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Typically, Long-Term Disability benefits are coordinated with which benefit
plan? - ANSWER-Social Security
The focus of major medical insurance is providing coverage for - ANSWER-
medical and hospitalization expenses
An insured under a Major Medical expense plan with a zero deductible and
80/20 coinsurance provision files a $1,000 claim. How much of this claim is the
insured responsible for? - ANSWER-$200
because this policy has a zero deductible, the insures is only responsible for the
20% coinsurance on this claim, or $200
An insured has a stop-loss limit of $5,000 and an 80/20 coinsurance. The
insured incurs $25,000 of covered losses. How much will the insured pay? -
ANSWER-$5,000
Which type of plan would be the most appropriate for an individual on
Medicare and concerned that Medicare will NOT pay for charges exceeding the
approved amount? - ANSWER-Medicare supplement Plan F
,When can a group health policy renewal be denied according to the Health
Insurance Portability and Accountability Act (HIPAA)? - ANSWER-when
contribution or participation rules have been violated
What does the word "level: in Level Term describe? - ANSWER-the face amount
A non-contributory health insurance plan helps the insurer avoid - ANSWER-
adverse selection
because all eligible employees are usually covered, non-contributory plans are
desirable from an underwriting standpoint because adverse selection is
minimized.
To qualify for a resident producer license in the state of Michigan, an individual
- ANSWER-must complete the required pre-licensing education within 12
months of license application
Under an expense-incurred individual health policy, what is the MAXIMUM
length of time after issuance of the policy that an insurer can exclude coverage
for a pre-existing condition? - ANSWER-12 months
pre-existing conditions may be excluded for a maximum of 12 months from the
date of enrollment.
An insured has a health plan that pays established amounts in accordance with
a list of injuries, surgical procedures, or other losses. This list is called a -
ANSWER-benefit schedule
benefits schedule set predetermined limits or maximums on how much money
and insured can be reimbursed for a covered loss.
,Who is the individual paid on a fee-for-service basis? - ANSWER-Provider
Which of the following is NOT an illegal inducement? - ANSWER-Giving the
insured an article of merchandise printed with the producer's name costing $5
$5 or less of tokens or merchandise to applicants is allowed.
Making a statement that is false or maliciously critical of the financial condition
of an insurer is known as - ANSWER-defamation
Which of the following is NOT a required provision in an accident and health
insurance policy? - ANSWER-change of occupation
the change of occupation provision is considered an OPTIONAL provision
Which of these statements about Medicaid is CORRECT? - ANSWER-Funded by
federal, sate, and local taxes
Medicaid is funded by federal, state, and local taxes but is administered by
each state.
All of these are considered key factors in underwriting life insurance EXCEPT -
ANSWER-Marital Status
Correct: tobacco use, health history, age
, The time limit for filing claim disputes is addressed in which provision of an
accident and health policy? - ANSWER-legal actions
All of the following plans allow for employee contributions to be taken on a
pre-tax basis EXCEPT - ANSWER-Health reimbursement Arrangement plan
employers contribute to health reimbursement Arrangement planz (HRA's), not
employees.
Which of the following gifts from a producer would NOT be considered
rebating? - ANSWER-$5 pen
A producer quoting life insurance may give an applicant an article of
merchandise having an invoice value of $5.00 or less.
Written notice for a health claim must be given to the insurer ___ days after
the occurrence of the loss. - ANSWER-20
Chris is an insured bricklayer who severed his left hand in an automobile
accident. Although his primary duty cannot be performed, Chris is also a
substitute high school teacher. He collects a full disability income check every
month. How does his policy define total disability? - ANSWER-own occupation
the "own occupation" definition of total disability requires that the insured be
unable to perform the insured's current occupation as a result of an accident or
sickness.
Which approach predicts a person's earning potential and determines how
much of that amount would be devoted to dependents? - ANSWER-Human life
value approach