question

A claiment wants to bring a recovery action against an insurance company for a loss claimed under a policy. The action must be brought a) Within 2 years. b) Within 3 years. c) Immediately. d) Only within 60 days.

answer

b) Within 3 years. Some states require a provision limiting the time parameters in which a claimant may seek recovery from an insurer under a policy. Georgia requires legal action to be brought forth no sooner than 60 days and no later than 3 years after proof of loss.

question

All the following are Nonforfeiture options EXCEPT a) Reduced paid-up b) Interest only c) Cash surrender d) Extended term

answer

b) Interest only Nonforfeiture values include cash surrender, extended term and reduced paid-up. Interest only is a settlement option.

question

Brandon is rendered totally disabled for half a year. Which type of insurance would help him pay for expenses of the company during the time of his disability? a) Business Expense Policy b) Employer's Disability Provision c) Business Disability Policy d) Business Overhead Expense Policy

answer

d) Business Overhead Expense Policy Business Overhead Expense (BOE) insurance is sold to small business owners for the purpose of reimbursing the policyholder for various business overhead expenses during a period of total disability. Benefit payments are typically limited to one of two years. Expenses such as rent, utilities, and employee salaries are covered. The employer's actual salary and profits are not compensated under this provision.

question

In disability income coverage the policy covers the insured if he is unable to perform any job for which he is qualified. Total disability is defined as a) Own occupation - more restrictive b) Own occupation - less restrictive c) Any occupation - more restrictive d) Any occupation - less restrictive

answer

c) Any occupation - more restrictive than other definitions. If total disability is defined as any occupation, it means the coverage will apply only if the insured cannot find any means of income whatsoever. This is more strict than own occupation, where a person merely has to prove that they cannot perform the job for which they were previously trained.

question

Which nonforfeiture option has the highest amount of insurance protection? a) Conversion b) Decreasing Term c) Reduced Paid-up d) Extended Term

answer

d) Extended Term The Extended Term nonforfeiture option has the same face amount as the original policy, but for a shorter period of time.

question

An insurance contract must contain all of the following to be considered legally binding EXCEPT a) Consideration b) Competent parties. c) Beneficiary's consent d) Offer and Acceptance

answer

c) Beneficiary's consent The four essential elements of all legal contracts are offer and acceptance; consideration; competent parties; and legal purpose.

question

Which is NOT true about uniform mandatory provisions for claims? a) Insured must give notice within 20 days. b) Insured is 2 years late in filing proof of loss, claim can be denied. c) Insured must notify insurer of claim on forms from insurer.

answer

c) An insured must notify the insurer of a claim on forms prescribed by the insurer. If forms are not furnished, written proof of the occurrence, nature of the loss, and extent of loss must be submitted to the insurer.

question

All of the following are true of Key Employee life insurance EXCEPT a) The death benefit is free from income taxes. b) The key employee has premiums deducted from his salary. c) The business is the owner and beneficiary of the policy. d) The key employee is the insured.

answer

b) The key employee has premiums deducted from his salary. The business pays the premiums that are not deductible, but the death benefit is free from income taxes.

question

What is a material misrepresentation? a) Any misstatement made by an applicant for insurance b) Any misstatement by the producer c) Concealment d) A statement by the applicant that, upon discovery, would affect the underwriting decision of the insurance company

answer

d) A statement by the applicant that, upon discovery, would affect the underwriting decision of the insurance company A material misrepresentation is a statement that, if discovered, would after the underwriting decision of the insurance company.

question

Which is INCORRECT concerning an MSA? a) If there is a balance at year end, employee can let it earn interest or withdraw the amount (as taxable income). b) The employee can use funds from the MSA to cover health ins deductibles during the year. c) MSAs are only available to group of 250+ employees.

answer

c) Medical savings accounts are only available to group of 250 or more employees. Medical savings accounts are only available to groups of 50 or fewer.

question

A Medicare Supplement policy must provide coverage for pre-existing conditions after the policy has been in force for a) 1 year b) 2 years c) 90 days d) 6 months

answer

d) 6 months Pre-existing conditions must be covered after a policy has been in force for 6 months.

