NV Health Final Exam 1 Questions & Answes

Which law requires the applicant be notified before a consumer report is ordered: - ANSWERSFair Credit Reporting Act The Insuring Clause of an A&H policy usually states all of the following, EXCEPT: A. That insurance against loss is provided B. That a loss must result directly from stated accidents or sicknesses C. The method of premium payment D. The identities of the insurance company and the insured - ANSWERSC. The method of premium payment Which of the following statements about Medicare is/are true? I. Payments are made directly to the hospital providing services rather than to the insured II. Benefits can continue beyond the hospitalization period - ANSWERSCorrect Answer: Both I and II The Misstatement of Age provision gives the insurance company the right to: A. Bring suit for fraud B. Cancel the contract C. Adjust benefits payable D. Reduce dividends payable - ANSWERSC. Adjust benefits payable Which of the following statements about group A&H provisions and practices is/are true? I. Insurance company practices are generally less liberal under Group policies than under Individual policies II. Experience rating is generally utilized under Group policies - ANSWERSCorrect Answer: II only A&H insurance provides coverage for sickness and injury that includes which of the following benefits? I. Income benefits due to loss of time from work II. Benefit payments for hospital care - ANSWERSCorrect Answer: Both I and II Explanation: There are three different types of A&H insurance: 1) Medical Expense; 2) Disability Income and 3) AD&D. A&H is a general term including all three types. The part of a HMO policy, which provides for the claim to be shared between the insurer and the insured, is known as which of the following? A. Deductible B. Out of pocket maximum C. Co-pay D. Usual, customary and reasonable - ANSWERSC. Co-pay Answers given by applicants to questions on applications for A&H insurance are considered which of the following? I. Representations II. Warranties - ANSWERSI only - - Representations A&H coverage becomes effective when the: A. First premium has been paid and received in the insurance company's home office B. First premium has been paid and the application has been approved C. Producer delivers the policy to the insured D. Medical examination has been completed and the premium paid - ANSWERSB. First premium has been paid and the application has been approved Which of the following policies can be written on a Non-cancelable and Guaranteed Renewable basis? I. A Major Medical Expense policy II. A Disability Income policy - ANSWERSII only - A Disability Income policy Explanation: Major Medical policies are cancelable, meaning the insurer may cancel you at any time with proper advance notice. AD&D and Disability Income policies often voluntarily give up the right to cancel as a marketing strategy and may be non-cancelable, guaranteed renewable or both. An optionally renewable policy is renewable: A. If a physical exam is passed B. At the option of the insured C. Must be renewed D. At the option of the insurer - ANSWERSD. At the option of the insurer Explanation: An optionally renewable policy is renewable entirely at the option of the insurer.