The tendency of persons with above average risk to acquire insurance at a greater extent than those with average or below average risk is defined as:
A. adverse selection
insurance is a method of risk_________?
C. transfer
if you retain risk, you are:
A. self-insured
this law is the basis for statistical prediction of loss upon which rates for insurance are calculated
C. law of large numbers
mutual companies are owned by their
B. policyholders
this is a method of distributing insurance products to the public by using salaried employees rather than commissioned agents...
C. direct writers
a policy that pays dividends is known as a ______ policy.
A. participating
an insurance company that is licensed in the state in which it operates is called a/an _______ insurer
C. admitted
a(n) _______ insurer is one that is incorporated and domiciled outside the United States
C. alien
these producers typically represent only one insurance company.
D. captive agents
these insurers are organized for the benefit of a society's members and their families.
B. fraternal benefit societies
which of the following is not a rating company used by the insurance industry?
D. SIPC
an applicant for life insurance cannot generally bargain for terms, rates, or benefits because the nature of the contract is.
A. adhesive
which of the following terms means that an insurance contract is dependent on chance or uncertain outcome?
A. aleatory
statements which are guaranteed to be true are
C. warranties
statements which are deemed to be untrue are _________
A. misrepresentations
offer and acceptance, legal purpose, competent parties and ________ are all essential requirements of a legal contract
C. consideration
the authority granted to a producer by contract to enable him or her to act as an agent is called
A. express authority
contracts wherein only one party is mandated to perform are called ________ contracts.
D. unilateral
________ is the term that describes the intentional giving up of a knowing right.
B. waiver
the primary source of insurance regulation is the :
A. state goverment
what did the McCarran-Ferguson Act of 1945 do?
it reaffirmed the primary role of states in regulating the insurance industry
what is the primary role of the NAIC?
a. to act as a forum for the development of uniform policy when uniformity is appropriate
b. to enforce insurance laws in each state
c. to renew, approve or deny insurer rate or premium requests.
A. to act as a forum for the development of uniform policy when uniformity is appropiated
an agent is a representative of:
A. the insurance company
a health insurance policy that pays a specified amount for covered surgical expenses is called:
C. schedule basis
principal types of losses covered by accident and health insurance include all of the following except:
C. medicaid
all of the following policies are defined as limited policies except:
A. HMO
the amount paid by and AD&D policy for the accidental dismemberment of a finger is called:
B. capital sum
a policy that only pays for losses that occur due to disease specified in the policy is called:
A. specified disease
an insurance underwriter's primary job is to:
D. protect the insurer from adverse selection
all of the following are producer's responsibilities at the time a policy is delivered EXCEPT:
A. provide copies of medical records obtained by the insurer
the effective date of an accident and health policy is:
B. the date specified in the policy
which of the following are considerations in replacing an accident and health polity?
D. all of the above
a producer's responsibilities include all of the following, EXCEPT:
B. guaranteeing a policy is issued
an insurer must furnish claim forms to an insured within how many days of receiving a notice of claim?
B. 15
all of the following are uniform mandatory provisions, EXCEPT:
C. change of occupation
the police provision that provides an insured a specified amount of time to pay the premium after being billed is called:
C. grace period
all of the following are uniform optional provisions, EXCEPT:
C. change of beneficiary
the reinstatement provision states that a policy is automatically reinstated if the insurer does not issue a decision after:
D. 45 days
the insuring clause of a policy describes:
C. the conditions necessary for benefits to be paid
a policy in which an insurer cannot cancel coverage or change the premium is called:
B. noncancellable
this provision describes who will receive payment for claims made if the insured dies:
C. payment of claims provision
the provision that allow an insured a period of time to study a policy that was just delivered is called:
D. right to examine ( free look )
an insured can bring legal action against an insurer after how many days form the filing of a proof of loss?
