MASSACHUSETTS HEALTH &
ACCIDENT INSURANCE EXAM
ACCURATE
Hazard - ANSWER Situation that increases chance of loss
Annuity - ANSWER Policy issued by an insurance company to promise you an income
that can last you a lifetime
Insurer - ANSWER An insurance company
Insured - ANSWER A person or business covered by an insurance policy
Health Insurance - ANSWER Broad field of insurance plans that provide protection
against financial consequences of illness, accidents, injury, and disability
- Paid on a year-to-year basis
- Subject to periodic premium increases
- Benefits not fixed
Medical Expense Insurance - ANSWER Pays benefits for nonsurgical doctors' fees
commonly rendered in a hospital; sometimes pays for home and officecalls
Disability Income Insurance - ANSWER Provide a replacement income when wages are
lost due to disability; based on education, training, experience
- income creates limits
- monthly income payments
- highest premium = 14 day waiting period w/ 10 year benefit
- ceiling amount
Accidental Death and Dismemberment Insurance (AD&D) - ANSWER Provides the
insured with a lump-sum benefit amount in the event of accidental death or
dismemberment under accidental circumstances
Interim Coverages - ANSWER Term insurance for a period of months or less by special
agreement of the company; it permits a permanent policy to become effective at a
selected future date.
Interim - ANSWER the intervening time
Subrogation - ANSWER the right for an insurer to pursue a third party that caused an
insurance loss to the insured
,Business Continuation Plans - ANSWER continue the operation of the business in the
event of a disabling sickness to a business owner or key employee
Employee Benefit Plans - ANSWER - help employee in event of disabling sickness or
injury
- rare to not include provision of health insurance/benefits
- contributes to morale and productivity of employee
- provides needed benefits (helps hold down demands for wage increases)
- gives employer tax deductions
- enhances employer image
Business Overhead Expense Insurance - ANSWER - sold individually
- designed to reimburse business for overhead expenses in the event a business owner
becomes disabled (day to day operations)
- does not include compensation for disabled owner
- premiums are tax-deductible as insurance expense
- benefits are taxable income
Disability Buy-Sell Plan/Disability Buy-Outs - ANSWER An agreement between
business co-owners that provides that shares owned by any one of them who becomes
disabled shall be sold to and purchased by the other co-owners or by the business
using funds from disability income insurance.
- legal binding agreement funded with disability income policy
- pay benefits in periodic payments
- buy-out plan contains provision allowing for a lump-sum payment of the benefit
- benefits tax-free
- premiums not tax deductible
- lengthy elimination periods (2+ yrs)
Conversion Privilege - ANSWER - allows insured to convert group certificate to an
individual medical expense policy with the same insurer
- available to terminated employees
- exercised within 30-31 days depending on state
Excess Benefits - ANSWER
Refusal of Policy Renewal - ANSWER refusing a policy... - benefits resulting in over
insurance
- fraud or material misrepresentation
- if insured is covered under Medicare
HIPPA Privacy Rule - ANSWER - federal protection for individuals health information
and gives patients an array of rights in respect to health information
- individually identifiable = health claim information
- requires healthcare providers to disclose info
, - notice of information practices must be given to a policyholder at least every 3 years
HIPPA Security Rule - ANSWER provides technological safeguards to ensure
confidentiality of electronic health information
HIPPA Rules apply to... - ANSWER ...group health plans; excludes coverage (workers
compensation/disability income plans)
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) - ANSWER federal
law that guarantees a continuation of group coverage if terminated (unless misconduct)
- requires 20+ employees
- up to 18 months coverage (29 if disabled)
- 36 months (death, Medicare, divorce)
- does not protect if covered by medical, surgical, or hospital group plans
- employer must provide written notification of continuation privilege
- benefits will end if employer terminates health plans
- 102%
Group Coverage Exclusions - ANSWER Dental/Vision/Prescription Drug Benefits
Pregnancy Discrimination Act of 1978 - ANSWER - amendment to Civil Rights Act of
1964
- designed to prohibit sex discrimination on basis of pregnancy
- treat as disability
- requires group coverage plans of 15+ people
Health insurance group plans are predetermined by - ANSWER the employer in
conjunction with the insurer's benefit schedules and covering limits
Group Basic Medical Expense - ANSWER combines two or more coverages or only one
type of coverage
- hospital, surgical, physicians expenses
Group Major Medical Plans - ANSWER offered as single extensive plan
(comprehensive major medical) or group (supplemental major medical)
- required to satisfy initial deductible (comprehensive)
- required to satisfy corridor/integrated deductible (supplemental)
- extensive benefits
- begins on effective date (possible waiting period)
Dental & Vision Care - ANSWER cover costs associated with dental maintenance, oral
surgery, root canal, orthodontia
- reasonable and customary charge
- dollar per service schedule
cost coverage for eye exams
ACCIDENT INSURANCE EXAM
ACCURATE
Hazard - ANSWER Situation that increases chance of loss
Annuity - ANSWER Policy issued by an insurance company to promise you an income
that can last you a lifetime
Insurer - ANSWER An insurance company
Insured - ANSWER A person or business covered by an insurance policy
Health Insurance - ANSWER Broad field of insurance plans that provide protection
against financial consequences of illness, accidents, injury, and disability
- Paid on a year-to-year basis
- Subject to periodic premium increases
- Benefits not fixed
Medical Expense Insurance - ANSWER Pays benefits for nonsurgical doctors' fees
commonly rendered in a hospital; sometimes pays for home and officecalls
Disability Income Insurance - ANSWER Provide a replacement income when wages are
lost due to disability; based on education, training, experience
- income creates limits
- monthly income payments
- highest premium = 14 day waiting period w/ 10 year benefit
- ceiling amount
Accidental Death and Dismemberment Insurance (AD&D) - ANSWER Provides the
insured with a lump-sum benefit amount in the event of accidental death or
dismemberment under accidental circumstances
Interim Coverages - ANSWER Term insurance for a period of months or less by special
agreement of the company; it permits a permanent policy to become effective at a
selected future date.
