COLORADO LIFE & HEALTH INSURANCE EXAM
utilization review - Answers - a set of formal techniques to monitor the use or clinical
necessity of health care, determining the application of exclusions, and the medical
necessity of treatment.
30 days for electronic; 45 days for paper - Answers - With a clean claim, the insured has
? days for paying or denying electronic and ? days for paper claims.
Enforces - Answers - The Commissioner ______ laws and does not create them.
5 years - Answers - Every ____ years, a licensed insurer must be examined by the state
commissioner.
Adverse selection - Answers - What is a major concern for Underwriters, especially
during the open enrollment period?
Class - Answers - The guaranteed renewable provision states that premiums can only
be increased by _________.
Legal Actions Provision - Answers - The ___________ states that one has 60 days after
proof of loss with a 2-year limit on certain defenses.
Insurers - Answers - The insuring clause includes ____________'s promise to pay
benefits.
Proof of loss provision - Answers - This provision states that the insured must provide
proof of loss within 90 days, up to a 1-year maximum.
elimination period - Answers - waiting period after a loss occurs before benefit period
begins (30, 90 days, up to 1 year)
Part C - Answers - Medicare Advantage plan, substitution for original benefits (A & B)
Medicare Part A - Answers - Hospital insurance, covers inpatient and hospice
Medicare Part B - Answers - Outpatient treatment, ER treatment, preventive care is
looped under Part ___
Supplement Part A - Answers - Also known as Medigap, this part covers core benefits,
including hospice care; premiums vary.
Guaranteed Insurability Rider - Answers - Optional rider that enables the policyowner to
purchase additional amounts of coverage at predetermined times without proof of
insurability
, Accidental Death Benefit Rider - Answers - doubles the face amount of life insurance if
death occurs as a result of an accident
Term Insurance Rider - Answers - Often added to a whole life policy to increase
coverage.
Coverage more affordable. Insured buys some whole life and some term (TERM
coverage may be level or decreasing).
Consideration clause - Answers - A part of the insurance contract that states that both
parties must give something of value for the transfer of risk, and specifies the conditions
of the exchange.
Conversion privilege - Answers - Allows individual policy conversion upon plan group
termination
Non-taxable - Answers - Benefits are taxable or non-taxable (?) to employees.
20 - Answers - Employers with ___ + employees are required to offer COBRA for up to
18 months after an employee is terminated.
Master policy - Answers - In group health insurance a ______ type of policy is issued to
the group sponsor.
Impairment rider - Answers - Temporary or permanent rider added to a policy that
includes specific conditions which would normally cause a policy to be declined.
Free Look Period - Answers - The period of time for the insured to look over a policy
after it is issued (10 days for health insurance, 15 for life)
Higher premium - Answers - The more frequent premium payment, the ______ (higher
or lower) the premium.
Joint Life Policy - Answers - Covers two or more lives and provides for the payment of
the proceeds at the death of the first among those insured, at which time the policy
automatically terminates.
Survivorship Life Policy - Answers - Joint life policy in which the policy proceeds are
paid out upon the death of the second insured. Synonymous with second-to-die joint life
policy.
Long-term care rider - Answers - A rider that costs extra; nursing home covered
usual, customary, and reasonable (UCR) - Answers - the charge consistent with what
other medical vendors would assess
utilization review - Answers - a set of formal techniques to monitor the use or clinical
necessity of health care, determining the application of exclusions, and the medical
necessity of treatment.
30 days for electronic; 45 days for paper - Answers - With a clean claim, the insured has
? days for paying or denying electronic and ? days for paper claims.
Enforces - Answers - The Commissioner ______ laws and does not create them.
5 years - Answers - Every ____ years, a licensed insurer must be examined by the state
commissioner.
Adverse selection - Answers - What is a major concern for Underwriters, especially
during the open enrollment period?
Class - Answers - The guaranteed renewable provision states that premiums can only
be increased by _________.
Legal Actions Provision - Answers - The ___________ states that one has 60 days after
proof of loss with a 2-year limit on certain defenses.
Insurers - Answers - The insuring clause includes ____________'s promise to pay
benefits.
Proof of loss provision - Answers - This provision states that the insured must provide
proof of loss within 90 days, up to a 1-year maximum.
elimination period - Answers - waiting period after a loss occurs before benefit period
begins (30, 90 days, up to 1 year)
Part C - Answers - Medicare Advantage plan, substitution for original benefits (A & B)
Medicare Part A - Answers - Hospital insurance, covers inpatient and hospice
Medicare Part B - Answers - Outpatient treatment, ER treatment, preventive care is
looped under Part ___
Supplement Part A - Answers - Also known as Medigap, this part covers core benefits,
including hospice care; premiums vary.
Guaranteed Insurability Rider - Answers - Optional rider that enables the policyowner to
purchase additional amounts of coverage at predetermined times without proof of
insurability
, Accidental Death Benefit Rider - Answers - doubles the face amount of life insurance if
death occurs as a result of an accident
Term Insurance Rider - Answers - Often added to a whole life policy to increase
coverage.
Coverage more affordable. Insured buys some whole life and some term (TERM
coverage may be level or decreasing).
Consideration clause - Answers - A part of the insurance contract that states that both
parties must give something of value for the transfer of risk, and specifies the conditions
of the exchange.
Conversion privilege - Answers - Allows individual policy conversion upon plan group
termination
Non-taxable - Answers - Benefits are taxable or non-taxable (?) to employees.
20 - Answers - Employers with ___ + employees are required to offer COBRA for up to
18 months after an employee is terminated.
Master policy - Answers - In group health insurance a ______ type of policy is issued to
the group sponsor.
Impairment rider - Answers - Temporary or permanent rider added to a policy that
includes specific conditions which would normally cause a policy to be declined.
Free Look Period - Answers - The period of time for the insured to look over a policy
after it is issued (10 days for health insurance, 15 for life)
Higher premium - Answers - The more frequent premium payment, the ______ (higher
or lower) the premium.
Joint Life Policy - Answers - Covers two or more lives and provides for the payment of
the proceeds at the death of the first among those insured, at which time the policy
automatically terminates.
Survivorship Life Policy - Answers - Joint life policy in which the policy proceeds are
paid out upon the death of the second insured. Synonymous with second-to-die joint life
policy.
Long-term care rider - Answers - A rider that costs extra; nursing home covered
usual, customary, and reasonable (UCR) - Answers - the charge consistent with what
other medical vendors would assess
