DE Accident & Health Insurance
Major medical policies may include which types of deductibles? - ANS-Flat, corridor, per
cause
Most long term care policies provide coverage for ____________ care - ANS-Home
health care
The commissioner is elected by - ANS-The citizens
Guaranteed renewable health insurance policies ensure renewability up to - ANS-A
specific age of the insured
What is the maximum amount in life insurance benefits covered by the Delaware Life
and Health Insurance Guaranty Association? - ANS-$300,000
Medicare—Part D Prescription Drug Coverage is available to - ANS-Anyone enrolled in
Medicare Part A
Suppose an insurer has knowingly accepted insurance business from an individual who
is not licensed. He can be fined up to: - ANS-$20,000.00
Commissioner charges how much for nonwillful violations and how much for willful
violations? - ANS-$1000 per violation up to $10,000 for nonwillful violations
$5000 fine for willful violations, up to a total of $50,000 in any 6-month period.
Is illegal occupation a mandatory provision? - ANS-No , it is optional, because in some
cases it is not needed
Loss-of-time benefit adjustment - optional or required? - ANS-Optional , because in
some cases it is not needed.
Change of beneficiary - optional or required? - ANS-Required!
Dentists that are on a specified list, and whom are paid on a flat per capita basis,
characterizes an - ANS-HMO
Group plans are not tailored to - ANS-the individual
, What is the maximum number of days of skilled nursing facility care for which Medicare
will pay benefits? - ANS-100 days
According to the disability insurance time limit on certain defenses provision, how long
after the date of a policy's issue can innocent misstatements on an application be used
to void a claim?
For the life of the policy
5 years
2 years
1 year - ANS-2 years
Disability benefit payments with employee contributions are - ANS-Not taxable
Disability benefit payments funded fully by employer - ANS-Are taxable
How long must replaxing and existing insurers maintain a replacement register and
copies of all written communications regarding replacement? - ANS-Three years
A nonresident agent would not apply for a temporary license in Delaware, but for a -
ANS-nonresident agent's license
Identify the number of days the insured or insurer must do the following in this order:
Notice of Claim, Claims Forms, Proof of Loss, Waiting Period for Sickness Claims upon
Reinstatement - ANS-20, 15, 90, 10
Which of the following statements regarding persons participating in an HMO is correct?
They negotiate health care service fees with contracted HMO providers
They pay for health care services are they incurred
They pay a fixed periodic fee whether or not health care services are used
They pay for health care services as they are incurred, at a rate discounted for the HMO
- ANS-They pay a fixed periodic fee whether or not health care services are used
What is the definition of pre-existing condition in a long-term care policy? - ANS-A
condition for which advice or treatment was received within 6 months before the
effective date of coverage
Under many dental expense plans, diagnostic care is - ANS-Covered
Major medical policies may include which types of deductibles? - ANS-Flat, corridor, per
cause
Most long term care policies provide coverage for ____________ care - ANS-Home
health care
The commissioner is elected by - ANS-The citizens
Guaranteed renewable health insurance policies ensure renewability up to - ANS-A
specific age of the insured
What is the maximum amount in life insurance benefits covered by the Delaware Life
and Health Insurance Guaranty Association? - ANS-$300,000
Medicare—Part D Prescription Drug Coverage is available to - ANS-Anyone enrolled in
Medicare Part A
Suppose an insurer has knowingly accepted insurance business from an individual who
is not licensed. He can be fined up to: - ANS-$20,000.00
Commissioner charges how much for nonwillful violations and how much for willful
violations? - ANS-$1000 per violation up to $10,000 for nonwillful violations
$5000 fine for willful violations, up to a total of $50,000 in any 6-month period.
Is illegal occupation a mandatory provision? - ANS-No , it is optional, because in some
cases it is not needed
Loss-of-time benefit adjustment - optional or required? - ANS-Optional , because in
some cases it is not needed.
Change of beneficiary - optional or required? - ANS-Required!
Dentists that are on a specified list, and whom are paid on a flat per capita basis,
characterizes an - ANS-HMO
Group plans are not tailored to - ANS-the individual
, What is the maximum number of days of skilled nursing facility care for which Medicare
will pay benefits? - ANS-100 days
According to the disability insurance time limit on certain defenses provision, how long
after the date of a policy's issue can innocent misstatements on an application be used
to void a claim?
For the life of the policy
5 years
2 years
1 year - ANS-2 years
Disability benefit payments with employee contributions are - ANS-Not taxable
Disability benefit payments funded fully by employer - ANS-Are taxable
How long must replaxing and existing insurers maintain a replacement register and
copies of all written communications regarding replacement? - ANS-Three years
A nonresident agent would not apply for a temporary license in Delaware, but for a -
ANS-nonresident agent's license
Identify the number of days the insured or insurer must do the following in this order:
Notice of Claim, Claims Forms, Proof of Loss, Waiting Period for Sickness Claims upon
Reinstatement - ANS-20, 15, 90, 10
Which of the following statements regarding persons participating in an HMO is correct?
They negotiate health care service fees with contracted HMO providers
They pay for health care services are they incurred
They pay a fixed periodic fee whether or not health care services are used
They pay for health care services as they are incurred, at a rate discounted for the HMO
- ANS-They pay a fixed periodic fee whether or not health care services are used
What is the definition of pre-existing condition in a long-term care policy? - ANS-A
condition for which advice or treatment was received within 6 months before the
effective date of coverage
Under many dental expense plans, diagnostic care is - ANS-Covered
