Note 4 - Health Law PDF

Preview

Summary

Health Law...

Description

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take? - The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age

J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay: - 3,600

2000 + 20% of remaining bill

K applies for a health insurance policy on herself and submits the initial premium with the application. She is given a receipt by the producer stating that coverage begins immediately if the application is approved. What kind of receipt was used? - Conditional

K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income? - Major Medical

K completes an application for a disability policy but does not pay the initial premium. The company approves the policy standard and the agent delivers the policy. K then pays her initial premium 3 days later. At what point does K's policy take effect? - Date the initial premium is collected

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation? - Reinstatement

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

K is the insured and P is the sole beneficiary on an Accidental Death and Dismemberment (AD&D) insurance policy. Both are involved in a fatal accident where K dies before P. Under the Common Disaster provision, which of these statements is true? - Proceeds will be paid to P's estate

K is the insured and P is the sole beneficiary on an Accidental Death and Dismemberment (AD&D) insurance policy. Both are involved in a fatal accident where K dies before P. Under the Common Disaster provision, which of these statements is true? - proceeds will be paid to P's estate

Because the sole beneficiary outlived the insured, the proceeds will be payable to the estate of the deceased beneficiary.

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 applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional receipt is left with the applicant. The insurance company's underwriting department request's M's medical records and determines that M has had asthma for many years. All of the following are probable underwriting outcomes, EXCEPT: - Changing the policy's provisions

M becomes disabled and is unable to work for 6 months. M dies soon after the complications arising from this disability. M has a Disability Income policy that pays 2,000 a month. Which of the following statements BEST describes what is owed to her estate? - Earned, but unpaid benefits

M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a disability income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate. - Earned, but unpaid benefits

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 experienced

these DO occur: policy is delivered, insurance company issues policy, initial premium is collected

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 has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim? - 1600

2200 - 200 * 80*

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for? - determined by the terms of the policy

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

With a revocable beneficiary designation, the policyowner may change the beneficiary at any time without notifying or getting permission from the beneficiary.

M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force? - 45 days

Major Medical policies typically: - contain a deductible and coinsurance

Making incomplete comparisons of policies in order to induce the purchase of a policy is referred to as - twisting

Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is: - Business Overhead Expense

Medicare is intended for all of the following groups - - Those receiving Social Security disability benefits for at least 24 months - Those 65 and older - Those afflicted with chronic kideny failure

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

Medicare part b does NOT cover - inpatient hospital services

N has a Major Medical policy that only pays a portion of N's medical expenses. N is responsible for paying the remaining balance. This provision is known as: - Coinsurance

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

500+500+250

Non-occupational disability coverage is designed for - employees who suffer non-work related disabilities, since work-related disabilities are covered by Workers' Compensation

Nursing home benefits must be provided for at least 12 consecutive months in which of the following policies - long-term care

On Accidental Death and Dismemberment (AD&D) insurance policy who is qualified to change the beneficiary designation? - Policy owner

Consent may needed by current beneficiary if designated as irrevocable

P and Q are married and have three children. P is the primary beneficiary on Q's Accidental Death and Dismemberment (AD&D) policy and Q's sister R is the contingent beneficiary. P, Q, and R are involved in a car accident and Q and R are killed instantly. The Accidental Death benefits will be paid to: - P only

P and Q are married and have three children. P is the primary beneficiary on Q's Accidental Death and Dismemberment (AD&D) policy and Q's sister R is the contingent beneficiary. P, Q, and R are involved in a car accident and Q and R are killed instantly. The Accidental Death benefits will be paid to: - P Only

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 is a producer who notices 5 questions on a health application were not answered. What actions should P take? - Set up a meeting with the applicant to answer the remaining questions

P is an employee who quits her job and wants to convert her group health coverage to an individual policy. After the expiration of COBRA laws, which of the following statements is TRUE? - She does NOT need to provide evidence of insurability

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? - recurrent disability

Periodic health claim payments must be made at least - monthly

Pre-hospitalization authorization is considered an example of: - managed care

Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim? - 2100

10000 * 20% coinsurnce + 100

Q purchases a $500,000 life insurance policy and pays $900 in premiums over the first six months. Q dies suddenly and the beneficiary is paid $500,000. This exchange of unequal values reflects which of the following insurance contract features? - aleatory...