Accident and Health Insurance
Questions and Answers Latest Version
Already Passed
What does health insurance typically cover?
✔✔ Medical expenses related to illness, injury, and sometimes preventive care
What is the difference between a copayment and coinsurance?
✔✔ Copayment is a fixed fee per service, while coinsurance is a percentage of costs shared
Why might someone purchase disability income insurance?
✔✔ To replace lost income if they are unable to work due to illness or injury
What is a pre-existing condition in health insurance terms?
✔✔ A health issue that existed before the start of the insurance coverage
What does the term “elimination period” refer to in disability insurance?
✔✔ The waiting period before benefits begin after a disability occurs
1
,How does a high deductible health plan (HDHP) affect premium costs?
✔✔ It usually lowers premiums but increases out-of-pocket costs before coverage starts
What is the role of underwriting in accident and health insurance?
✔✔ To assess risk and decide eligibility and premium rates for applicants
What does a health maintenance organization (HMO) require from its members?
✔✔ To use a primary care physician and get referrals for specialist care within the network
What is meant by “group health insurance”?
✔✔ Insurance coverage provided to a group, often through an employer, rather than individually
How does long-term care insurance differ from standard health insurance?
✔✔ It covers services like nursing home care and home health aide, not routine medical
treatment
What is an insurance rider?
✔✔ A policy amendment that adds, removes, or modifies coverage terms
2
,Why is it important to disclose all health information when applying for health insurance?
✔✔ Because nondisclosure can lead to claim denial or policy cancellation
What does “out-of-pocket maximum” mean?
✔✔ The highest amount a policyholder must pay for covered services in a year before insurance
pays 100%
What does the “coordination of benefits” clause do?
✔✔ It prevents duplication of payments when insured has multiple health policies
What is the difference between temporary and permanent disability in insurance?
✔✔ Temporary disability is short-term inability to work, permanent disability is long-term or
lifelong
Why do some accident policies exclude injuries caused by war or self-inflicted harm?
✔✔ Because these risks are typically uninsurable or excluded by the insurer
3
, What is a premium?
✔✔ The amount paid by the insured for insurance coverage
What is meant by “renewability” in health insurance policies?
✔✔ The conditions under which a policy can be renewed or canceled by the insurer
What does a waiver of premium rider do?
✔✔ Allows premium payments to be waived if the insured becomes disabled
Why is catastrophic health insurance designed?
✔✔ To protect against very high medical costs due to severe illness or injury
What is a copayment in health insurance?
✔✔ A fixed fee paid by the insured at the time of receiving medical services
What is meant by the term “benefit period” in disability insurance?
✔✔ The length of time benefits will be paid after a disability begins
4
Questions and Answers Latest Version
Already Passed
What does health insurance typically cover?
✔✔ Medical expenses related to illness, injury, and sometimes preventive care
What is the difference between a copayment and coinsurance?
✔✔ Copayment is a fixed fee per service, while coinsurance is a percentage of costs shared
Why might someone purchase disability income insurance?
✔✔ To replace lost income if they are unable to work due to illness or injury
What is a pre-existing condition in health insurance terms?
✔✔ A health issue that existed before the start of the insurance coverage
What does the term “elimination period” refer to in disability insurance?
✔✔ The waiting period before benefits begin after a disability occurs
1
,How does a high deductible health plan (HDHP) affect premium costs?
✔✔ It usually lowers premiums but increases out-of-pocket costs before coverage starts
What is the role of underwriting in accident and health insurance?
✔✔ To assess risk and decide eligibility and premium rates for applicants
What does a health maintenance organization (HMO) require from its members?
✔✔ To use a primary care physician and get referrals for specialist care within the network
What is meant by “group health insurance”?
✔✔ Insurance coverage provided to a group, often through an employer, rather than individually
How does long-term care insurance differ from standard health insurance?
✔✔ It covers services like nursing home care and home health aide, not routine medical
treatment
What is an insurance rider?
✔✔ A policy amendment that adds, removes, or modifies coverage terms
2
,Why is it important to disclose all health information when applying for health insurance?
✔✔ Because nondisclosure can lead to claim denial or policy cancellation
What does “out-of-pocket maximum” mean?
✔✔ The highest amount a policyholder must pay for covered services in a year before insurance
pays 100%
What does the “coordination of benefits” clause do?
✔✔ It prevents duplication of payments when insured has multiple health policies
What is the difference between temporary and permanent disability in insurance?
✔✔ Temporary disability is short-term inability to work, permanent disability is long-term or
lifelong
Why do some accident policies exclude injuries caused by war or self-inflicted harm?
✔✔ Because these risks are typically uninsurable or excluded by the insurer
3
, What is a premium?
✔✔ The amount paid by the insured for insurance coverage
What is meant by “renewability” in health insurance policies?
✔✔ The conditions under which a policy can be renewed or canceled by the insurer
What does a waiver of premium rider do?
✔✔ Allows premium payments to be waived if the insured becomes disabled
Why is catastrophic health insurance designed?
✔✔ To protect against very high medical costs due to severe illness or injury
What is a copayment in health insurance?
✔✔ A fixed fee paid by the insured at the time of receiving medical services
What is meant by the term “benefit period” in disability insurance?
✔✔ The length of time benefits will be paid after a disability begins
4
