Note 6 - Health Law PDF

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Health Law...

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The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the: - waiting period

The provision in a health insurance policy that suspends premiums being paid to the insurer while the insured is disabled is called the - Waiver of Premium

The provision that defines to whom the insurer will pay benefits to is called - Payment of claims

The reason for a business having a Business Overhead Expense Disability Plan is to cover: fixed business expense

Business Overhead Expense Disability Plan is to cover fixed business costs in the event the owner becomes disabled

The reason for a business having a Business Overhead Expense Disability Plan is to cover: fixed business expenses

The replacement of an Accident and Health policy should be based upon each of the following, EXCEPT: - commissions to be paid

The rules pertaining to senior-specific certifications and professional designations do NOT apply to which of the following types of coverage? - title insurance

The sections of an insurance contract which limit coverage are called: - exclusions

The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n): - closed panel

The State Corporation Commission has the authority to: - make reasonable insurance rules and regulations

The State Corporation Commission has the authority to: - make reasonable insurance rules and regulations

The Virginia Commissioner of Insurance has the authority to examine the business records of all of the following entities, EXCEPT: - life insurance master policyholders

The Virginia organization responsible for approving all continuing education instructors, continuing education courses, and programs of instruction for insurance agents is the: - Virginia Insurance Continuing Education Board

Three types of agent authority include - express, implied, and apparent authority

To be eligible for a group health policy, a group MUST meet which of the following - be formed for a purpose other than obtaining insurance

Type of coverage best described as short term medical policy - interim coverage

Under a Long Term Care policy, which benefit would be typically excluded or limited? - alcohol rehabilitation

Under the Affordable Care Act (ACA), all of the following coverages must be provided, EXCEPT: - services involving elective cosmetic surgery

Under the Health Insurance Portability and Accountability Act (HIPAA), all of the following qualify as creditable coverage, EXCEPT: - accident only

Under which of the following circumstances will the benefits under COBRA continuation coverage end? - All group health plans are terminated by the employer

Unfair trade practices include: - boycott, coercion, and intimidation

Unilateral contracts are - one party makes a promise, and the other party can only accept by performance

V is insured under an individual Disability Income policy with a 30-day Elimination period. On July, 1, he is involved in an accident and temporarily disabled. He returns to work on December 1. How many months of benefit are payable? - 4 months

What action should a producer take if the initial premium is NOT submitted with the application? - Forward the application to the insurer without the initial premium.

What consists of an offer, acceptance, and consideration? - Contract

What does a Guaranteed Insurabilty rider provide a Disability Income policy owner - The ability to periodically increase the amount of coverage without evidence of insurability

What does Medicare parts A and B cover? - Part A hospitalizations Part B doctor's services

What is a warranty? - a statement guaranteed to be true

What is being delivered during a policy delivery? - Insurance contract to the proposed insured

What is issued to each employee of an employer health plan? - Certificate

What is Medicare? - is a hospital and medical expense insurance program

What is the biennial insurance continuing education requirement for an agent with 1 license type? - 16 hours

What is the consideration given by an insurer in the Consideration clause of a life policy? Promise to pay a death benefit to a named beneficiary

What is the elimination period of an individual disability policy? - Time period a disabled person must wait before benefits are paid

What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision? - Insured must be under a physician's care

What is the maximum Social Security Disability benefit amount an insured can receive? - 100% of the insured Primary Insurance Amount (PIA)

What is the MINIMUM number of Activities of Daily Living (ADL) an insured must be unable to perform to qualify for Long Term Care benefits? - 2

A qualified Long Term Care policy must stipulate that the insured be incapable of performing at least two of the ADL's without assistance for at least 90 days to qualify for benefits.

What is the primary factor that determines the benefits paid under a disability income policy? wages

What is the purpose of the Time of Payment of Claims provision? - Prevents delayed claim payments made by the insurer

What is true about Major Medical benefits? - - The deductible can be expressed as a fixed dollar amount - The benefit period begins only after a specified amount of expenses have accrued - Benefits are generally expressed as a percentage of eligible expenses

What kind of Accidental Death and Dismemberment (AD&D) insurance beneficiary requires his/her consent when a change of beneficiary is made? - Irrevocable beneficiary

What must the policyowner provide to the insurer for validation that a loss has occured? - Proof of loss

What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision? - Submit the claim in any form

What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? - Dread disease insurance

What type of renewability guarantees premium rates and renewability - Noncancellable

What type of renewability guarantees premium rates and renewability? - Noncancellable

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled? - Waiver of Premium rider

What would the Medical Information Bureau (MIB) identify? - Testing positive for marijuana use from a previous screening.

When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called: - residual disability

When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans? - Contributory

When an insurance application is taken by a producer, which of these statements is true? - any changes made on the application require the applicant's initials

When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the - entire contract provision

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? - Change of occupation provision

When determining the monthly benefit amount for a Disability Income policy, the factor limits the amount a prospective insured may purchase is: - income...