question

Which life policy is designed to provide the policyowner a hedge against the effects of inflation? a) Modified life b) Variable life c) Ordinary life d) Graded premium whole life

answer

b) Variable life Because variable life policies invest in the insurer's separate accounts and allow the policyowner to choose specific investment strategies, the interest rates will fluctuate depending upon the performance of the investments. The policy value, therefore, should reflect the effects of inflation up the economy.

question

Who does the sub-agent represents? a) The company b) The insured c) The agent d) The counselor

answer

c) The agent An agent represents the company. A sub-agent represents the agent. A sub-agent cannot take or sign an application. A counselor receives a fee for advice, and can maintain a dual license as an agent and counselor.

question

Which of the following would NOT be an exclusion in a long-term care policy? a) Treatment payable by Medicare b) Alcoholism c) A pre-existing condition d) Alzheimer's disease

answer

d) Alzheimer's disease While normally mental and nervous disorders or disease are excluded in long-term care policies, Alzheimer's disease is not. The rest are all possible exclusions.

question

Ron joins PPO provided by his employer. If Ron goes to a physician who is not a PPO provider, what will happen? a) PPO won't pay.. b) Ron will pay a higher deductible. c) The PPO will pay the same benefits as if Ron had seen a PPO physician. d) The PPO will pay reduced benefits.

answer

d) The PPO will pay reduced benefits. Ron's health insurance will not pay the full amount charged by the non-PPO doctor.

question

Which type of beneficiary is changeable at any point? a) Both Irrevocable and Revocable b) Tertiary c) Irrevocable d) Revocable

answer

d) Revocable Revocable beneficiaries can be changed at any point. Irrevocable beneficiaries must give permission to the policyowner in order for the beneficiary to be changed.

question

Julie pays for her life ins annually. She has collected a nontaxable dividend check. Julie decided she would use the dividends to pay next premium. What option allows her to do this? a) Reduction of Premium option b) Dividend-to-Premium option c) Accumulation at interest d) Cash option

answer

a) Reduction of Premium option The Reduction of Premium option allows the policyholder to apply dividends toward the next year's premium. The dividend is subtracted from the premium amount, yielding the new premium due for the next year.

question

The cash value under a MEC accumulates a) On an income-taxable basis. b) On a post-tax basis. c) On a tax-deferred basis. d) On a LIFO basis.

answer

c) On a tax-deferred basis. The cash value of a Modified Endowment Contract accumulates on a tax-deferred basis. Taxation occurs only when any of the cash value is distributed to the policyowner (i.e., withdrawals and surrenders).

question

An insured needs extraordinary medical care and sells his policy to a viatical settlement company. This is an example of a) A collateral assignment b) An assigned premium c) An insurable interest d) An absolute assignment

answer

d) An absolute assignment Absolute assignment involves transferring all rights of ownership to another person or entity, which is what happens in a viatical settlement.

question

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within a) 30 days of a loss. b) 60 days of a loss. c) 90 days of a loss. d) 20 days of a loss.

answer

c) 90 days of a loss. Under the Uniform Required Provisions, proof of loss under a health insurance policy normally should be filed within 90 days of a loss.

question

A medical expense policy establishes amount of benefit paid based on charges which fall within standard range of fees for a specific procedure by a doctor in that geographic area is known as a) Gatekeepers. b) Usual, customary and reasonable. c) Relative-value schedule. d) Benefit schedule.

answer

b) Usual, customary and reasonable. The usual, customary and reasonable approach for determining insurance benefits is based upon the fees normally charged for specific procedures in the geographic location where the services are provided.

question

Describe the deductible in a comprehensive major medical policy? a) There is no deductible, the insurer pays coinsurance only. b) Comprehensive major medical have deductibles on all benefits. c) Comprehensive major medical do not have deductibles. d) Policies have a corridor deductible.

