Course Final Exam - Kentucky Accident
and Health
what is not considered a course of underwriting information about an applicant? - Answer-rating
services
what is another name for individuals who participate in an HMO plan? - Answer-subscribers
the order issues by a commissioner to a person engaged in an unfair practice, which prohibits the person
from continuing the practice is known as a(n)? - Answer-cease and desist order
the clause in an accident and health policy which defines the benefit amounts the insurer will pay is
called the? - Answer-insuring clause
an incorporated insurer with its capital divided into shares and owned by its shareholders is? - Answer-
stock insurer
when a person returns to work after a period of total disability but cannot earn as much as he or she did
before the disability, this situation is called what? - Answer-residual disability
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? - Answer-submit the claim in any form
,when can an agent share commission with another agent? - Answer-when the other agent is licensed in
the same line of business
health insurance benefits may be assigned to who? - Answer-doctor, surgeon, and hospital
a health reimbursement arrangement MUST be established: - Answer-by the employer
a producer's license is not required for an office employee who: - Answer-takes factual information
relative to a claim
if a fraternal benefit society provides benefits on the lives of children, the age requirement for adult
membership may not be less than age: - Answer-15
which type of plan normally includes hospice benefits? - Answer-managed care plans
what is the intent of a coinsurance clause in a major medical policy? - Answer-discourages
overutilization of the insurance coverage
under the physical and mental handicap provision, parents have how many days to contact the insurer
upon the dependent's attainment of age? - Answer-31 days
examples of unfair trade practices: - Answer--making misleading statements with respect to the
business of insurance
-unfairly discriminating with regard to premium rates and plans of insurance
-coercion
what provides comprehensive insurance coverage? - Answer-prescription drug benefits
, which health coverage frequently uses a deductible? - Answer-major medical policy
facts about a preferred provider organization (PPO) - Answer--they normally have more providers to
choose from compared to an HMO
-prices are negotiated in advance for PPO providers
-in-network PPO providers offer members better coverage of incurred expenses
-are a managed healthcare system
what is an accurate portrayal of Medicare select? - Answer-lower premiums are normally given in
exchange for the insured using preferred providers
which of the following may the commissioner issue, evidencing the authority of an insurer to transact
insurance in this state: - Answer-certificate of authority
if a health insurer fails to issue a premiums rate quote to an individual within 30 days after receiving a
properly completed application requesting a quote, what happens? - Answer-the insurer must issue
coverage to the individual and may not impose any preexisting conditions exclusion
when an insured changes to a more hazardous occupation, which disability policy provision allows an
insurer to adjust policy benefits and rates? - Answer-change of occupation provision
Michelle purchased a long term care policy 12 months after suffering a stroke. Any future claims she will
have related to this stroke will be: - Answer-covered
-most LTC policies do not cover conditions that existed during the 6 months before the policy effective
date. In this situation, the event occurred 12 months prior.
and Health
what is not considered a course of underwriting information about an applicant? - Answer-rating
services
what is another name for individuals who participate in an HMO plan? - Answer-subscribers
the order issues by a commissioner to a person engaged in an unfair practice, which prohibits the person
from continuing the practice is known as a(n)? - Answer-cease and desist order
the clause in an accident and health policy which defines the benefit amounts the insurer will pay is
called the? - Answer-insuring clause
an incorporated insurer with its capital divided into shares and owned by its shareholders is? - Answer-
stock insurer
when a person returns to work after a period of total disability but cannot earn as much as he or she did
before the disability, this situation is called what? - Answer-residual disability
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? - Answer-submit the claim in any form
,when can an agent share commission with another agent? - Answer-when the other agent is licensed in
the same line of business
health insurance benefits may be assigned to who? - Answer-doctor, surgeon, and hospital
a health reimbursement arrangement MUST be established: - Answer-by the employer
a producer's license is not required for an office employee who: - Answer-takes factual information
relative to a claim
if a fraternal benefit society provides benefits on the lives of children, the age requirement for adult
membership may not be less than age: - Answer-15
which type of plan normally includes hospice benefits? - Answer-managed care plans
what is the intent of a coinsurance clause in a major medical policy? - Answer-discourages
overutilization of the insurance coverage
under the physical and mental handicap provision, parents have how many days to contact the insurer
upon the dependent's attainment of age? - Answer-31 days
examples of unfair trade practices: - Answer--making misleading statements with respect to the
business of insurance
-unfairly discriminating with regard to premium rates and plans of insurance
-coercion
what provides comprehensive insurance coverage? - Answer-prescription drug benefits
, which health coverage frequently uses a deductible? - Answer-major medical policy
facts about a preferred provider organization (PPO) - Answer--they normally have more providers to
choose from compared to an HMO
-prices are negotiated in advance for PPO providers
-in-network PPO providers offer members better coverage of incurred expenses
-are a managed healthcare system
what is an accurate portrayal of Medicare select? - Answer-lower premiums are normally given in
exchange for the insured using preferred providers
which of the following may the commissioner issue, evidencing the authority of an insurer to transact
insurance in this state: - Answer-certificate of authority
if a health insurer fails to issue a premiums rate quote to an individual within 30 days after receiving a
properly completed application requesting a quote, what happens? - Answer-the insurer must issue
coverage to the individual and may not impose any preexisting conditions exclusion
when an insured changes to a more hazardous occupation, which disability policy provision allows an
insurer to adjust policy benefits and rates? - Answer-change of occupation provision
Michelle purchased a long term care policy 12 months after suffering a stroke. Any future claims she will
have related to this stroke will be: - Answer-covered
-most LTC policies do not cover conditions that existed during the 6 months before the policy effective
date. In this situation, the event occurred 12 months prior.
