ARIZONA HEALTH INSURANCE 2027 ALL ANSWERS
AND QUESTIONS SET A+
✔✔Accidental Bodily Injury - ✔✔an unforseen and unintended injury that resulted from
an accident rather than a sickness
✔✔Sickness - ✔✔normally defined as an illness, which first manifests itself while the
policy is in force
✔✔What do a majority of health insurance claims result from? - ✔✔Sickness
✔✔Emergency Medical Condition - ✔✔a condition which is so severe in pain or
symptoms that if not treated quickly and properly could cause serious bodily harm or
possibly death
✔✔Loss of Income from Disability - ✔✔loss of income caused by accidnt ond/or
sickness causing an insured the inability to work and earn income is covered; a valued
contract or stated amount that pays weekly or monthly benefits due to an injury or
sickness; benefits may be determined by the insured's past earnings and may be limited
to a percentage of that income
✔✔Medical Expense - ✔✔a contract that covers many of the expenses one incurs from
an accident or sickness, such as a physician or hospital expense; expenses may be
paid directly to the insured an the insured would be responsible for paying the medical
expenses
✔✔Dental Expense - ✔✔a form of medical expense health insurance that covers the
treatment, care and prevention of dental disease and injury to the insured's teeth; an
important feature of this plan that is not typically found in a medical expense insurance
plan ins the inclusion of diagnostic and preventive care
,✔✔Long-Term Care Expense - ✔✔policies that provide benefits for medically necessary
services which one receives in a nursing home or one's own home, but not care
received in an acute care unit of a hospital
✔✔Individual Health Insurance Policies - ✔✔policies that are underwritten to cover the
applicant, their spouse and family; multiple claims per insured is the rule rather than the
exception
✔✔What are the three most important underwriting factors considered in accepting ot
classifying health insurance applicants? - ✔✔1. physical condition of the applicant and
other insureds
2. moral and morale hazards
3. occupation
✔✔How is underwriting for group policies different than for individual policies? -
✔✔While the purpose remains the same, evaluation of the inherent hazard and
assignment of the appropriate class and premium rate, the techniques and standards
for evaluation are decidedly different. The group underwriter has the responsibility not
only of deciding whether and on what basis the group may be insured, but also of
drawing the contract in such a way as to prevent adverse selection against the insurer
by individuals eligible for coverage. The underwriter's attitude toward group risks can be
less restrictive than with individual policies, because the group policies are subject to
annual re-evaluation on the anniversary date.
✔✔__________ offers assistance as both and federal and a state sponsored program. -
✔✔Medicaid
✔✔The federal government also offers disability insurance protection through
__________. - ✔✔the Social Security system
✔✔Limited Health Insurance Policy - ✔✔a policy that only covers specific accidents or
diseases
✔✔Comprehensive Health Insurance Policy - ✔✔a plan that would cover all sickness or
accidents that are not specifically excluded
✔✔Qualified Health Plans - ✔✔coverage offered through state insurance exchanges
✔✔Qualified health plans may not have what 3 things? - ✔✔- pre-existing condition
limitations
- lifetime maximums
- annual limits on the dollar amount of essential health benefots
,✔✔A health plan's status as a qualified health plan will be based on the plan's... - ✔✔-
benefit design
- marketing practices
- provider networks, including community providers
- plan activities related to quality improvement
- the use of standardized formats for consumer information
✔✔Accident-Only Limited Policy - ✔✔limited policies that provide coverage for death,
dismemberment, disability or hospital and medical care resulting from an accident; only
pays for losses resulting from accidents, not sickness
✔✔Accidental Death and Dismemberment Limited Policy - ✔✔a policy that provides for
the payment of a lump sum benefit, in the event that the insured dies from an accident
as defined in the policy or in the event of certain body parts caused by an accident; only
pays for accidental losses
✔✔Principal Sum - ✔✔the amount paid for an accidental death in an AD&D policy;
usually equal to the amount of coverage under the insurance contract, or the face
amount
✔✔Capital Sum - ✔✔the amount paid in the case of loss of slight or accidental
dismemberment; a percentage amount that varies based on the severity of an injury
✔✔Most policies will pay the accidental death benefit as long as the death is caused by
the accident and occurs within __________. - ✔✔90 days
✔✔Travel Accident Policy - ✔✔a policy that provides coverage for death or injury
resulting from accidents occurring while a fare-paying customer is on a common carrier;
the benefits are only paid if the loss occurs during the time of travel.