answer

d) Most policies have a corridor deductible. Most comprehensive major medical policies have corridor deductibles. The plan will provide first-dollar coverage for basic medical benefits, but a deductible may be applied to the major medical benefits.

question

Carol is insured under her employer's group life insurance plan at her place of employment. All of the following statements about her coverage are true EXCEPT a) Carol would not need to prove insurability for a conversion policy. b) If Carol quits, she may, within 31 days, request that her coverage be converted to an individual policy. c) Should Carol convert her coverage, the premium will be based upon her attained age. d) Carol could choose what type of insurance her conversion policy provided (Term or Permanent).

answer

d) Carol could choose what type of insurance her conversion policy provided (Term or Permanent). When group coverage is converted to an individual policy, the insurer will determine the type of coverage, (usually permanent insurance).

question

After a person's employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true? a) The employee can convert from group to individual insurance within 31 days of termination. b) The premium of the individual health insurance policy can be higher than the original policy. c) By law, the new, individual policy must provide the same benefits as the group insurance policy. d) Continuation of group coverage need not include dental, vision, or prescription drug benefits.

answer

c) By law, the new, individual policy must provide the same benefits as the group insurance policy. Terminated employees have 31 days to convert to an individual health insurance policy, without having to provide proof of insurability. The insurer can adjust the new, individual health policy's premium as it sees fit, as long as coverage is provided. The new policy could offer lesser benefits than the original group health policy.

question

The life insurance policy clause that prevents an insurance company from denying payment of a death claim after a specified period of time is known as the a) Insuring clause. b) Misstatement of Age clause. c) Incontestability clause. d) Reinstatement clause.

answer

c) Incontestability clause. If an insurer wishes to contest any statements on an application, they must do so within the first two years.

question

Because an insurance policy is a contract between the insurer and the insured, it must conform to the state laws governing contracts which require all of the following elements EXCEPT a) Legal purpose. b) Offer and acceptance. c) Conditions. d) Competent parties.

answer

c) Conditions. Conditions are part of the policy structure. Consideration is an essential part of a contract.

question

Which of the following is NOT a feature of a noncancelable policy? a) The insurer may terminate the contract only at renewal for certain conditions. b) The premiums cannot be increased beyond the amount stated in the policy. c) The guarantee to renew coverage usually applies until the insured reaches certain age. d) The insured has the right to renew the policy for the life of the contract.

answer

a) The insurer may terminate the contract only at renewal for certain conditions. The insurance company cannot cancel a noncancelable policy, nor can the premium be increased beyond what is stated in the policy. The insured has the right to renew the policy for the life of the contract; however, the guarantee to renew coverage usually only applies until the insured reaches age 65.

question

When a reduced-paid up nonforfeiture option is chosen, what happens to the face amount of the policy? a) It is reduced to the amount of what the cash value would buy as a single premium. b) It is increased when extra premiums are paid. c) It decreases over the term of the policy. d) It remains the same as the original policy, regardless of any discrepancies in value.

answer

a) It is reduced to the amount of what the cash value would buy as a single premium. In a reduced paid-up policy, the original policy's cash value is used as single premium to pay for a permanent policy with a reduced face amount from the original, hence the name. The new policy accumulates in cash value until its maturity or the insured's death.

question

Which of the following is true regarding a term health policy? a) It is conditionally renewable. b) It is guaranteed renewable. c) It is noncancelable. d) It is nonrenewable.

answer

d) It is nonrenewable. In term health policies, the owner has no rights of renewal. He or she must purchase another policy.

question

Which of the following statements regarding Business Overhead Expense policies is NOT true? a) Benefits are usually limited to six months. b) Premiums paid for BOE are tax-deductible. c) Any benefits received are taxable to the business. d) Leased equipment expenses are covered by the plan.

answer

a) Benefits are usually limited to six months. Business Overhead Expense (BOE) insurance is sold to small business owners for the purpose of reimbursing the policyholder for business overhead expenses during a period of total disability. Premiums are tax-deductible for a business, but any benefits received are not tax-deductible. Overhead expenses, including equipment and employee salaries, are covered by the plan. Salaries and profits of the employer are not protected.