Interim - ANSWER the intervening time
Subrogation - ANSWER the right for an insurer to pursue a third party that caused an
insurance loss to the insured
,Business Continuation Plans - ANSWER continue the operation of the business in the
event of a disabling sickness to a business owner or key employee
Employee Benefit Plans - ANSWER - help employee in event of disabling sickness or
injury
- rare to not include provision of health insurance/benefits
- contributes to morale and productivity of employee
- provides needed benefits (helps hold down demands for wage increases)
- gives employer tax deductions
- enhances employer image
Business Overhead Expense Insurance - ANSWER - sold individually
- designed to reimburse business for overhead expenses in the event a business owner
becomes disabled (day to day operations)
- does not include compensation for disabled owner
- premiums are tax-deductible as insurance expense
- benefits are taxable income
Disability Buy-Sell Plan/Disability Buy-Outs - ANSWER An agreement between
business co-owners that provides that shares owned by any one of them who becomes
disabled shall be sold to and purchased by the other co-owners or by the business
using funds from disability income insurance.
- legal binding agreement funded with disability income policy
- pay benefits in periodic payments
- buy-out plan contains provision allowing for a lump-sum payment of the benefit
- benefits tax-free
- premiums not tax deductible
- lengthy elimination periods (2+ yrs)
Conversion Privilege - ANSWER - allows insured to convert group certificate to an
individual medical expense policy with the same insurer
- available to terminated employees
- exercised within 30-31 days depending on state
Excess Benefits - ANSWER
Refusal of Policy Renewal - ANSWER refusing a policy... - benefits resulting in over
insurance
- fraud or material misrepresentation
- if insured is covered under Medicare
HIPPA Privacy Rule - ANSWER - federal protection for individuals health information
and gives patients an array of rights in respect to health information
- individually identifiable = health claim information
- requires healthcare providers to disclose info
, - notice of information practices must be given to a policyholder at least every 3 years
HIPPA Security Rule - ANSWER provides technological safeguards to ensure
confidentiality of electronic health information
HIPPA Rules apply to... - ANSWER ...group health plans; excludes coverage (workers
compensation/disability income plans)
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) - ANSWER federal
law that guarantees a continuation of group coverage if terminated (unless misconduct)
- requires 20+ employees
- up to 18 months coverage (29 if disabled)
- 36 months (death, Medicare, divorce)
- does not protect if covered by medical, surgical, or hospital group plans
- employer must provide written notification of continuation privilege
- benefits will end if employer terminates health plans
- 102%
Group Coverage Exclusions - ANSWER Dental/Vision/Prescription Drug Benefits
Pregnancy Discrimination Act of 1978 - ANSWER - amendment to Civil Rights Act of
1964
- designed to prohibit sex discrimination on basis of pregnancy
- treat as disability
- requires group coverage plans of 15+ people
Health insurance group plans are predetermined by - ANSWER the employer in
conjunction with the insurer's benefit schedules and covering limits
Group Basic Medical Expense - ANSWER combines two or more coverages or only one
type of coverage
- hospital, surgical, physicians expenses
Group Major Medical Plans - ANSWER offered as single extensive plan
(comprehensive major medical) or group (supplemental major medical)
- required to satisfy initial deductible (comprehensive)
- required to satisfy corridor/integrated deductible (supplemental)
- extensive benefits
- begins on effective date (possible waiting period)
Dental & Vision Care - ANSWER cover costs associated with dental maintenance, oral
surgery, root canal, orthodontia
- reasonable and customary charge
- dollar per service schedule
cost coverage for eye exams
