Tennessee Health Exam questions and answers 100% verified.

Tennessee Health Exam questions and answers 100% verified. What are the 4 elements of an insurance contract? - correct answers.The elements of this are: Agreement - Offer and Acceptance Consideration Competent Parties Legal Purpose How can an insurance company use the information it obtains from the MIB? - correct answers.The information from this can be used to conduct further investigation into an applicant's current insurability. Explain the concept of coverage on a first-dollar basis. - correct answers.This coverage does not require the insured to pay a deductible. What coverages are provided by a Major Medical Expense policy? - correct answers.This will provide coverage for expenses that were not covered by the basic policy, or if the time limitation is up in the basic policy. Why do HMOs encourage members to get regular check-ups? - correct answers.By doing this, it is hoped that disease will be treated in it's earliest stages when the treatment has the best chance of success. How does a POS plan differ from a traditional HMO? - correct answers.In this plan, the employees do not have to be locked in to one plan or make a choice between the two plans. What is the purpose of an HSA (Health Savings Account)? - correct answers.These are designed to help individuals save for qualified health expenses that they, their spouse, or their dependents occur. How long will a disability pay? - correct answers.This insurance is designed to provide a reasonable and predetermined income to a party for a set period of time; this time is subject to a "time deductible: termed an elimination period. How long does an elimination period usually last? Give a range. - correct answers.The range of this, found in most policies, is 30 to 180 days. What is a probationary period? - correct answers.This is a waiting period, usually 10-30 days after the policy issue date. What is the purpose of a buy-sell agreement? - correct answers.This specifies how the business will pass between owners when one of the owners dies or becomes disabled. Describe the taxation of premiums and benefits in a disability buyout agreement. - correct answers.The premiums paid by the business are not tax deductible and the benefits are received tax-free. In what 2 ways can accidental death and dismemberment coverage be written? - correct answers.This coverage can be written as a rider or as a separate policy. Under AD&D coverage, when would the capital amount be paid? When would the principal amount be paid? - correct answers.In case of loss of sight or accidental dismemberment, a percentage of the principal sum is paid. (Capital Amount) The principal amount is paid for accidental death. How do Limited Risk and Special Risk policies differ from each other? - correct answers.The first policy defines the specific risk in which AD&D benefits would be paid. The second, will cover unusual types of risks that are not normally covered under AD&D. Where is skilled nursing care generally provided? - correct answers.This care is almost always provided in institutional setting. Describe an individual who would be a candidate for custodial care. Who would provide it? - correct answers.This care is for meeting personal needs and must be given under doctors orders. Who would be eligible for adult day care? What services would be provided? - correct answers.This care is provided for functionally impaired adults on less than a 24-hour basis. This care includes transportation, a variety of health/social activities, and meals are usually included. What types of groups are eligible for group insurance? - correct answers.There are generally 2 types of groups eligible for this, employer sponsored and association sponsored. How is underwriting unique for group policies? - correct answers.This is unique in that when it is written, every member must be covered regardless of sex, age, gender, physical condition, etc. How is the cost of a group policy determined? - correct answers.Cost of this policy will vary by ratio of males to females and the average age of the group. What is required for eligibility in a group policy? - correct answers.The requirements include employees being full-time and meet minimum service requirements. When is the group policy cost reevaluated and for what purpose? - correct answers.This is reevaluated annually and makes adjusting the premium possible based upon group claims. How many members must an association have to qualify for group insurance? - correct answers.In order to qualify for this a group must have at least 100 members. Under COBRA, when are dependents covered and for how long? - correct answers.This requires any employer with 20 or more employees to extend group health coverage to terminated employees and their families after a qualifying event. This coverage is extended for up to 18 months. What is included in the "entire contract"? - correct answers.This includes the signed application, the health insurance policy, and any attached endorsements. Who has the authority to change a policy provision? - correct answers.Only an executive officer