Colorado Health Insurance Exam| Questions and Verified Answers|100% Correct (2023/2025)

Colorado Health Insurance Exam| Questions and Verified Answers|100% Correct (2023/2025) 2 reasons for medical examination - ANSWER-Paramedical report or Attending physical statement (will require MIB report) .4 parts of Medicare - ANSWER-- Part A: Hospital insurance - Part B: medical insurance (e.g., doctor's fees, diagnostic testing) - Part C:Medicare advantage (Parts A+B) - Part D: Prescription drugs .Acceptability of Risk - ANSWER-is determined by checking individual risk from factors directly related to risk potential for loss. .Acceptance - ANSWER-takes place when an insurer's underwriter approves the application and issues a policy .Accidental bodily injury - ANSWER-Unplanned, unforeseen traumatic injury to the body. .Agent - ANSWER-Agents are the agents of the insurer .Aleatory exchange - ANSWER-unequal amounts or values and uneven exchange of values. .An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action? - ANSWER-the old policy should stay in force until the new policy is issued. .An agent makes a mistake on application and correct his mistake by physically entering necessary information who must then initial change? - ANSWER-Applicant .An agent makes a mistake on the application and the corrects his mistake by physically entering the necessary information . Who must then initial that change? - ANSWER-Applicant .An applicant for a health insurance policy returns a completed application to her agent, along with a check for the first premium. She receives a conditional receipt two weeks later. which of the following has the insurer done by this point? - ANSWER-neither approved the application nor issued the policy. .An application is. form completed by the agent as questions are asked of the applicant, responses are recorded. It then submitted to insurance company for approval or rejection. If policy is issued a copy of application will be stapled on the back of the policy. It then becomes apart of the? - ANSWER-Entire contract .An insured with medicare part d has reached the initial benefit limit and must now pay a portion of prescription drugs costs. What is the term for this gap in coverage? - ANSWER-The donut hole .Applicant - ANSWER-usually makes the offer when submitting the application. .Applicant must be aware of - ANSWER-sources being used and how all the information is gathered up. Due to fair credit reporting act. .Applicant or proposed insured - ANSWER-A person applying for insurance .Application process - ANSWER-Completeness and accuracy Signatures Changes in the application premiums with application submitting application to company for underwriting. .At what age do individuals qualify for Medicare? - ANSWER-age 65 .Attending Physical report - ANSWER-Under writer deems its necessary (APS) will be sent to applicant doctor to be completed. Best for accurate information on medical history. can explain what applicant was treated for treatment, recovery and outcome. .Basic Hospital Expense Coverage - ANSWER-Covers hospital room and board, and miscellaneous expenses, such as lab and x-ray charges and medicines while insured is confined to a hospital. .Basic medical expense coverage - ANSWER-Non surgical expense coverage. Limited to visits, and limited to number of stays in hospitals and doctor visits. appoints may be paid for no deductible with benefits. can be purchased to cover emergency benefits, maternity, mental. nervous disorder, hospice, home care, outpatient and nurse expense. .Basic Surgical Expense Coverage - ANSWER-Covers costs of surgeons' services, whether the surgery is performed in or out of the hospital .Before a consumes agent delivers his policy, insurers make last minute change to the policy. agent informs customer of this change and he accepts it? What must the agent do now? - ANSWER-Agent should ask customer to sign a statement acknowledging he is aware of change. .Benefit period - ANSWER-a period of tine during which benefits are paid under the policy .Breach of Warranty - ANSWER-can be considered grounds for voiding policy or a return of premium. .cafeteria plan - ANSWER-A selection of health care benefits from which an employee may choose the ones that he/she needs. .Cancellation - ANSWER-The termination of an in-force insurance policy by either the insured or the insurer prior to the expiration date shown in the policy. .Capitated Basis - ANSWER-The Hmo receives a flat amount each month attributed to each member prepaid medical .Changes in application requires - ANSWER-Ink, if mistake occurs use new app, if not practical draw a line through the incorrect answer. Applicant needs to be informed. .Completness and accuracy - ANSWER-Agent need to be accurate with interest of company and insured. Main source of under writing information. Agent responsible for application and correctly filled out. .Comprehensive coverage - ANSWER-health insurance that provides coverage for most types of medical expenses .Conditional Contract - ANSWER-Requires that certain conditions must be met by the policyowner and the company in order for the contract to be executed, and before each party fulfills its obligations. .Consent - ANSWER-permission to do something .Consideration - ANSWER-Is the value that each party gives each other. .Consumer Reports - ANSWER-Include written and/or oral information regarding a consumer's credit, character, reputation, or habits collected by a reporting agency from employment records, credit reports, and other public sources. .Contract of adhesion - ANSWER-prepared by one of the parties (insurer) and accepted or rejected by the other party (insured) .Contracts to be legally binding: - ANSWER-Agreement- Offer and acceptance Consideration Competent parties Legal Purpose .Conversion factor - ANSWER-Represents total amount payable per point .Copayments - ANSWER-A specific part of the cost of care or a flat dollar amount that must be paid by the member. .Corridor deductible - ANSWER-Once basic policy are exhausted insured must pay this before medical coverage will pay benefits. .cost sharing - ANSWER-Provision of a healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services; a cost-control mechanism. Deductible and coinsurance. .Deductible - ANSWER-A specific dollar amount that must be paid by the insured before a medical insurance plan or government program begins covering health care costs. .Enrollee - ANSWER-a person enrolled in a health insurance plan, an insured (doesn't include dependents of the insured) .Exclusions - ANSWER-War or military service self-inflicted injuries elective cosmetic conditions covered by workers comp conditions covered by government plans Participation in criminal activities and cremating crime/ shot .Explaining policy and its provision, riders elusions and ratings - ANSWER-Agent is responsible to provide insured with explanation of policy principal benefits and provisions. Policy is issued with any changes or adenments, agent require to explain changes and obtain insured signature acknowledge and amendments. .Fair Credit Reporting Act - ANSWER-Regulate consumer reports. Act that protects privacy of background information and ensures that information supplied is accurate. Law used to protect consumers. .Federal Credit Reporting Act - ANSWER-Regulates consumer reports .First dollar coverage - ANSWER-doesn't require insured to pay a deductible .General enrollment period - ANSWER-between January 1st and March 31st each year .Health Maintenance Act 1973 - ANSWER-federal legislation that provided incentives for the formation of health maintenance organizations. Forced employers with more than 25 employees to offer HMO main cost to lower cost of health care. .HIPPA Privacy - ANSWER-Individually insatiable health information, held or transmitted by covered entity to business associate, any form or media, rather electric, paper or oral. Protected health information. .HMO - ANSWER-health maintenance organization .HMO - ANSWER-Provide forms of services. provides both financing and patient care for its members. .Home Health Care - ANSWER-Provides nursing, therapy, personal care, or housekeeping services in patient's own home .Hospice care - ANSWER-treatment of the terminally ill in their own homes, or in special hospital units or other facilities, with the goal of helping them to die comfortably, without pain