question

Which of the following LTC Coverages would NOT encourage an insured to receive care at home? a) Respite Care b) Home Health Care c) Adult Day Care d) Residential Care

answer

d) Residential Care Respite care, home health care, and adult day care are all coverages used to reduce the necessity of admission into a care facility.

question

An applicant is denied insurance because of information found on a consumer report. Which of the following requires that the insurance company supply the applicant with the name and address of the consumer reporting company? a) Consumer Privacy Act b) Conditional Receipt c) Disclosure Rule d) Fair Credit Reporting Act

answer

d) Fair Credit Reporting Act The Fair Credit Reporting Act governs what information can be collected and how the information can be used.

question

Teresa pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? a) 60 days b) 7 days c) 10 days d) 31 days

answer

c) 10 days The grace period is seven days if paid weekly, 10 days if paid monthly, 31 days for all other modes.

question

A claimant wants to bring a recovery action against an insurance company for a loss claimed under a policy. The action must be brought a) Only within 60 days. b) Within 2 years. c) Within 3 years. d) Immediately.

answer

c) Within 3 years. Some states require a provision limiting the time parameters in which a claimant may seek recovery from an insurer under a policy. Gerogia requires legal actions to be brought forth no sooner than 60 days and no later than 3 years after proof of loss.

question

An insured receives an annual life insurance dividend check. What term best describes this arrangement? a) Reduction of Premium b) Annual Dividend Provision c) Accumulation at Interest d) Cash option

answer

d) Cash option The cash option allows an insurer to send the policyholder an annual, nontaxable dividend check.

question

Lucy has a major medical policy with a $500 deductible and 80/20 coinsurance. Lucy is hospitalized and sustains a $2,500 bill. What is the maximum amount that Lucy will have to pay? a) $900 (deductible + 20% of the bill after the deductible [20% of $2,000]). b) $500 (amount of deductible). c) $1,000 (deductible + 20% of the entire bill). d) $2,500 (the entire bill).

answer

a) $900 (deductible + 20% of the bill after the deductible [20% of $2,000]). d) $2,500 (the entire bill). Lucy would first pay the $500 deductible; out of the remaining $2,000, the insurer will pay 80% ($1,600) and the insured will pay 20% ($400).

question

in forming an insurance contract, when does acceptance usually occurs ?

answer

when insurer approves a prepaid application

question

benefits periods for individually short-term disability policies will usually continue from...

answer

six months to two years

question

when an employee covered under a health reimbursment account changes employer, the HRA ?

answer

stays with the employer

question

most policies will pay the accident death benefits as long is caused by the accident that occurs within

answer

90 days

question

which report will provide the underwriter with the information about a consumer's credit ?

answer

consumers report

question

what's the initial period of time specified in a disability income policy that must pass after the policy is in force before a loss can be covered ?

answer

probationary period

question

todd has been informed that he has an hernia which requires repair. he researches the cost and learns his insurance will cover 200 points worth of surgical expenses. each point represents $10, which it means $2,000 of his surgery be covered by his plan. what system is todd insurance company is using ?

answer

relative value

question

a participating insurance policy may....

answer

pay dividends to policyowners

question

an agent makes a mistake on the application and then corrects his mistake by physically entering the necessary information, who must then initial the change ?

answer

the applicant

question

HIPPAA or health unsurance portability and accountability act, applies to groups of

answer

2 or more

question

which statement is correct concerning the COBRA act of 1985

answer

it covers terminated employee's and dependants for up to 36 months after a qualifying event

question

a man decides to purchase a $100,000 annually renewable term insurance life policy to provide additional protection until his children finished college, he discovered that this policy

answer

required a premium increase at each renewal

question

when a life insurance policy is cancelled and the insured selected the extended term nonforfeiture option, the cash value will be used to purchase term insurance that has the face amount of ?

