Florida Health Insurance 240 Chapters 6 – 8 Already Passed

Florida Health Insurance 240 Chapters 6 – 8 Already Passed Which renewability best describes a Disability Income Policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class? Guaranteed Renewable Describe a Guaranteed Renewable Health Insurance policy. The premiums normally increase at time of renewal for the entire class; renewed without proof of insurability; benefits and coverage are not changed According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare Supplement applicant? At the time of application Within how many days after policy delivery can a Medicare Supplement policy be returned for a 100% premium refund? 30 P is a producer who noticed 5 questions on a health insurance application were not answered. What actions should P take? Set up a meeting with the applicant to answer the remaining questions Group long-term care policy premiums are typically deducted from the employee's __________ and cost _________ than individual long term care coverage. income; less Medicare Parts A and B is known as ______________. Part A covers ___________, while Part B covers _____________. Original Medicare; Part A - hospitalization; Part B - doctor's services Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim? $2,100 Which of the following health insurance policy provisions specifies the insured, insurer, amount and time of coverage, and covered perils? Insuring clause G is involved in an automobile accident while fleeing the scene of a robbery and suffers numerous injuries. According to the ____________ provision in G's policy, who is responsible for paying the medical bills? Illegal Occupation; G -The insured M owns an Individual Disability Income policy with a 30-day elimination period for sickness and accidents and a monthly indemnity benefit of $500. If M is disabled for 3 1/2 months, what is the MAXIMUM amount he would receive for an approved claim? $1,250 M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force? 45 days Deductibles are used in health insurance policies to do what? share costs and lower overuse of medical services During the course of an insurance transaction, if an applicant makes a false statement that is also known as a ____________. misrepresentation What do families pay who have children that are covered by the Florida Healthy Kids Corporation? A portion of the premium On an Accidental Death and Dismemberment (AD&D) insurance policy, who is qualified to change the beneficiary designation? If the beneficiary is irrevocable, what must happen? Policyowner; the policyowner must obtain the signature of that beneficiary before making any changes The insurer must provide a prospective LTC policy buyer with a Buyer's Guide and Outline of Coverage What can an agent provide to help a prospective Medicare Supplement client understand and purchase the most appropriate product? Buyer's guide at the time of application Accurately describe the Waiver of Premium provision in an Accident and Health policy. Premiums are waived after the insured has been totally disabled for a specified time period; premiums payed during the waiting period are refunded. K has an Accidental Death and Dismemberment (AD&D) insurance policy where her husband is beneficiary and her daughter is contingent beneficiary. If K and her husband are both killed in an automobile accident, who would receive the AD&D benefit? K's daughter Defamation occurs when an agent makes a false statement intended to __________. be malicious towards another insurer J purchased a Disability Income Policy that only J can terminate and on which the premium rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase? Noncancelable Within how many days must a health insurance licensee notify the Department of Financial Services of a change in address? 30 days T has Disability Income policy that pays a monthly benefit of $5000. If T becomes partially disabled, what can he likely expect? Less than $5,000 per month The reimbursement of benefits to the insurance company for the treatment of a beneficiary's injuries caused by a third party; prevents the insured from collecting twice on the same claim. Subrogation The practice of selling insurance to family members or businesses where the producer is engaged is called __________________. Controlled business Which Federal law allows an insurer to obtain an inspection report on a potential insured? Fair Credit Reporting Act The mandatory provision that states the policyowner/beneficiary should be paid immediately. Time of payment of claims N has a Major Medical policy that pays 80% of N's medical expenses. N is responsible for paying the remaining 20%. This shared cost is known as ______________. Coinsurance When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under a _____________ plan. Contributory Which of the following statements BEST describes what the Legal Actions provision of an Accident and Health policy requires? An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed. When does a Probationary Period provision become effective in a health insurance contract? At the policy's inception (when the policy goes into effect) Under an Individual Disability policy in Florida, what is the minimum schedule of time in which claim payments must be made to an insured? Monthly The coordination of benefits provision exists in order to ________________. avoid duplication of benefit payments A person insured under a health policy is required to give the insurance company a Notice of Claim within how many days after a covered loss? 20 What percentage of eligible persons must a policy cover in a noncontributory group? 100% What is the purpose of the Life and Health Insurance Guaranty Association? Protects policyowners against insolvent insurance companies (insurers who can't pay) P received Disability income benefits for 3 months then returns to work. She is able to work one month before her condition returns, leaving her disabled once again. What would the insurance company regard this second disability as? A recurrent disability An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period? 31 The Health Insurance Portability and Accountability Act (HIPAA) gives privacy protection for __________________. health information In Florida, deceptive or misleading advertising is considered to be_____________. misrepresentation ____________ policies pay lump to cover high costs associated with certain illnesses, such as cancer. Dread disease When is a Group Health policy required to provide coverage for a newborn child? At birth 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 Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident and out of work for six weeks? Business Overhead Expense In Florida, monthly-premium health insurance policies must provide a grace period of at least __________ days. 10 K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation? Reinstatement With the purchase of a Guaranteed Insurability Rider, the insured can _________________. This is also known as the ________________. have additional benefits without evidence of insurability; Future Insurability Option T is receiving $3,000/month from a Disability Income policy in which T's employer had paid the premiums. What is the correct tax treatment for the $3,000 benefit payments? Benefits are taxable to T What type of renewability guarantees premium rates and renewability? Noncancellable J is an agent who recently told a claimant that his rights might be impaired if he does not complete a release form within a specified time. What could this agent be found guilty of? Coercion Pre-hospitalization authorization and utilization reviews are considered characteristics of _______________. managed care A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will do what? continue coverage but exclude the heart condition A group plan was recently terminated. In Florida, how many days are covered individuals guaranteed coverage after a group plan's termination? 31 days According to the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, when do nonfraudulent misstatements become incontestable? 2 years from the date of the policy was issued P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax? $0 S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning when? November 1 (after 60 days or 2 months) How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment (AD&D) policy? If the primary beneficiary dies before the insured Describe a Hospital Indemnity policy. Coverage that pays a stated amount per day of a covered hospitalization Disability Income policies normally include a _________ period. elimination What is issued to each employee of an employer/group health plan? Certificate and Summary of Benefits In a employer/employee group health plan, the employer receives the ____________ and the employees receive the _____________. master policy; certificate of insurance Which provision specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due? Grace Period Which type of provider is known for stressing preventative medical care? Health Maintenance Organizations (HMO's) Employers with less than __ employees are affected by Florida's Health Insurance Coverage Continuation Act (Mini COBRA). 20 Upon reaching the limiting age, when can a handicapped child extend their health insurance coverage as a dependent? only if the child is incapable of employment and dependent on the policyowner How long is the typical free look period for Long Term care insurance policies? 30 days What is the purpose of the Time of Payment of Claims provision? Prevents delayed claim payments made by the insurer The Financial Services Commission may hold hearings for what reasons? for any reason deemed necessary 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 Inpatient hospital services is covered by what part of Medicare A A policy of adhesion can only be modified by whom? The insurance company