Colorado Health Insurance Exam| Questions and Verified Answers|100% Correct (2025/2026)

Colorado Health Insurance Exam| Questions and Verified Answers|100% Correct (2025/2026) $750,000 - ANSWER-The maximum penalty for a knowing violation of Unfair Trade Practices law is: .A small employer insurers must - ANSWER-Offer a basic and a standard health plan .An insured with a cognitive impairment has how many days to reinstate the LTC policy that was cancelled for nonpayment of premium? - ANSWER-90 days .Any substantial gainful activity - ANSWER-Social Security uses which definition to determine total disability? .Benefits Received - ANSWER-Benefits received under any medical expense and dental plan, regardless of the premium payer, are not taxable .Cancellable-PRP - ANSWER-A policy allowing the insurer to cancel the policy at any time with notice, 5 days, provided the insurer return all unearned premiums. .Certificate of Insurance and Summary of Benefits - ANSWER-A document provided to the individual employees of a group insurance contract. .Change of Beneficiary Provision-Mandatory Uniform - ANSWER-Stipulates that the policy owner may change the beneficiary at any time by providing a written request to the insurer, unless the beneficiary is designated as irrevocable. .Change of Occupation Provision-Optional - ANSWER-If Insured changes to: more hazardous job - benefits reduced; less hazardous job - premiums reduce. .claim forms provision-Mandatory Uniform - ANSWER-The insurer is required to send the insured a claim form within 15 days after notice is received .community rating - ANSWER-Determines premiums by examining the claims history of a particular geographic region .Concurrent review - ANSWER-Determines whether length of time and scope of inpatient stay is justified, to determine medical necessity .Conditionally Renewable-PRP - ANSWER-Renew unless insurer gives notice to not renew .Consideration Clause-other - ANSWER-Payments and promise .Continuation (COBRA) - ANSWER-Coverage may also continue for dependents up to 36 months if certain qualifying events happen :Death of employee :Divorce or legal separation :Empolyees entitlement to Medicare benefits :A child ages out of group plan as a dependent at age 26 .Continuation of Coverage COBRA - ANSWER-Act states that employers with 20 or more employees must provide health continuation coverage to all covered employees and dependents up to 18 months in event of :Termination of employee :Reduction of hours as they no longer qualify for full time :Coverage may continue up to 29 months if an employee(or dependent) is totally disabled .Contributory - ANSWER-A group insurance plan that requires the employees to pay part of the premium. Usually 75% of eligible employees .Conversion Privilege - ANSWER-Clause in a group insurance policy that allows the insured to continue the same or lesser coverage under an individual policy without proof of insurability, request to convert and payment of premium must be submitted within 31 day grace period. .Coordination of Benefits - ANSWER-Which provision in a health insurance plan is used to avoid overinsurance when a person is covered by more than one plan? .Coordination of benefits-other - ANSWER-A provision that determines the method of reimbursement when more than one insurer is responsible for the loss .cost containment (managed care provisions) - ANSWER-procedures used to control costs or expenses .Eligibility for Coverage - ANSWER-Minimum of 30 hour week, empolyer can not discriminate when determining eligibility and employee benefit .Elimination Period (Waiting Period)-other - ANSWER-A period of days (time) that must pass after the onset of an illness or occurrence of an accident before benefits will be payable. .Entire Contract Clause- Mandatory Uniform - ANSWER-Includes the policy and provisions, c a copy of the application and any riders, waivers, or endorsements .Experience Rating - ANSWER-Rating system that bases insurance rates on claims history .First dollar coverage-other - ANSWER-Provides that no out of pocket charges ( deductibles or co payments) will be paid by the insured before benefits are payable by the plan .Free Look Period = - ANSWER-Right to Examine is the same as .Free Look Provision( Right to Examine )-other - ANSWER-Generally 10 days after policy delivery to cancel policy w/ full refund, except 30 days for seniors or for replacement policies. .Grace Period-Mandatory Uniform - ANSWER-Period after premium due date before policy lapse, (7-10-31) 7 days for weekly premium; 10 days for a monthly premium; 31 days of every thing else .Guaranteed Insurability Rider - ANSWER-Optional rider that enables the policyowner to purchase additional amounts of coverage at predetermined times without proof of insurability. .Guaranteed Renewable means: - ANSWER-Renewable with adjustable premiums, by classification only .Guaranteed Renewable-PRP - ANSWER-A clause in an insurance policy that means the insurance company must renew the policy as long as premium payments are made. However, the premium may be increased when it is renewed. .If a policy is issued with a surcharge, this means that the policy - ANSWER-Policy was issued with a higher premium due to the increased risk. .Illegal Occupation-Optional - ANSWER-If the insured is connected with a felony or has an illegal occupation and incurs injury, the insurance company is not held responsible .Impairment Rider - ANSWER-Excludes coverage for a specific ailment or condition that otherwise would be covered (e.g., previous back injury) .Insured - ANSWER-Before a policy will be issued, an insurable interest must exist between the owner (applicant) and th .Insuring Clause-other - ANSWER-Appears on first page of contract has a summary of all the main points of the contract like the "promise to pay" death benefit .legal action - ANSWER-Insured must wait 60 days but no later than 3 years after proof of loss (POL) before legal action may be brought against the isurer .Mandatory Second Surgical Opinion - ANSWER-This requirement may be included in policies that offer surgical expense benefits, requiring the insured to consult a physician, other than the attending physician, to determine the necessity of surgery and/or alternate methods of treatment. If the insured should fail to obtain the second opinion, benefits are greatly reduced.