answer

equal to the original policy, for as long of a period of time that the cash value will purchase

question

ron joins the PPO that is provided by his employer. if ron decides to go to a physician who is not a PPO provider, what would happens ?

answer

the PPO will pay reduced benefits

question

if a life insurance develops cash value faster than a seven-paywhole life contract, it's a

answer

modified endowment contract

question

an adjustable life policyowner can....

answer

change the coverage period

question

what's the purpose of the buyer's guide ?

answer

to allow the consumer to compare the costs of differents policies

question

what's the purpose of a disclosure statement in life insurance policies ?

answer

help consumers make more informed decisions

question

a married couple owns a permanent policy which covers both of their lives and pays the face amount of the policy upon the death of the first. wich policy is that ?

answer

joint life policy

question

the provisions which prevents the insured, from bringing any legal action against the company for the last 60 days after proof of loss, is known as

answer

legal actions

question

regarding the concept of creditable coverage, the number of days of coverage spent under the group plan, will be used to reduce the 12-month waiting period for pre-existing conditions coverage, if the employee does not have a break in coverage of more than....

answer

63 days

question

which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner ?

answer

payment of claims

question

what is "not" correct about the required provisions of a health insurance policy ?

answer

that a reinstated policy provides immediate coverage for an illness

question

the limits of a health reimbursement account are set by....

answer

the employer

question

when a replecement is involved, a replacing insurance company is "not" reponsible for....

answer

providing a copy of the important notice regarding replacement of life insurance to the applicant

question

an individual has just been diagnosed with a quickly-spreading fatal form of cancer, his oncologist predicts that he will live for 5 months. he applies for individual life insurance. what risk classification will he most likely receive ?

answer

declined

question

a statements concerning Medicare part B says..

answer

it pays for physician services, diagnostic test and physical therapy

question

is a false statement that in a modified endowment contract (MEC)....

answer

the policyowner can receive contributions at any time without been penalized

question

which rider would not increase the premium for a policyowner ?

answer

impairment rider

question

what entity has the authority to make changes to an insurance policy ?

answer

insurer's executive officer

question

is incorrect regarding whole life insurance ...

answer

that the policy loans are tax-deductible

question

which rider available in disability income insurance, will provide benefits above the base policy amount ?

answer

multiple indemnity rider

question

julie pays for her life insurance annually. until now she has collected an non-taxable dividend check each year. julie has decided that she would rather use the dividends to help pay for her next premium, what option would allow her to do this ?

answer

reduction of premium option

question

an agent tries to sell insurance to an applicant who appears to be confused but is eventually able to give enough info for the applicationto be completed. after the policy was issued the agent talked to the insured's family and they explained that the insured was recovering from a surgery and might have been under the influence of meds at the time of application. what happen then ?

answer

the policy may be voided if it can be proven that the applicant was not capable of making a buying decision at the time of the application

question

donald purchase a life insurance from company. the agent told him that depending upon the company's investements and expense factor the cash value could be more or less than those show in the policy at issue time. donald policy is..

answer

interest-sensitive whole life

question

how long does an insurer have to contest fraudulent misstatements made in a health insurance application ?

answer

as long as the policy is in force

question

what is "not" a feature of a non-cancelable policy ?

answer

that the insurer may terminate the contract only at renewal for certain conditions

question

what best defines target premium in a universal policy ?

answer

the recommended amount to keep the policy en force throughout it's lifetime

question

a license agent in utha want to become a nonresident agent in nevada in the same line of insurance, considering that all requirements are met, what is more likely to happen ?

answer

the division will waive education and examination requirements

question

after a person's employment is terminated, it's possible to obtain individual health insurance, after loosing the group health coverage provided by the employer, which of the following is "not" true ?

answer

A) the employee can convert from group to individual withing 31 days of termination B)the premium of the individual health policy can be higher than the original policy *C)by law, the new individual policy must provide the same benefits as the group insurance policy, that is not true.

question

what type of individual may act as a producer without a license?

answer

an insurer company president who is solely responsible for the administration of the company

question

on it's advertisement, a company claims that it has funds in its possession that are, in fact, no available for the payment of losses of claims. the company is guilty of...