✔✔Critical Illness Policy - ✔✔a policy that covers multiple illnesses and pays a lump
sum benefit to the insured upon the diagnosis and survival of any of the illnesses
covered by the policy
✔✔Dread Disease Policy - ✔✔a limited risk policy that provides a variety of benefits for
specific diseases
✔✔Dread Disease Policy benefits are usually paid as a __________, __________for
specified events or medical procedures. - ✔✔Scheduled/Fixed Dollar Amount
✔✔Hospital Indemnity Policy - ✔✔provides a specific amount on a daily, weekly, or
monthly basis while the insured is confined to a hospital
, ✔✔Payout of a Hospital Indemnity Policy is based on what? - ✔✔The number of days
that the insured is confined to a hospital; it is unrelated to the medical expenses
incurred
✔✔Credit Disability Policy - ✔✔a policy that is only issued to those in debt to a specific
creditor; in the case of the borrower's disability, payments to the creditor will be made
on the loan until the disabled borrower is able to return to work
✔✔__________ coverage is usually an optional benefit under a group medical policy.
generally, the insured pas a copayment amount and the insurance company pays the
balance. There are generally limitations on quantities. - ✔✔Prescription drug
✔✔Per the Affordable Care Act, __________ benefits are mandatory. - ✔✔Pediatric
vision
✔✔To make sure that the insured is aware that the policy's benefits are limited, the
insurance company must, by law, plainly state the __________ on the first page of the
policy. - ✔✔Limited Policy Notice
✔✔The renewability, eligibility, and benefit requirements for the individual health
insurance market do not apply to the following limited lines coverages and are
considered __________ under all circumstances: accident only coverage, disability
income insurance and credit-only insurance. - ✔✔Excepted Benefits
✔✔Common Exclusions From Coverage Include: - ✔✔- war or act of war injuries or
sicknesses
- active military duty
- intentionally self-inflicted injuries
- elective cosmetic surgery (unless treatment is required to correct a condition due to an
accident or birth defect or the surgery is medically necessary)
- experimental/investigation procedures
- conditions covered by workers compensation
- government plans (policies exlude expenses either paid or eligible for payment under
government funded programs)
- participation in illegal activity (if a person is injured while committing an illegal act,
health insurance will not cover the expense of the injury)
✔✔The purpose of rules and regulations regarding __________ is to ensure truthful and
adequate disclosure of relevant information to the consumer, and to prevent unfair
competition among insurers. - ✔✔Advertisements
✔✔What do advertising rules apply to? - ✔✔Any accident and sickness insurance
advertisements intended for presentation, distribution, dissemination or other
AND QUESTIONS SET A+
✔✔Accidental Bodily Injury - ✔✔an unforseen and unintended injury that resulted from
an accident rather than a sickness
✔✔Sickness - ✔✔normally defined as an illness, which first manifests itself while the
policy is in force
✔✔What do a majority of health insurance claims result from? - ✔✔Sickness
✔✔Emergency Medical Condition - ✔✔a condition which is so severe in pain or
symptoms that if not treated quickly and properly could cause serious bodily harm or
possibly death
✔✔Loss of Income from Disability - ✔✔loss of income caused by accidnt ond/or
sickness causing an insured the inability to work and earn income is covered; a valued
contract or stated amount that pays weekly or monthly benefits due to an injury or
sickness; benefits may be determined by the insured's past earnings and may be limited
to a percentage of that income
✔✔Medical Expense - ✔✔a contract that covers many of the expenses one incurs from
an accident or sickness, such as a physician or hospital expense; expenses may be
paid directly to the insured an the insured would be responsible for paying the medical
expenses
✔✔Dental Expense - ✔✔a form of medical expense health insurance that covers the
treatment, care and prevention of dental disease and injury to the insured's teeth; an
important feature of this plan that is not typically found in a medical expense insurance
plan ins the inclusion of diagnostic and preventive care
,✔✔Long-Term Care Expense - ✔✔policies that provide benefits for medically necessary
services which one receives in a nursing home or one's own home, but not care
received in an acute care unit of a hospital
✔✔Individual Health Insurance Policies - ✔✔policies that are underwritten to cover the
applicant, their spouse and family; multiple claims per insured is the rule rather than the
exception
✔✔What are the three most important underwriting factors considered in accepting ot
classifying health insurance applicants? - ✔✔1. physical condition of the applicant and
other insureds
2. moral and morale hazards
3. occupation
✔✔How is underwriting for group policies different than for individual policies? -
✔✔While the purpose remains the same, evaluation of the inherent hazard and
assignment of the appropriate class and premium rate, the techniques and standards
for evaluation are decidedly different. The group underwriter has the responsibility not
only of deciding whether and on what basis the group may be insured, but also of
drawing the contract in such a way as to prevent adverse selection against the insurer
by individuals eligible for coverage. The underwriter's attitude toward group risks can be
less restrictive than with individual policies, because the group policies are subject to
annual re-evaluation on the anniversary date.
