Note 5 - Health Law PDF

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Health Law...

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Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount that the insurer will pay in the event of a loss.

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

Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount that the insurer will pay in the event of a loss.

Qualified Long-Term Care policies may take into consideration an applicant's pre-existing conditions for a maximum of not more than __ month(s) prior to the effective date of coverage. 6

R had received full disability income benefits for 6 months. When he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity? - Residual Disability

S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning: November 1

must wait 60 days after written proof of loss before legal actions can be brought against the company

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

S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a: - High-deductible health plan

To be eligible for a Health Savings Account, an individual must be covered by a high-deductible health plan (HDHP), must not be covered by other health insurance (does not apply to accident insurance, disability, dental care, vision care, long-term care), must not be eligible for Medicare, and can't be claimed as a dependent on someone else's tax return.

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

Subrogation is - the right for an insurer to pursue a third party that caused an insurance loss to the insured. This is done as a means of recovering the amount of the claim paid to the insured for the loss

T and S are named co-primary beneficiaries on a $500,000 Accidental Death and Dismemberment policy insuring their father. Their mother was named contingent beneficiary. Five years later, S dies of natural causes and the father is killed in a scuba accident shortly afterwards. How much of the death benefit will the mother receive? - 0

T is still alive and the sole primary beneficiary while the mother is still the contingent beneficiary

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 defences

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

An irrevocable designation may not be changed without the written consent of the beneficiary.

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 owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take? - Increase her policy's coverage amount

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

T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition? - Insurer will likely treat as a pre-existing condition which may not be covered for one year

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.

Testimonials used in Accident & Health insurance advertisements do not need to 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 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 identifying which losses resulting from an accident or sickness are insured by the policy is called the: - Insuring clause

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

The Consideration clause of an insurance contract includes: - the schedule and amount of premium payments

The Consideration clause of an insurance includes - the schedule and amount of premium payments

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families whose employment has been terminated the right to - 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 guarantee of insurability option provides a long-term care policy owner the ability to - buy additional coverage at a later date

In long-term care insurance, the guarantee of insurability option provides the insured with the ability to purchase additional insurance at a later date without evidence of insurability.

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

The individual most likely to buy a Medicare Supplement policy would be a(n): - 68 year old male covered by Medicare

The individual who provides general medical care for a patient as well as the referral for specialized care is known as - long-term care

The individual who provides general medical care for a patient as well as the referral for specialized care is known as - Primary Care Physician

The insuring clause - States the scope and limits of the coverage

The Legal Actions provision of an insurance contract is designed to do all of the following, EXCEPT: - protect the producer

The Notice of Claims provision requires a policy owner to - notify an insurer of a claim within a specified time

The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs - Social Security Disability Income

The phrase "This policy will only pay for a semi-private room" is an example of a(n): - internal limit

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is: - time limit on certain defenses...