answer

misrepresentation

question

for the purpose of determining its financial condition, fulfillment of its contractual obligations and compliance with nevada law, the commissioner will examine affairs of each insurer as often as deemed necessary. each domestic insurer must be examined at least

answer

every 5 years

question

what provides specific information about the products that an insurer is offering and must be left with a prospective insured at the time of the application ?

answer

policy summary

question

what type of insurance company is an incorporated insurer without capital stock or shares ?

answer

mutual insurer

question

what's the penalty for transacting insurance without a proper license?

answer

$1,000

question

how many hours of approved continued education within a 3 year period are required ?

answer

30 hours

question

how many consecutive months of coverage(other than in an acute care unit of a hospital) does LTC insurance cover in Nevada ?

answer

24 months

question

existing insurers must provide policyowners with a policy summary for the existing life insurance within how many days of receiving the written communication of replacement ?

answer

20 days

question

disability income coverage specifies that the policy covers the insured if he is unable to perform any job for which he is qualified. in this case, total disability is define as....

answer

any ocupation..more restrictive than other definitions

question

which of the following is "not" a feature of a non-cancellable policy ?

answer

A)the insurer has the right to renew the policy for the life of the contract *B)the insurer may terminate the contract only at renewal for certain conditions, is not a feature C)the premiums can not be increased beyond the amount stated in the policy D)the guarantee to renew coverage ussually applies until the insured reaches certain age

question

according to the fair credit reporting act, all of the following would be considered negative info about a consumer, "except" ?

answer

A)late payments *B)poor credit history is the exception C)prior arrests D)tax delinquencies

question

pete is hopitalized with back injury. upon checking his "disability income policy", he learns that he will not be elegible for benefits for at least 30 days. this would indicate that his policy was probably written with a 30 day ?

answer

elimination period

question

what would best describe total disability ?

answer

a person's ability to work is significantly reduced or eliminated for the rest of his life

question

what two terms are associated directly with the premium ?

answer

level or flexible

question

when kent purchased his health policy he was a window washer. he has since change occupation and now manages a library. upon notifying the insurer of the change of occupation, the insurer should....

answer

consider decreasing the premium

question

teresa pays a monthly premium of $100 for her health insurance. what would be the duration of the "grace period"under her policy ?

answer

10 days

question

an insured is covered under a medicare policy, that provides a list of network healthcare providers that he must use in order to receive coverage. in exchange for the inconvenience, he is offered a lower premium, which type of "medicare" policy does he own ?

answer

"Select"

question

an applicant is discussing his options for "Medicare supplement coverage" with his agent. He is 65 years and has just enrolled in "Medicare part A and part B". what is the insurance company obligated to do ?

answer

offer the supplement policy on a guaranteed basis

question

a "medical expense policy" that establishes the amount of benefit paid base upon the prevailing charges, which fall withing the "standard" range of fees, normally charged by specific procedure by a doctor of a similar training and experience and that geographic area is known as ?

answer

usual, customary and reasonable

question

what is true regarding underwriting for a person with HIV ?

answer

the person may be declined

question

which LTC coverage, would "not" encourage an insured to receive care at home ?

answer

residential care

question

Sam has a life insurance policy from a participating company and receives "quarterly dividends". he instructed the company to apply his dividends to the policy, to increase the death benefit. The dividend option that he has chosen is called ...

answer

paid-up options

question

which of the following provisions give an employee the right to exchange group insurance for an individual policy withing 60 days from termination of employment ?

answer

conversion provision

question

an insurer is helping a married couple determine their children's needs, assets, and liabilities in the event that one or both of the spouses should die. what's the term most closely associated with this ?

answer

survivor protection

question

priscilla won the state lottery, the state will send her a check each month for the next 25 years. what type of investment are they likely to use to provide these benefits ?

answer

immediate annuity

question

mortality figures are normally developed by studying and interpreting statistics...

answer

developed by the deaths of millions of persons over long period of time...

