Kevin and Nancy decide to legally separate, which means that Nancy will no longer be eligible for health insurance coverage under Kevin. Introducing Cram Folders! Although he is still receiving benefits from his disability income policy, he does not have to pay premiums. -producer -insurer's executive officer -department of insurance -broker, insurer's executive officer (the insurer must have the insured's written agreement to the change) U3, What is the purpose of coinsurance provisions? The second kind of catastrophic risk involves any unpredictably large loss of value not anticipated by either the insurer or the policyholder. The insurable risk needs to be statistically predictable An insurance risk must involve a loss that is definite as to cause, time, place and amount. In fact, the agent has no such power.). This is called: -prospective review -comprehensive review -schedule monitoring -concurrent review, concurrent review (under the concurrent review process, the insurance company will monitor the insureds hospital stay to make sure that everything is proceeding according to schedule and that the insured will be released from the hospital as planned) U5, What term is used to describe when the medical caregiver provides services to only members or subscribers of a health organization, and contractually is not allowed to treat other patients? (All insurers (domestic, foreign, or alien) must obtain a Certificate of Authority before transacting insurance within a given state. Insurance is a contract by which one seeks to protect another from (Insurance will protect a person, business or entity from loss.). Which of the following options best depicts how the eligibility of members for group health insurance is determined? 1. The HIH Casualty & General Insurance Ltd. v. New Hampshire Insurance Co. and Ors case is a good example illustrating the problems that can arise when the pa Purchasing car insurance is costly. A. -Business Loss -Business Disability -Individual Disability -Management Loss, Which of the following is an eligibility requirement for all Social Security Disability Income benefits? When an applicant is applying for an insurance contract, the statements he or she makes are generally not warranties, but representation. 1.Legal 2. Granting insurance must not be mandatory, selecting insureds randomly will help the insurer to have a fair proportion of good risks to poor risks. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. An applicant for health insurance has not had a medical claim in 5 years. 1 Although this classification is somewhat subjective, surely imperfect, and to some extent artificialthere is a richer spectrum of empirical approaches that could be broken down to many more than two categoriesthis simple classification is . -the insurable risk needs to be statistically predictable -an insurable risk must involve a loss that is definite as to cause, time, place & amount -insureds cannot be randomly selected -insurance cannot be mandatory. -closed panel -corridor -probationary -open panel, Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage? Which statement regarding insurable risks is NOT correct? Acceptance 4. Reinsurance Assumed, Life Insurance: What It Is, How It Works, and How To Buy a Policy. -insuring clause -cancellation provision -renewal provision -policy duration provision, renewal provision (renewability provisions are included in each health insurance contract and outlines both the insurers and insureds right to cancel or renew coverage. When she is not wearing the ring, she keeps it in a safe deposit box at a local bank, This is an example of risk. when losses experienced by an industry exceed a specified threshold. -18 months -2 years -6 months -1 year, Which of the following is considered a presumptive disability under a disability income policy? -low risk -standard -superior -preferred, Which of the following do the Standard & Preferred risk categories share? In exchange for this limitation, the insured is offered a lower premium. This is an example of: All of the following actions by a person could be described as risk avoidance EXCEPT (Investing in the stock market is not an example of risk avoidance; it creates the possibility of a loss.). Applicants who smoke cigarettes are approved on a preferred basis. The growing tendency of individuals to file lawsuits and to claim tremendous amounts of alleged damages is known as, Not all losses are insurable, and there are certain requirements that must be met before a risk is a proper subject for insurance. Insurance companies require policyholders to submit proof of loss (often via bills) before they will agree to pay for damages. We weren't able to detect the audio language on your flashcards. What is the major difference between a Stock Company and a Mutual Company? All insurance schemes operate based on the law of large numbers. Cram has partnered with the National Tutoring Association, Risky Management: Homeland Security And Homeland Defense, Advantages And Limitations Of The Reinsurance Contract. -Disability Income -Major Medical -Dental Expense -Basic Medical Expense, Insurance that would pay for hiring a replacement for an important employee who becomes disabled is called: -Key employee disability insurance -Blanket disability insurance -Long-term disability -Business overhead expense disability insurance, What percentage of individually-owned disability income benefits is taxable? -have permanent kidney failure -be at least age 50 -have attained fully insured status -be disabled for at least 1 year, have attained fully insured status (although Social Security offers many benefits, such as retirement, survivors and Medicare, only those who have attained fully insured status are eligible for Disability Income benefits. A. Home health care might include physical therapy and some custodial care such as meal preparations) U7, How many pints of blood will be paid for by Medicare Supplement core benefits? C. Offering additional coverage to his client. -cost reduction -claims reduction -claims discrimination -case management provision, case management provision (cost-saving services, also known as case management provisions, include the following: controlled access of providers, large claim management, preventive care, hospitalization alternatives, second surgical opinions, preadmission testing, catastrophic case management, risk sharing, and providing high quality of care) U5, Which of the following is true regarding inpatient hospital care for HMO members? -age is the only requirement; upon reaching age 65, LTC benefits are available -the insured must be unable to perform some activities of daily living -the insured must meet certain economic standards -he insured must have been receiving disability benefits for 6 months, the insured must be unable to perform some activities of daily living U7, OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage? -if paid by the individual, the premiums are tax deductible -if the employer paid the premiums, income benefits are taxable to the insured as ordinary income -if the insured paid the premiums, any disability income benefits are tax-free -if the benefits are for a permanent loss, the benefits paid to the employee are not taxable, if the employer paid the premiums, income benefits are taxable to the insured as ordinary income (if an individual purchases his or her own disability insurance with before-tax dollars, any benefits paid are tax free, but the premium is not tax deductible. -20 -50 -100 -15, In long-term care (LTC) policies, as the benefit period lengthens, the premium -LTC premiums are not based on benefit periods -decreases -increases -remains unchanged, What type of health insurance policy provides an employer with funds to train a replacement if a valued employee becomes disabled? Which of the following is NOT the consideration in a policy? For an insurance company, catastrophic risk is simply any severe loss deemed too expensive, pervasive, or unpredictable for the insurance company to reasonably cover. This law states there must be a sufficient large number of homogeneous exposures to any specific event in order to make a reasonable prediction about the loss related to an event. -disability insurance for the owner -cash to the owner's business partner to accomplish a buyout -the rent money for the building -the business manager's salary, cash to the owner's business partner to accomplish a buyout U4, An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. General Insurance Exam Simulator Flashcards - Cram.com Which Statement Regarding Insurable Risks Is Not Correct. This is a method where the reinsurer indemnifies the ceding insurer for part or all of the losses it sustains related to a policy issued previously.). Any benefits paid to an employee are taxable, unless it is for the permanent loss of a body part, or loss of use of a body part) U8, Which of the following statements is correct concerning taxation of long-term care insurance? Insurance 2-15 Flashcards | Quizlet However, in these instances, no plan will be required to pay more than its policy limits) U6, What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged? All of the following statements are true regarding fire department service charge additional coverage under the businessowners policy EXCEPT: -10 days -30 days -60 days -90 days, 30 days (if plans cannot agree on the order of benefits within 30 days of the receipt of all necessary claim information, these plans will immediately pay the claim in equal shares. -medical expenses associated with a disability -income lost by the insured's inability to work -rehabilitation costs -copayment, -income lost by the insured's inability to work U2, Most policies will pay the accident death benefits as long as the death is caused by the accident & occurs within: -30 days -60 days -90 days -120 days, Which of the following statements regarding conditional receipts is true? Catastrophe reinsurance protects catastrophe insurers from financial ruin in the event of a large-scale natural or human-made disaster. -apply for social security benefits -apply for coverage under the same group policy that covers Kevin -convert to an individual insurance policy within 31 days so she won't have to provide evidence of insurability -COBRA, COBRA (dependents of employees are eligible to receive group health insurance under the employees plan. -race -age -medical history -sex, What is the minimum grace period required in health insurance policies in this state? Chapter 1- General Insurance Flashcards | Quizlet C. The application given to a prospective insured. D. It is the period of time during which the annuitant makes premium payments into the annuity. This is best for Nancy, since she has endured a long-term illness. -assumed -express -implied -apparent, implied (not written in agent's contract but is required in order for the agent to conduct business) U1, Because an agent is using stationery with the logo of an insurance company, applicants for insurance assume that the agent is authorized to transact on behalf of that insurer. The premium amount paid at the time of application. The Business Model of Reinsurance Companies, Deducting Disaster: Casualty And Theft Losses. -if a person receives disability benefits, he or she is eligible for credits on their group policies for future disabilities -a person receiving disability benefits cannot receive a credit disability policy -if an insured has filed bankruptcy & his premiums are waived, he can be issued a credit disability policy -if an individual is in debt to a specific creditor, payments will be made for him/her until the return to work, if an individual is in debt to a specific creditor, payments will be made for him/her until the return to work U2, Which of the following groups would most likely be covered under a blanket accident policy? B. COMING UP: 7 AM ET - Wake Up America 9 AM ET -. Insurance cannot be mandatory. -pap smear -annual physical exam -mammogram -chemotherapy, On a major medical insurance policy, the amount that an insured must pay on a claim before the insurer will pay is known