of the company, not an agent, has this authority. What are the grace periods for an individual policy? (Weekly vs Monthly vs Others) - correct answers.In most cases, this cannot be less than 7 days for weekly pay policies 10 days for monthly pay policies 31 days for all other modes If a premium has not been paid by the end of the grace period, what will happen to the policy? - correct answers.In this case, the policy would lapse for non payment of the premium. When an individual needs to file a health insurance claim, what are his/her responsibilities? - correct answers.Notice for this is required within 20 days of the loss. Which provision states to whom the claims are to be paid? - correct answers.The payment of claims provision specifies this. If the insured misstates his/her age, how will benefits be paid? - correct answers.In this case, the benefits paid will be what would have been purchased at the correct age. In what way could changing to a more dangerous occupation affect a person's insurance policy? - correct answers.In this case, benefits would be reduced to that which premiums paid would have purchased assuming the more hazardous occupation. What provision can reduce the disability benefit based upon the insured's current income? - correct answers.The Relation of Earnings to Insurance provision can do this. What is identified in the insuring clause? - correct answers.This clause identifies the insured and the insurance company. Where is the consideration clause usually located in the policy? - correct answers.This clause is usually located on the first page of the policy? What are unusual, reasonable, and customary charges based on? - correct answers.This means that the insurance company will pay an amount for a given procedure based upon the average charge for that procedure in that specific geographic area. Which rider will allow the insured to purchase additional amounts of disability income coverage without evidence of insurability? - correct answers.The Guaranteed Insurability Rider allows this. What is the difference between a guaranteed renewable and non-cancellable policy? - correct answers.With this, the insurer can increase the policy premium on the policy anniversary date. Which renewable provision gives the insured the right to renew the policy for the life of the contract but allows the insurer to alter the premiums? - correct answers.The Guaranteed Renewable provision allows this. What is Medicare? To whom is Medicare available? - correct answers.This is a federal medical expense insurance program for people age 65 and older even if the individual continues to work. What does Medicare Part A cover? - correct answers.This helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care. What is the initial enrollment period for Medicare Part A? - correct answers.This period is when as individual first becomes eligible. This is 3 months prior to turning 65 to 3 months after birth month. How is part B of Medicare funded? - correct answers.This is funded by monthly premiums and from the general revenues of the federal government. Who is eligible for Medicare Part B? - correct answers.This is optional and offered to everyone who enrolls in Part A. When is the general enrollment period for Medicare Part B? - correct answers.This period is from January 1 - March 31 each year. What is excluded from coverage under Medicare Part B? - correct answers.This does not cover private duty nursing, skilled nursing home care costs over 100 days per benefit period, or intermediate nursing home care. What are the advantages of an HMO or PPO for a Medicare recipient? - correct answers.The advantages of these may be that there are no claim forms required, almost any medical problem is covered forn a set fee so health care costs can be budgeted. These may also pay for services not usually covered by Medicare or supplemental policies, such as prescriptions, or eye/hearing/dental expenses. Who provides primary coverage if an individual who is eligible for Medicare is still active under an employer plan? - correct answers.In this case, employer plans continue to be primary coverage, and Medicare is secondary coverage. What is the purpose of Medicare Supplement Plans? Also referred to as Medigap. - correct answers.These policies are issued by private insurance companies and are designed to fill in some of the gaps in Medicare. Which Medicare Supplement Plan must be offered in all plans? - correct answers.Plan A must be offered by any insurer marketing Medigap plans, while plans B-N are optional. What is the purpose of Medicaid? - correct answers.This is a federal and state funded program for those whose income and resources are insufficient to meet the cost of necessary medical care. How does someone qualify for Social Security disability income benefits? - correct answers.In order to qualify, the individual must have the proper insured status, meet the definition of disabled, and satisfy the waiting period. How is someone determined to be totally disabled according to Social Security? - correct answers.This is when someone has the inability to engage in any gainful work