ARIZONA HEALTH INSURANCE 2027 FINAL EXAMS
ANSWERS AND QUESTIONS SET A+
✔✔Health care insurers must provide without charge written certificates of credible
coverage, if the individuals in question: - ✔✔- are no longer covered under a policy
offered by any health care insurer
- request certification 24 months after coverage under a health insurance policy ceases
✔✔A certificate of credible coverage protects an individual's rights under __________. -
✔✔HIPAA
✔✔What will a disability income policy require of the insured? - ✔✔That they cannot
perform the duties of their occupation due to sickness or injury.
✔✔Own Occupation Policy - ✔✔provides benefits when the insured is unable to perform
any duties of their own occupation because of sickness or injury; usually limited to the
first 24 months after a loss; typically used for highly trained, skilled occupations
✔✔After 24 months, if the insured is still unable to perform the duties of his or her own
occupation, the definition of disability narrows to mean the inability to perform
__________ for which the insured is reasonably suited by education, training or
experience. - ✔✔any occupation
✔✔Any Occupation Disability Provision - ✔✔only provides benefits when the insured is
unable to perform any of the duties of the occupation for which they are suited by
reason of education, training, or experience; it is much easier for an insurance company
to justify this provision when agreeing to issue a policy
✔✔Income Replacement Contract - ✔✔policies which replace a certain percentage of
the insured's income lost due to a covered accident or sickness, without first requiring a
period of total disability
,✔✔Presumptive Disability Provision - ✔✔a provision that is found in most disability
policies which specifies the conditions that will automatically qualify the insured for full
disability benefits; provides a benefit for dismemberment, total and permanent
blindness, or loss of speech or hearing
✔✔Requirement to Be Under Physician Care Provision - ✔✔most disability income
policies require that the insured be under the care of a physician and possibly confined
to the house in order to receive benefits
✔✔An __________ is applied for and paid for by the individual rather than through the
employer as for the group disability income. The premiums are paid with after-tax
dollars and benefits are not tax deductible. - ✔✔Individual Disability Income Policy
✔✔A __________ plan protects the family or an individual against the economic loss
that comes with the total disability of the wage earner. - ✔✔total disability
✔✔How are disability benefits paid? - ✔✔Most often, benefits are paid monthly, but
could be paid weekly in some policies. The amount of the benefit is stated in the policy
and is usually limited to a percentage of one's income at the time of application to
prevent over insurance.
✔✔Elimination Period - ✔✔a waiting period that is imposed on the insured from the
onset of disability until the benefit payments commence
✔✔How is an elimination payment measure? - ✔✔As a deductible measured in days as
opposed to dollars, and range from 30-180 days.
✔✔Benefit Period - ✔✔the length of time over which the monthly disability benefit
payments will last for each disability after the elimination period has been satisfied; most
policies offer benefit periods of 1, 2, or 5 years until the age of 65; the longer the benefit,
the higher the premium
✔✔Recurrent Disability - ✔✔specifies the period of time (usually within 3-6 months),
during which the recurrence of an injury or illness will be considered as a continuation of
a prior period of disability
✔✔Waver of Premium Feature - ✔✔usually included in a basic disability income policy;
allows the insured, when disabled, to forego paying the premiums once they qualify for
benefits
✔✔Probationary Period for Disability - ✔✔another type of waiting period (often 10-30
days) that does not replace the elimination period, but is in addition to it; applies only to
sickness, not accidents or injury
,✔✔What helps the insurer guard against those who would purchase a disability income
policy shortly after developing a disease or other health condition that warrants
immediate action? - ✔✔The probationary period
✔✔Additional Monthly Benefit (AMB) - ✔✔a rider that is offered in the approximate
amount that Social Security would pay; only provided for one year and anticipated that
Social Security benefits would commence at the end of the year
✔✔Social Insurance Supplement (SIS) - ✔✔a rider that will pay a benefit in the
approximate amount that Social Security would pay, but if SS does in fact py, the SIS
benefit is reduced dollar for dollar by the SS benefit payment
✔✔Social Insurance Supplements are used to supplement regular benefits that might
be payable under Social Security Disability in 3 situations: - ✔✔1. when the insured is
eligible for Social Security benefits but before the benefits begin
2. if the insured has been denied coverage under SS (nearly 75% of the people who
apply for SS are denied due to their definition of "total disability")
- when the amount payable under SS is less than the amount payable under the rider
✔✔What does occupational disability coverage do? - ✔✔Provides benefits for illness,
injury or disability resulting from accidents or sicknesses that occur on or off the job.
✔✔What does nonoccupational disability coverage do? - ✔✔Only covers claims that
result from accidents or sicknesses occurring off the job
✔✔Partial Disability Benefit - ✔✔often defined as the inabiltiy to perform one or more of
the regular duties of one's own occupation or the inability to work on a full-time bases,
which results in the decrease in the individual's income; the purpose is to cover partial
loss of income when the insured is disabled to the point that he or she can still report to
work, but is not able to perform all of the regular duties of their job
✔✔The __________ is typically 50% of the total disability benefit, and is limited to a
certain period of time, as noted in the policy. - ✔✔Partial Disability Benefit
✔✔How are benefits paid on a partial disability policy? - ✔✔In a flat or residual amount.
