Study Guide for Wisconsin Health and Accident Insurance Course Exam 2024 Questions and Answers

Study Guide for Wisconsin Health and Accident Insurance Course Exam 2024 Questions and Answers Medical Expense Insurance - CORRECT ANSWER -includes plans that cover hospital care, surgical expenses, doctor visits, and outpatient care, along with most of your other basic medical expenses Disability Income Insurance - CORRECT ANSWER -provides replacement income when wages are lost due to a disability -does not cover medical expenses associated with a disability Accidental Death and Dismemberment Insurance - CORRECT ANSWER -provides a beneficiary with a lump sum death benefit in the event of accidental death and will pay a living benefit to for a dismemberment Renewability Provisions - CORRECT ANSWER -define the rights of the insurer to cancel the policy at different points during the life of the policy. The more advantages the renewability provisions the more expensive the coverage There are five principal renewability classifications -cancellable -optionally renewable -conditionally renewable -guaranteed renewable -noncancellable. Premium Factors - CORRECT ANSWER --interest -expenses -Types of benefits -Morbidity -Age -Sex -occupation Business Overhead Expense Insurance - CORRECT ANSWER -is sold to small business owners who must continue to meet overhead expenses such as rent, utilities and payroll -reimburses business owners for the actual overhead expenses incurred while the business owner is totally disabled -does not reimburse business owner for salary Disability Buyouts - CORRECT ANSWER -just as the life insurance buy sell agreement, the disability buy out agreement specifies who will purchase a disabled partner's interest and legally obligates that person or party to purchase the business interest of th e disabled partner Eligible Groups - CORRECT ANSWER -To qualify for a group health insurance, applicants must be a part of a group formed for a reason other than just obtaining health insurance Contributory - CORRECT ANSWER -with this plan both the employees and employer pay part of the premiums and 75% of all eligible employees must participate Noncontributory - CORRECT ANSWER -the employer pays the entire premium and 100% of the employees must participate Conversion Privileges - CORRECT ANSWER -members of a group have the ability to convert their policy to an individual plan Pre-existing conditions - CORRECT ANSWER -An individual may be excluded from group coverage for up to a year for any conditions in which the individual sought treatment 6 months prior to the enrollment date Coordination of Benefits - CORRECT ANSWER --avoid duplication of benefit payments and over insurance when an individual is covered under more than one group health plan -limits the total amount of claims paid from all insurers covering the patient to no more than the total allowable medical expenses. -it establishes which plan is the primary plan, or the plan that is responsible for providing the full benefit amounts -in no case will the total amount the insured receives exceed the medical expenses Maternity Benefits - CORRECT ANSWER --any policy of health insurance that provides coverage for maternity care must also cover the services of certified nurse -midwives, and services of licensed birth centers -the insurance company cannot limit the length of stay for maternity or newborns that are less than medically necessary Cobra - CORRECT ANSWER -requires employers with 20 or more employees to extend group coverage to terminated employees and their families for up to 18 months Franchise Health Plans - CORRECT ANSWER -Provides health coverage for small groups whose numbers are too small to qualify for true group insurance Health Savings Accounts - CORRECT ANSWER -is a tax -favored vehicle for accumulating funds to cover medical expenses -individuals under age of 65