Xcel Final Exam | 243 Questions and Answers(A+ Solution guide)

Typically, Long-Term Disability benefits are coordinated with which benefit plan? - Social Security The focus of major medical insurance is providing coverage for - medical and hospitalization expenses An insured under a Major Medical expense plan with a zero deductible and 80/20 coinsurance provision files a $1,000 claim. How much of this claim is the insured responsible for? - $200 because this policy has a zero deductible, the insures is only responsible for the 20% coinsurance on this claim, or $200 An insured has a stop-loss limit of $5,000 and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured pay? - $5,000 Which type of plan would be the most appropriate for an individual on Medicare and concerned that Medicare will NOT pay for charges exceeding the approved amount? - Medicare supplement Plan F When can a group health policy renewal be denied according to the Health Insurance Portability and Accountability Act (HIPAA)? - when contribution or participation rules have been violated What does the word "level: in Level Term describe? - the face amount A non-contributory health insurance plan helps the insurer avoid - adverse selection because all eligible employees are usually covered, non-contributory plans are desirable from an underwriting standpoint because adverse selection is minimized.To qualify for a resident producer license in the state of Michigan, an individual - must complete the required pre-licensing education within 12 months of license application Under an expense-incurred individual health policy, what is the MAXIMUM length of time after issuance of the policy that an insurer can exclude coverage for a pre-existing condition? - 12 months pre-existing conditions may be excluded for a maximum of 12 months from the date of enrollment. An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a - benefit schedule benefits schedule set predetermined limits or maximums on how much money and insured can be reimbursed for a covered loss. Who is the individual paid on a fee-for-service basis? - Provider Which of the following is NOT an illegal inducement? - Giving the insured an article of merchandise printed with the producer's name costing $5 $5 or less of tokens or merchandise to applicants is allowed. Making a statement that is false or maliciously critical of the financial condition of an insurer is known as - defamation Which of the following is NOT a required provision in an accident and health insurance policy? - change of occupation the change of occupation provision is considered an OPTIONAL provision Which of these statements about Medicaid is CORRECT? - Funded by federal, sate, and local taxesMedicaid is funded by federal, state, and local taxes but is administered by each state. All of these are considered key factors in underwriting life insurance EXCEPT - Marital Status Correct: tobacco use, health history, age The time limit for filing claim disputes is addressed in which provision of an accident and health policy? - legal actions All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT - Health reimbursement Arrangement plan