✔✔Residual Disability Benefit - ✔✔the type of disability income policy that provides
benefits for loss of income when a person returns to work after a total disability, but is
still not able to work as long or at the same level as they worked before becoming
disabled
✔✔Cost of Living Adjustment (COLA) Rider - ✔✔helps protect against the inflation that
can erode the purchasing power of disability benefits; annually increases the insured's
monthly benefit automatically once claim payments have begun
, ✔✔Future Increase Option/Guaranteed Insurability Rider - ✔✔allows an insured to
increase the benefit level to a specific predetermined amount at certain times or on
certain occasions without proof of insurabiltiy
✔✔What are the ages at which the benefit may be increased under the Future Increase
Option/Guaranteed Insurabiltiy Rider? - ✔✔25, 28, 31, 34, 37 and 40, or at one's
marriage or the birth of a child
✔✔Accidental Death and Didmemberment Cash Benefit - ✔✔a rider that pays for
accidental losses only and is thus considered a pure form of accident insurance
✔✔Under the Accidental Death and Dismemberment Cash Benefit, what is paid in the
case of an accidental death? - ✔✔The principal sum, usually equal to the amount of
coverage under the insurance contract, or the face amount.
✔✔Under the Accidental Death and Dismemberment Cash Benefit, what is paid in the
case of an accidental dismemberment? - ✔✔A percentage of the principal sum (the
capital sum), which varies according to the severity of the injury.
✔✔Medical Reimbursement Benefit (Nondisabling Injury) - ✔✔a benefit that provides for
the payment of medical expenses incurred due to an accidental bodily injury when the
insured is not disabled
✔✔Return of Premium Rider - ✔✔provides a refund of a percentage of premiums at
certain times; ex: at the end of the 10th year, the insurance company may offer to
refund 80% of the excess of premiums paid over claims
✔✔Cash Surrender Value Rider - ✔✔creates a cash value of around 70% of the
premiums paid in excess of claims; often only available to the owner at the termination
of the contract
✔✔Generally, disability income policies do not cover losses sue to: - ✔✔- war
- military service
- intentionally self inflicted injuries
- overseas residence
- injuries suffered while committing or attempting to commit a felony
✔✔The more __________ the insured's occupation, the higher the premium the
insurance company will charge. - ✔✔dangerous
✔✔The amount of benefit that the insurance company will issue is based on the
applicant's __________. - ✔✔net earned income
ANSWERS AND QUESTIONS SET A+
✔✔Health care insurers must provide without charge written certificates of credible
coverage, if the individuals in question: - ✔✔- are no longer covered under a policy
offered by any health care insurer
- request certification 24 months after coverage under a health insurance policy ceases
✔✔A certificate of credible coverage protects an individual's rights under __________. -
✔✔HIPAA
✔✔What will a disability income policy require of the insured? - ✔✔That they cannot
perform the duties of their occupation due to sickness or injury.
✔✔Own Occupation Policy - ✔✔provides benefits when the insured is unable to perform
any duties of their own occupation because of sickness or injury; usually limited to the
first 24 months after a loss; typically used for highly trained, skilled occupations
✔✔After 24 months, if the insured is still unable to perform the duties of his or her own
occupation, the definition of disability narrows to mean the inability to perform
__________ for which the insured is reasonably suited by education, training or
experience. - ✔✔any occupation
✔✔Any Occupation Disability Provision - ✔✔only provides benefits when the insured is
unable to perform any of the duties of the occupation for which they are suited by
reason of education, training, or experience; it is much easier for an insurance company
to justify this provision when agreeing to issue a policy
✔✔Income Replacement Contract - ✔✔policies which replace a certain percentage of
the insured's income lost due to a covered accident or sickness, without first requiring a
period of total disability
,✔✔Presumptive Disability Provision - ✔✔a provision that is found in most disability
policies which specifies the conditions that will automatically qualify the insured for full
disability benefits; provides a benefit for dismemberment, total and permanent
blindness, or loss of speech or hearing
✔✔Requirement to Be Under Physician Care Provision - ✔✔most disability income
policies require that the insured be under the care of a physician and possibly confined
to the house in order to receive benefits
✔✔An __________ is applied for and paid for by the individual rather than through the
employer as for the group disability income. The premiums are paid with after-tax
dollars and benefits are not tax deductible. - ✔✔Individual Disability Income Policy
✔✔A __________ plan protects the family or an individual against the economic loss
that comes with the total disability of the wage earner. - ✔✔total disability
✔✔How are disability benefits paid? - ✔✔Most often, benefits are paid monthly, but
could be paid weekly in some policies. The amount of the benefit is stated in the policy
and is usually limited to a percentage of one's income at the time of application to
prevent over insurance.
✔✔Elimination Period - ✔✔a waiting period that is imposed on the insured from the
onset of disability until the benefit payments commence
✔✔How is an elimination payment measure? - ✔✔As a deductible measured in days as
opposed to dollars, and range from 30-180 days.