question

the intentional and voluntary surrendering of a known right or privilege in a contract is known as ....

answer

waiver

question

what is "not" an optional provision in individual health insurance policies ?

answer

notice of claim

question

which of the following entities ultimately determines if an advertisement is deceptive or confusing ?

answer

the commisioner

question

the minimum number of person to be insured under a group health insurance plan is establish by

answer

state laws

question

if an employer who employs lees than 20 employee's mantains a group health insurance policy which cover those employee's, the policy must contain a provision which permits an employee who is terminated involuntarily, for other than gross misconduct, to continue identical coverage for....

answer

18 months

question

when an insurance company or agent advertises health insurance products to the public, the advertisement must include......

answer

clear identification of the insurer

question

which of the following "LTC" coverages would encourage an insured to receive care at home ?

answer

custodial care facility, respite care and home health care

question

what is an elegibility requirement for "social security disability income benefits"

answer

fully insured status

question

insurance is the transfer of

answer

risk

question

an insurer wants to obtain information from investigators regarding an insured. what must the insure do in order to legally acquire this information ?

answer

present the insured with a "disclosure authorization notice"

question

what rider would "not" cause the "death benefit" to increase ?

answer

payor benefit rider

question

the two types of assignment are

answer

absolute and collateral

question

what is true of a children's rider added to an insured's permanent life insurance policy

answer

it is "term coverage" that's convertible to "permanent insurance" at or prior to the child reaching the maximum coverage age

question

what is incorrect concerning a "noncontributory" group plan ?

answer

the employee's receive individual policies

question

who would "not" be elegible to establish a "keogh" retirement plan ?

answer

the president and employee of a corporation

question

norma jean is joining a group insurance plan, in order to avoid proving insurability, she must...

answer

join during the enrollment period

question

an insurer that holds a "certificate of authority" in the state in which transacts business is considered...

answer

and authorized insurer

question

in insurance, an offer is usually made when....

answer

the application is submitted

question

what is true of the "fair credit reporting act"

answer

that the purpose of the act is to protect the consumer's right to privacy by making certain that underwriting data is confidential, accurate, relevant and properly used

question

what is "not" provided by an HMO

answer

reimbursement

question

sherman owns a general disability policy and is injured during a war, rendering him "disabled". what will be the extent of benefits he will receive ?

answer

$0, "general disabilities policies not cover losses caused by war, military service, inentionally self-inflected injuries,overseas residence or injuries suffered while commiting or attemting to commit a felony"

question

"LTC" may be sold in all various ways, "except"

answer

endorsement to health policy

question

what is "respite" care ?

answer

"relief" for a major care giver

question

what type of "LTC" care is not provided in an intitutional setting ?

answer

home health care

question

what statement accurately describes "group disability income" insurance ?

answer

the extent of benefits offered is determined by the insured's income

question

when both parties in a contract must perform certain duties and follow rules of conduct to make the contract enforceable, the contract is

answer

conditional

question

in comparison to a policy that uses the "accidental means" definition, a policy that uses the "accidental bodily injury definition would provide a coverage that is......

answer

broader in general

question

what would "not" be an exclusion in a long-term policy ?

answer

alzheimer's disease

question

what would be a typical deductible for "basic surgical expense insurance"

answer

$0

question

which "renewability provision" are you most likely to see on a travel accident policy ?

answer

period of time

question

wich provision states that the insurance company must pay "medical expense" claims immediately?

answer

time of payment of claims

question

if a person is 27 years old and meets "social security definition of "total disability" how many work credits must have earned to receive benefits ?

answer

12 credits

question

once the deductible is met for "medicare part D" the plan will pay for what percentage of prescription drug cost ?

answer

75 %

question

once the person meets the stringent requirements for disability benefits, how long is the waiting period under "social security", before any benefits will be paid ?

answer

5 months

question

HMO and PPO for a Medicare recipient does not cover....

answer

cosmetic surgery

question

*in order to pay for administrative expenses the "Nevada Insurance Guaranty Association may charge assessments of its members insurers. what is the maximum amount that the Association charge for this assessments ?