as: -deductible -copayment -inside limit -coinsurance, In order to be eligible for group health insurance, all of these are conditions an employee must meet EXCEPT: -must have dependents -must be working in a covered classification -must be actively at work -must be a full-time employee, Which of the following is considered a qualifying event under COBRA? -the cost the company is paying for monthly premiums -the policy benefits and exclusions -the procedures for filing a claim -the length of coverage, the cost the company is paying for monthly premiums U6, Which statement best defines a Multiple Employer Welfare Arrangement (MEWA)? Consideration This compensation may impact how and where listings appear. A) Insurance cannot be mandatory. -coverage is not renewable beyond the insured's age 65 -the insured's benefits cannot be reduced -the insurer can increase the policy premium on an individual basis -the insured has a unilateral right to renew the policy for the life of the contract, the insurer can increase the policy premium on an individual basis (guaranteed renewable provision has all the same features that the noncancellable provision does, with the exception that the insurer can increase the policy premium on the policy anniversary date. Which kind of insurance will protect the business? -application -policy request -insurance request form -request for insurance, In which of the following situations is it illegal for an insurer to disclose privileged information about an insured? -decrease -increase -remain the same -either increase or decrease, Which of the following is NOT a cost-saving service in a medical plan? If the employee and the dependent become legally separated or divorced, or if the employee dies, the dependent will be eligible for COBRA benefits for up to 36 months. What describes a situation when poor risks are balanced with preferred risks, and average risks are in the middle? All of the following actions are examples of risk avoidance EXCEPT. -100% -75% -50% -25%, Who is the beneficiary in a credit health policy? How soon after this surrender can her license be reinstated? What is the term for the entity that an agent represents regarding contractual agreements with third parties? The insurable risk needs to be statistically predictable B. -no tax -tax deductible -state income tax -federal income tax, no tax (daily benefits from the LTC policy are received income tax free, as long as they do not exceed the daily cost of long-term care) U8, The benefits received by the business in a Disability Buy-Sell policy are: -income tax free -tax deductible -partially taxable -fully taxable, Which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner? If a court ordered payment for a loss that was not covered in the policy even if it was clearly worded, it would be an example of which legal concept? The amount of benefits that an insured receives is determined by the insured's earned income & is usually limited to a certain percentage of that amount) U2, What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided? What type of license should the producer obtain? In return, the insured pays lower premium amounts) U7, All of the following statements about Medicare supplement insurance policies are correct EXCEPT: -they cover Medicare deductibles and copayments -they supplement Medicare benefits -they are issued by private insurers -they cover the cost of extended nursing home care, they cover the cost of extended nursing home care U7, An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. D. Promptly forwarding premiums to the insurance company. Standard insurance does not guard against catastrophic perils. The insurer must be able to rely on the statements in the application, and the insured must be able to rely on the insurer to pay valid claims. The insurable risk needs to be statistically predictable. -residential care -assisted living -home health care -adult day care, What is necessary in order to be eligible to receive benefits from a long-term care policy? Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Please select the correct language below. If an employer pays the premium, the employer may deduct the premium as a business expense. -they have to be reevaluated -coinsurance carries over, but deductibles are generally higher -deductibles carry over, but coinsurance is generally higher -they carry over from the old plan to the new plan, they carry over from the old plan to the new plan U6, What type of information is NOT included in a certificate of insurance? 2003-2023 Chegg Inc. All rights reserved. -Medicare -Blue Cross -Blue Shield -Medicaid, Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care? -revocation of license -$2,500 -$1,000 -$100 per violation, $2500 (an individual who willfully violates this Act enough to constitute a general pattern or business practice will be subject to a penalty of up to $2,500) U9, For how many years must an insurance producer be licensed prior to adding surplus lines to their repertoire? -an individual who was previously covered by group health insurance for 6 months is eligible -an individual who has used up COBRA continuation coverage is eligible -an individual who doesn't qualify for Medicare may be eligible -the gap of coverage for eligibility is a period of 63 days or less, an individual who was previously covered by group health insurance for 6 months is eligible (HIPAA requires that the individual have a previous continuous creditable health coverage for at least 18 months) U5, A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called: -reimbursement plan -fee-for-service plan -prepaid plan -indemnity plan. -guaranteed renewable -optionally renewable -conditionally renewable -cancellable, Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within: -60 days of a loss -90 days of a loss -20 days of a loss -30 days of a loss, Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to: -beneficiary of the death benefit -the spouse of the insured -the insured -creditors, While a claim is pending, an insurance company may require: -the insured to be examined only once annually -an independent examination only once every 45 days -an independent examination as often as reasonably required -the insured to be examined only within the first 30 days, an independent examination as often as reasonably required U3, Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is: -within 45 days -weekly -biweekly -monthly, In an optionally renewable policy, the insurer has which of the following options? Insurers are required to file a statement with the Superintendent. Which statement regarding insurable risk is not correct? -only post-hospitalization benefits -full benefits -partial benefits -no benefits, Under the Physical Exam & Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending? In forming of an insurance contract, this is referred to as (The insurer must be able to rely on the statements given by the insured in the application. Contributing to Social Security for 40 quarters (10 years) attains fully insured status) U4, All of the following are requirements of eligibility for Social Security disability income benefits EXCEPT: -fully insured status -waiting period of 5 months -being age 65 -inability to perform any gainful work, A man's physician submits claim information to his insurer before she actually performs a medical procedure on him. Chapter 1 Flashcards by Antonio Abarca | Brainscape -24-hour care -relief for a major care giver -daily medical care, given by medical personnel -institutional care, Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis? If the extent of the loss cannot be calculated or cannot be fully identified, then it is not insured. Hazard insurance is a term sometimes used to describe the coverages in a standard homeowners insurance policy. A) The Guaranty Association. As deductible amounts increase, premium amounts change in what way? by JayDJohnson, -certificate of insurance -master policy -entire contract -certificate of authority, The Coordination of Benefits provision in Utah requires that both primary and secondary plans pay the benefit in equal shares if the plans cannot agree on the order of payment within how many days after receiving the claim information? Feb. 2015. In what way can an agent demonstrate a high standard of ethics? Morale 4. The. C. Something that increases the chance of loss. -an insurer with a home office in another country -an insurer with licensed agents doing business in other countries -an insurer with licensed agents who are citizens in more than one country -an insurer with a home office in another state, an insurer with a home office in another state U1, The authority granted to an agent through the agent's contract is referred to as: -apparent authority -implied authority -absolute authority -express authority, On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are: -not taxable since the IRS treats them as a return of a portion of the premium paid -paid at a fixed rate every year -taxable as ordinary income -guaranteed, not taxable since the IRS treats them as a return of a portion of the premium paid U1, An applicant knowingly fails to communicate information that would help an underwriter make a sound decision regarding coverage. What type of health benefits will her health insurance policy pay for her injuries if the policy includes the narcotics & intoxicants provision? The concepts I have learned in this course will not only help me in my future work, but have also given me extremely useful life knowledge to apply to my per Insurance contract special characteristics they are conditional contract, a contract involving fortuitous evens and the exchange of unequal amounts, a contra Lindell, Perry and Prater define risk as the possibility that personnel, property or resources could be impacted in a negative way (2007). -representation -warranty -concealment -indemnity, Courts will interpret any ambiguity in an insurance contract: -based on the prudent person rule -in favor of the insured -in favor of the insurer -through arbitration, in favor of the insured (insurance policies are contracts of adhesion) U1, Insurance is the transfer of: -hazard -peril -risk -loss, risk (insurance is the transfer of financial responsibility associated with a potential of a loss/risk to an insurance company) U1, What is a foreign insurer? Reinsurance ceded is the portion of risk that an insurance company passes to another insurer in order to reduce its overall risk exposure. D Insurance cannot be mandatory., Which of the following is . B) A stock market venture is an example of a pure risk. Insurance Quiz Part 1 - Multiple Choice Questions (MCQs -4 years -2 years -1 year -3 years, A resident agent licensed in another state may obtain a nonresident license in Utah without taking the examination provided that: -the agent is currently licensed in the state of domicile -the agent has obtained that license by passing a test suitable to the Utah Department -the state where the agent lives affords the same privilege to residents of Utah -all of these requirements are met, An agent voluntarily surrendered her license. -possible modifications to include expanded coverage -permanent coverage -premiums are not elevated -more medical evaluations are required, Hospital indemnity/hospital confinement indemnity policy will provide payment based on? And individuals tendency to be dishonest would be indicative of a. A hospital indemnity policy will pay, A benefit for each day the insured is in a hospital The applicant must be subject to loss death, illness,or disability of insured. -denial of coverage -preventive care -second surgical opinions -risk sharing, All of the following may be excluded from coverage in a Major Medical Expense policy, EXCEPT: -emergency surgery -custodial care -cosmetic surgery -coverage provided under workers compensation, 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: -gatekeepers -usual, customary & reasonable -relative-value schedule -benefit schedule, Which of following is NOT true of basic medical expense plans?
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