✔✔Benefit Period - ✔✔the length of time over which the monthly disability benefit
payments will last for each disability after the elimination period has been satisfied; most
policies offer benefit periods of 1, 2, or 5 years until the age of 65; the longer the benefit,
the higher the premium
✔✔Recurrent Disability - ✔✔specifies the period of time (usually within 3-6 months),
during which the recurrence of an injury or illness will be considered as a continuation of
a prior period of disability
✔✔Waver of Premium Feature - ✔✔usually included in a basic disability income policy;
allows the insured, when disabled, to forego paying the premiums once they qualify for
benefits
✔✔Probationary Period for Disability - ✔✔another type of waiting period (often 10-30
days) that does not replace the elimination period, but is in addition to it; applies only to
sickness, not accidents or injury
,✔✔What helps the insurer guard against those who would purchase a disability income
policy shortly after developing a disease or other health condition that warrants
immediate action? - ✔✔The probationary period
✔✔Additional Monthly Benefit (AMB) - ✔✔a rider that is offered in the approximate
amount that Social Security would pay; only provided for one year and anticipated that
Social Security benefits would commence at the end of the year
✔✔Social Insurance Supplement (SIS) - ✔✔a rider that will pay a benefit in the
approximate amount that Social Security would pay, but if SS does in fact py, the SIS
benefit is reduced dollar for dollar by the SS benefit payment
✔✔Social Insurance Supplements are used to supplement regular benefits that might
be payable under Social Security Disability in 3 situations: - ✔✔1. when the insured is
eligible for Social Security benefits but before the benefits begin
2. if the insured has been denied coverage under SS (nearly 75% of the people who
apply for SS are denied due to their definition of "total disability")
- when the amount payable under SS is less than the amount payable under the rider
✔✔What does occupational disability coverage do? - ✔✔Provides benefits for illness,
injury or disability resulting from accidents or sicknesses that occur on or off the job.
✔✔What does nonoccupational disability coverage do? - ✔✔Only covers claims that
result from accidents or sicknesses occurring off the job
✔✔Partial Disability Benefit - ✔✔often defined as the inabiltiy to perform one or more of
the regular duties of one's own occupation or the inability to work on a full-time bases,
which results in the decrease in the individual's income; the purpose is to cover partial
loss of income when the insured is disabled to the point that he or she can still report to
work, but is not able to perform all of the regular duties of their job
✔✔The __________ is typically 50% of the total disability benefit, and is limited to a
certain period of time, as noted in the policy. - ✔✔Partial Disability Benefit
✔✔How are benefits paid on a partial disability policy? - ✔✔In a flat or residual amount.
✔✔Residual Disability Benefit - ✔✔the type of disability income policy that provides
benefits for loss of income when a person returns to work after a total disability, but is
still not able to work as long or at the same level as they worked before becoming
disabled
✔✔Cost of Living Adjustment (COLA) Rider - ✔✔helps protect against the inflation that
can erode the purchasing power of disability benefits; annually increases the insured's
monthly benefit automatically once claim payments have begun
, ✔✔Future Increase Option/Guaranteed Insurability Rider - ✔✔allows an insured to
increase the benefit level to a specific predetermined amount at certain times or on
certain occasions without proof of insurabiltiy
✔✔What are the ages at which the benefit may be increased under the Future Increase
Option/Guaranteed Insurabiltiy Rider? - ✔✔25, 28, 31, 34, 37 and 40, or at one's
marriage or the birth of a child
✔✔Accidental Death and Didmemberment Cash Benefit - ✔✔a rider that pays for
accidental losses only and is thus considered a pure form of accident insurance
✔✔Under the Accidental Death and Dismemberment Cash Benefit, what is paid in the
case of an accidental death? - ✔✔The principal sum, usually equal to the amount of
coverage under the insurance contract, or the face amount.
✔✔Under the Accidental Death and Dismemberment Cash Benefit, what is paid in the
case of an accidental dismemberment? - ✔✔A percentage of the principal sum (the
capital sum), which varies according to the severity of the injury.
✔✔Medical Reimbursement Benefit (Nondisabling Injury) - ✔✔a benefit that provides for
the payment of medical expenses incurred due to an accidental bodily injury when the
insured is not disabled
✔✔Return of Premium Rider - ✔✔provides a refund of a percentage of premiums at
certain times; ex: at the end of the 10th year, the insurance company may offer to
refund 80% of the excess of premiums paid over claims
✔✔Cash Surrender Value Rider - ✔✔creates a cash value of around 70% of the
premiums paid in excess of claims; often only available to the owner at the termination
of the contract
✔✔Generally, disability income policies do not cover losses sue to: - ✔✔- war
- military service
- intentionally self inflicted injuries
- overseas residence
- injuries suffered while committing or attempting to commit a felony
✔✔The more __________ the insured's occupation, the higher the premium the
insurance company will charge. - ✔✔dangerous
✔✔The amount of benefit that the insurance company will issue is based on the
applicant's __________. - ✔✔net earned income