D. 60 days
the most restrictive definition of total disability is:
A. any occupation
a disability policy provision that allows a person to receive disability benefits for the entire benefit period, even if that person can earn an income is:
A. presumptive disabiity
the time frame selected by an insured during which otherwise payable disability income benefits would not be paid is called:
D. elimination period
a person that would like to receive benefit payments for a partial disability would purchase this rider
A. residual disability rider
a rider that allows an insured to increase his disability income coverage periodically without regard to changes in the insured's health is called:
B. future increase option rider
the unique aspects of underwriting a disability policy is include all of the following, EXCEPT:
D. beneficiary designations
all of the following are necessary for an individual to receive full disability benefits, EXCEPT:
B. completion of the benefit period
features of group disability insurance include:
A. no individual underwriting
a disability income policy that promises to pay a sole proprietor a monthly benefit to cover the fixed expenses of running his business is called:
A. business overhead expense insurance
a policy designed to fund the purchase of a departing partner's share of business is called:
A. disability buy/sell insurance
the shorter the elimination period
B. the higher the premium
group disability income benefits may be reduced by:
A. workers compensation benefits and social security disability income benefits
a medical plan that provides low maximum limits of coverage is called:
C. basic medical
major medical plan characteristics include all of the following, except:
D. limited access to providers
which of the following plans would be considered managed care?
D. all of the above
a medical plan that combines basic medical expense coverage and major medical expense coverage in one policy is called:
B. supplemental major medical
common limitations of major medical insurance include all of the following, EXCEPT:
d skilled nursing facility care
B. custodial care
the expenses that must be paid by an insured before major medical insurance pays is called:
A. deductible
a closed panel HMO is one that:
D. limits the numbers of providers it will place under contract
all of the following are characteristics of HMOs, except:
A. they only pay for medical necessary treatment for illness or injury
the point of service part of an HMO/POS contract :
D. none of the above
managed care plans use the following practices to control costs:
D. all of the above
a concurrent review is used by insurers to:
D. adjust ongoing care to appropriate leves
The federal law that allows employees covered under a group plan to be guaranteed coverage under another group plan if the employee change jobs is called:
A. Hipaa
A waiver for pre-existing conditions is now limited to :
B. 12 months
A special type of saving account established under HIPAA to encourage the use of high deductible medical plans is called:
D. MSA
HSAs can be used to pay for the following medical expenses:
D. all of the above
a plan that allows either the employer or the employee to make a tax deductible contribution to a special account is called:
A. HSA
which of the following is NOT considered a natural group?
A. members of a block association
once an employee completes the probationary period, the employee can enroll in the company's group benefit plan without underwriting:
D. during the open enrollment period
all of the following are group characteristics, EXCEPT:
D. individual policies for all enrollees
if a group plan sponsor sets up a contributory plan, what percentage of eligible employees are required to participate?
B. 75%
a federal law created to protect employee pensions is called:
C. ERISA
the federal law that mandates that Medicare be secondary to group medical insurance for groups with more than 20 employees is called;
B. TEFRA
a condition that would be suitable for a self-funded medical plan is:
D. an employer has operations in several states
under ADEA, it is illegal for employers to:
B. discriminate against employees age 40 or older
an employee can be disqualified for COBRA benefits if:
D. the employer does not pay premiums in a timely manner
an arrangement designed to limit an employer's exposure if employee medical claims become very high is called:
C. stop loss coverage
an individual that loses group coverage can convert to an individual medical insurance plan without evidence of insurability within:
B. 31 days
in order for an illness to qualify for worker's compensation, it must:
C. be due to conditions peculiar to the job
the four basic benefits of worker's compensation include all of the following, EXCEPT:
D. disability income benefits of 50% of the disabled employee's salary
to qualify for social security disability income benefits, a person must be:
C. fully insured
medicare part A covers all of the following, EXCEPT:
C. custodial care
a person can qualify for medicare part A:
A. by suffering from end stage renal disease
medicare part A pays for the first 60 days in hospital:
B. after the insured pays the Part A deductible
medicare is financed by:
C. payroll taxes paid equally by the employer and the employee
the federal law that allows employees covered under a group plan to be guaranteed coverage under another group plan if the employee changes job is called:
B. HIPAA
a waiver for pre-existing conditions is not limited to :
B. 12 months
a special type of savings account established under HIPAA to encourage the use of high deductible plans is called:
B. MSA
HSAs can be used to pay for the following medical expenses:
D. all of the above
a plan that allows either the employer or the employee to make a tax deductible contribution to a special account is called:
D. HSA
which of the following is NOT considered a natural group?