✔✔__________ offers assistance as both and federal and a state sponsored program. -
✔✔Medicaid
✔✔The federal government also offers disability insurance protection through
__________. - ✔✔the Social Security system
✔✔Limited Health Insurance Policy - ✔✔a policy that only covers specific accidents or
diseases
✔✔Comprehensive Health Insurance Policy - ✔✔a plan that would cover all sickness or
accidents that are not specifically excluded
✔✔Qualified Health Plans - ✔✔coverage offered through state insurance exchanges
✔✔Qualified health plans may not have what 3 things? - ✔✔- pre-existing condition
limitations
- lifetime maximums
- annual limits on the dollar amount of essential health benefots
,✔✔A health plan's status as a qualified health plan will be based on the plan's... - ✔✔-
benefit design
- marketing practices
- provider networks, including community providers
- plan activities related to quality improvement
- the use of standardized formats for consumer information
✔✔Accident-Only Limited Policy - ✔✔limited policies that provide coverage for death,
dismemberment, disability or hospital and medical care resulting from an accident; only
pays for losses resulting from accidents, not sickness
✔✔Accidental Death and Dismemberment Limited Policy - ✔✔a policy that provides for
the payment of a lump sum benefit, in the event that the insured dies from an accident
as defined in the policy or in the event of certain body parts caused by an accident; only
pays for accidental losses
✔✔Principal Sum - ✔✔the amount paid for an accidental death in an AD&D policy;
usually equal to the amount of coverage under the insurance contract, or the face
amount
✔✔Capital Sum - ✔✔the amount paid in the case of loss of slight or accidental
dismemberment; a percentage amount that varies based on the severity of an injury
✔✔Most policies will pay the accidental death benefit as long as the death is caused by
the accident and occurs within __________. - ✔✔90 days
✔✔Travel Accident Policy - ✔✔a policy that provides coverage for death or injury
resulting from accidents occurring while a fare-paying customer is on a common carrier;
the benefits are only paid if the loss occurs during the time of travel.
✔✔Critical Illness Policy - ✔✔a policy that covers multiple illnesses and pays a lump
sum benefit to the insured upon the diagnosis and survival of any of the illnesses
covered by the policy
✔✔Dread Disease Policy - ✔✔a limited risk policy that provides a variety of benefits for
specific diseases
✔✔Dread Disease Policy benefits are usually paid as a __________, __________for
specified events or medical procedures. - ✔✔Scheduled/Fixed Dollar Amount
✔✔Hospital Indemnity Policy - ✔✔provides a specific amount on a daily, weekly, or
monthly basis while the insured is confined to a hospital
, ✔✔Payout of a Hospital Indemnity Policy is based on what? - ✔✔The number of days
that the insured is confined to a hospital; it is unrelated to the medical expenses
incurred
✔✔Credit Disability Policy - ✔✔a policy that is only issued to those in debt to a specific
creditor; in the case of the borrower's disability, payments to the creditor will be made
on the loan until the disabled borrower is able to return to work
✔✔__________ coverage is usually an optional benefit under a group medical policy.
generally, the insured pas a copayment amount and the insurance company pays the
balance. There are generally limitations on quantities. - ✔✔Prescription drug
✔✔Per the Affordable Care Act, __________ benefits are mandatory. - ✔✔Pediatric
vision
✔✔To make sure that the insured is aware that the policy's benefits are limited, the
insurance company must, by law, plainly state the __________ on the first page of the
policy. - ✔✔Limited Policy Notice
✔✔The renewability, eligibility, and benefit requirements for the individual health
insurance market do not apply to the following limited lines coverages and are
considered __________ under all circumstances: accident only coverage, disability
income insurance and credit-only insurance. - ✔✔Excepted Benefits
✔✔Common Exclusions From Coverage Include: - ✔✔- war or act of war injuries or
sicknesses
- active military duty
- intentionally self-inflicted injuries
- elective cosmetic surgery (unless treatment is required to correct a condition due to an
accident or birth defect or the surgery is medically necessary)
- experimental/investigation procedures
- conditions covered by workers compensation
- government plans (policies exlude expenses either paid or eligible for payment under
government funded programs)
- participation in illegal activity (if a person is injured while committing an illegal act,
health insurance will not cover the expense of the injury)
✔✔The purpose of rules and regulations regarding __________ is to ensure truthful and
adequate disclosure of relevant information to the consumer, and to prevent unfair
competition among insurers. - ✔✔Advertisements
✔✔What do advertising rules apply to? - ✔✔Any accident and sickness insurance
advertisements intended for presentation, distribution, dissemination or other
