncancellable

If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the Uniform Simultaneous Death Act? - Insured's contingent beneficiary

Under the Uniform Simultaneous Death Act, if both insured and primary beneficiary are killed in the same accident and there is insufficient evidence to show who died first, policy proceeds will be paid as if the insured died last. In other words, the proceeds will be paid to the secondary or contingent beneficiary.

In a Disability Income policy, which of these clauses acts as a deductible? - Elimination Period

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

In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments: - after an insured has become totally disabled as defined in the policy

In Major Medical Expense policies what is the intent of a Stop Loss provision - limits an insured's out-of-pocked medial expenses

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

In order to establish a Health Reimbursement Arrangement (HRA), it MUST: - be established by the employer

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, an insurance agent is BEST defined as: - a person who sells, solicits, or negotiates contracts of insurance or annuity

In Virginia, COBRA permits terminated employees to receive which of the following - continued coverage in group health plan

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

In Virginia, records must be kept for each of the following insurance transactions EXCEPT Premium quotes not accepted by the insured or prospective insured

Information obtained from a phone conversation to the proposed insured can be found in which of these reports? - Inspection Report

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 policy holder 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

J has a Disability Income policy that does NOT provide benefits for losses occurring as the result of his employment. What kind of coverage is this? - Nonoccupational coverage

J has an Accidental Death and Dismemberment policy with a principal sum of $50,000. While trimming the hedges, J cuts off one of his fingers. What is the MAXIMUM J will receive from his policy? - 25,000

J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase? - Noncancelable...