Health Insurance certification Study guides, Class notes & Summaries

The stated amount or percent of liquid assets that an insurer must have on hand that will satisfy future obligations to its policyholders is called: Reserves An insurance applicant MUST be informed of an investigation regarding his/her reputation and character according to the: Fair Credit Reporting Act A nonprofit incorporated society that does not have capital stock and operates for the sole benefit of its members is known as: A fraternal benefit society What I the name...

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as Usual, customary and reasonable What provision would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner? Payment of Claims All of the following are true about gr...

Nursing home care act became effective in - 1980 State agency that enforced nursing home care act - Public health Annual license renewal for skilled and intermediate care facilities - 6 to 18 months To qualify for two year license must have - An average occupancy rate of 90% or more for previous 24 months Two year license can be issued and renewed - 18 to 30 months Term Intermediate care facility can use in their title - Nursing home Skilled and intermediate care facilities code a...

Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs? Metal level classification. Other than conditions stipulated by the Director, what is a permissible reason for an HMO to cancel or not renew an enrollee's contract? Failure to pay monthly premiums. According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan? 60% Which of the following offers limited health care plans, in which som...

What are the four elements of an insurance contract? - 1. agreement- offer and acceptance 2. consideration 3. competent parties 4. legal purpose What does representation mean and how does it differ from a warranty? - representations are statements believed to be true to the best of one's knowledge. A warranty is an absolutely true statement upon which the validity of the insurance policy depends How can an insurance company use the information it obtains from the MIB? - it can use M...

First Dollar coverage - -basic medical insurance -no deductible Basic hospital expense - -policy states that the max daily room and board benefit is $500 per day for 30 days. -surgery not covered Usual Customary and reasonable (UCR) - -insurer calculates by averaging the cost of a specific surgery in a defined geographic area. -if actual charge is more, policyowner pays the difference Major medical expense plan - -designed to provide broad coverage under one policy -low benefit limit...

How is the binder deposit shown on the Closing Disclosure Form? - >>credit to the buyer what is the status of a sales associates license if he does not complete the required post licensing education prior to his first renewal section? - >>null and void Mortagee - >>lender when you sell or transfers - >>due on sale 2 mortgage clauses - >>due on sale clause, acceleration clause acceleration clause - >>the buyer defaulted government insured loan - >&gt...

Agent/Producer - ANSWERS-A legal representative of an insurance company Broker - ANSWERS-An insurance producer not appointed by an insurer and whom represents the client Insured - ANSWERS-A person covered by an insurance policy Insurance policy - ANSWERS-A legal contract between a policyowner (and/or insured) and an insurance company which agrees to pay the insured/beneficiary for losses caused by specific events Principal - ANSWERS-Insurer, company who issues insurance policies Policyow...

Agent/Producer - ANSWERS-A legal representative of an insurance company Broker - ANSWERS-An insurance producer not appointed by an insurer and whom represents the client Insured - ANSWERS-A person covered by an insurance policy Insurance policy - ANSWERS-A legal contract between a policyowner (and/or insured) and an insurance company which agrees to pay the insured/beneficiary for losses caused by specific events Principal - ANSWERS-Insurer, company who issues insurance policies Policyow...

When can a policy owner change a revocable beneficiary? - CORRECT ANSWER Anytime M purchased an Accidental Death and Dismemberment (AD&D) policy and named his son as beneficiary. M has the right to change the beneficiary designation at anytime. What type of beneficiary is his son? - CORRECT ANSWER Revocable How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment (AD&D) policy? - CORRECT ANSWER If the primary beneficiary dies before the...

Final Exam: California Life, Accident, and Health Insurance 2023 with complete solution 1. What is considered the most common type of specified disease insurance policy?: Cancer 2. Minimum participation standards exist for a group health insurance plans in order to: Prevent Adverse Selection 3. How does underwriting differ between group life and individual life insur- ance?: Medical questions must be answered on individual life insurance 4. when handling premiums for an insured an agent is actin...

What is meant by referring to an insurance policy as a uliteral contract? - Only one party makes a legally enforceable promise When must insurance records of insurance agents and brokers be made available to the insurance commissioner? - At all times Any situation that presents the possibility of a loss is known as... - A loss exposure Which of the following information is not required to be communicated with a life insurance contract? - Personal judgment Directed ration of insurance util...