B. members of a block association
once a employee completes the probationary period, the employee can enroll in the company's group benefit plan without underwriting:
D. during the open enrollment period
all of the following are group characteristics, EXCEPT:
C. individual policies for all enrollees
if a group plan sponsor sets up a contributory plan, what percentage of eligible employees are required to participate?
B. 75%
a federal law created to protect employee pensions is called:
B. ERISA
the federal that mandates that Medicare be secondary to group medical insurance for groups with more than 20 employees is called;
D. TEFRA
a condition that would be suitable for a self-funded medical plan is :
C. an employer has operations in several states
under ADEA, it is illegal for employers to:
C. discriminate against employees age 40 or older
an employee can be disqualified for COBRA benefits if:
D. the employee does not pay premiums in a timely manner
an arrangement designed to limit an employer's exposure if employee medical claims become very high is called:
B. stop loss coverage
an individual that loses group coverage can convert to an individual insurance plan without evidence of insurability within:
A. 31 days
in order for an illness to qualify for worker's compensation, it must be:
D. be due to conditions peculiar to the job
the four basic benefits of Worker's compensation include all of the following, EXCEPT:
A. disability income benefits of 50% of the disabled employee's salary
to qualify for social security disability income benefits, a person must be:
A. fully insured
medicare part A covers all of the following, EXCEPT:
D. custodial care
a person can qualify for Medicare part A:
C. by suffering from end stage renal disease
medicare part A pays for the first 60 days in a hospital:
A. after the insured pays the Part A deductible
medicare is financed by :
B. the payroll taxes paid equally by the employer and the employee
skilled nursing facility care is paid for by Medicare:
C. in full for the first 20 days
the medicare part B deductible is:
C. per calendar year
all of the following are exclusions under medicare part A and part B, EXCEPT:
D. flu shots
a medicare plan that requires the insured to utilize a provider in an HMO is called:
A. medicare part C
under federal law, how many standardized medicare supplement plans are there?
C. 12
enrollment for medicare part B is handled by:
B. the social security administration
medicare part B covers all of the following, EXCEPT:
A. skilled nursing facility
according to the 2000 census, the fastest growing segment of our population is the cohort ages:
C. 65 and above
the average cost for a stay in a private room in a nursing home, nationally, in 2005 was:
D. over $200 per day
which type of care is the most provided long-term care in the US?
A. custodial care
a LTCI policy that is tax qualified is one that:
C. meets the standards of health insurance set forth by the IRS and HIPAA
all of the following are activities of daily living (ADLs), EXCEPT:
C. taking medications
LTCI policies my pay for long term care in all of the following settings, EXCEPT:
A. VA hospital
a benefit in tax qualified LTCI policies that provides short term care to give temporary relief to an unpaid care giver is called:
B. respite care
Tom and Mary, ages 54 and 52, want to purchase a long term care insurance policy with the strongest inflation protection. They should purchase which inflation option?
C. 5% compound
a period selected by the applicant made up of the number of dates of service that would otherwise be covered by the policy if it were not for this period is called:
C. the elimination period
an employer with 500 employees wants to offer LTCI
D. periodic issue
a federal law that requires states to recover funds spent by medicaid on long term is called:
B. OBRA 93
Author
zacariasripollcid
ID
198141
Card Set
Accident and Health Insurance Questions From Pohs Textbook
Description
This are the questions from posh institute textbook
