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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
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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
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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.
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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