Wisconsin Health and Accident Insurance Course Questions with Complete Correct Answers | Grade A+

Accidental Death and Dismemberment Insurance Ans: provides a beneficiary with a lump sum death benefit in the event of accidental death and will pay a living benefit to for a dismemberment Renewability Provisions Ans: define the rights of the insurer to cancel the policy at different points during the life of the policy. The more advantages the renewability provisions the more expensive the coverage There are five principal renewability classifications -cancellable -optionally renewable -conditionally renewable -guaranteed renewable -noncancellable. Premium Factors Ans: -interest -expenses -Types of benefits -Morbidity -Age -Sex -occupation Business Overhead Expense Insurance Ans: is sold to small business owners who must continue to meet overhead expenses such as rent, utilities and payroll -reimburses business owners for the actual overhead expenses incurred while the business owner is totally disabled -does not reimburse business owner for salary Disability Buyouts Ans: just as the life insurance buy sell agreement, the disability buy out agreement specifies who will purchase a disabled partner's interest and legally obligates that person or party to purchase the business interest of the disabled partner Eligible Groups Ans: To qualify for a group health insurance, applicants must be a part of a group formed for a reason other than just obtaining health insurance Contributory Ans: with this plan both the employees and employer pay part of the premiums and 75% of all eligible employees must participate Noncontributory Ans: the employer pays the entire premium and 100% of the employees must participate Conversion Privileges Ans: members of a group have the ability to convert their policy to an individual plan Pre-existing conditions Ans: An individual may be excluded from group coverage for up to a year for any conditions in which the individual sought treatment 6 months prior to the enrollment date Coordination of Benefits Ans: -avoid duplication of benefit payments and over insurance when an individual is covered under more than one group health plan -limits the total amount of claims paid from all insurers covering the patient to no more than the total allowable medical expenses. -it establishes which plan is the primary plan, or the plan that is responsible for providing the full benefit amounts -in no case will the total amount the insured receives exceed the medical expenses Maternity Benefits Ans: -any policy of health insurance that provides coverage for maternity care must also cover the services of certified nurse-midwives, and services of licensed birth centers -the insurance company cannot limit the length of stay for maternity or newborns that are less than medically necessar