answer

$100

question

an agent offer his clients free ticket to the superbowl game in exchange for the purchase of an insurance policy. the agent is guilty of ?

answer

rebating

question

*in Nevada, in the event of death or disability of a licesed agent, the commissioner may authorize the issuance of a temporary license to an individual that is otherwise qualified, for a period of up to....

answer

180 days

question

*a "participating life insurance policy may ?

answer

pay dividends to the policy owner

question

*how many concecutives months of coverage (other than in acute care unit of a hospital) does TLC insurance cover in Nevada ?

answer

24 months

question

*which bob purchase a policy to provide coverage on himself, his wife linda, and their two children, john and kristen. all of them would need to prove insurability "EXCEPT"

answer

any children born to them after the inception of the contract

question

*what is true regarding insurance company appointment for a broker ?

answer

brokers "do not need to be appointed"

question

*which of the following will "not"qualified for a limited lines producer license ?

answer

A)a person selling credit life insurance only *B)a person selling annuities will not qualify C)a person selling rental car insurance D)a person selling travel baggage insurance

question

after a person's emplyoment is terminated, it is possible to abtain individual health insurance after loosing the group health coverage provided by the employer, which is "Not true "

answer

A)the employee can convert from group to individual withing 31 days of termination B)the premium of the individual health insurance policy can be higher than the original policy *C) that by law, the new individual policy must provide the same benefits as the group insurance policy is "not true" D)non of the above,

question

*for how long must agents reatin copies of notices and sales proposals for the life insurance appplication ?

answer

3 years

question

* in order to provide the funds necessary to carry out the duties of the Nevada Life& Helath Insurance Guaranty Association members insurers must pay an assessment, after written notice is provided how soon must the insurers pay these assessments ?

answer

30 days

question

*which of the following must be obtained by someone who intends to function as an administrator ?

answer

A)admisnistrator license B)limited lines producer license C)certificate of registration is the right answer D)certificate of authority

question

which of the following types of insurance companies is an incorporated insurer without capital stock or shares ?

answer

A)reciprocal insurer B)stock insurer C)mutual insurer is the right answer D)fraternal insurer

question

which of the following is "not" an allowable exclusion of Medicare supplemental insurance ?

answer

A)dental treatment B)hearing aids C)emotional disorders *D)all of the above are allowable exclusion and that is the right answer

question

the duty of an agent where replacement is involved include...

answer

A)leaving a copy or original of all solicitation material used for presentation to the applicant B)submitting to the replacing insurer a copy of all soliciting material C)submitting to the replacing insurer a statement signed by applicant as to whether or not has existing life insurance *D)all of the above is the answer

question

the commissioner denied an application for insurance license and notified the applicant. what is true regarding a hearing regarding this...

answer

must be held within 30 days of the request

question

what is a penalty for transacting insurance without a license ?

answer

$1,000

question

the commissioner must reasonable notice to all interested parties as to the time, place and purpose of a hearing within the minimum of how many days of the hearing ?

answer

20 days

question

what is "not" a characteristic of a Universal Life policy.....

answer

that the planned premium pays for mortality charges and expenses and any excess is returned to the policyowner

question

who determines the elegibility and contributions limits in an H.R.A. ?

answer

the employer determines both

question

what is "not" true regarding uniform mandatory provisions concerning claims ?

answer

an insured must notify the insurer of a claim on forms prescribed by the insurer

question

quincy's has a $1,000 H.R.A. account. he incurred $750 in medical expenses the first year of the plan and $1,200 in the second year. what is the maximum amount Quincy is entitled to recover for this expenses under the plan ?

answer

$1,950

question

a brain surgeon has an accident and develops tremors in her right arm. what disability income policy definition of total disability will cover her for all losses ?

answer

own occupation - less restrictive than other definitions

question

an insured is covered under a Medicare policy that provides a list of network healthcare providers that he must use (except in emergency situations) in order to receive coverage in exchange for this inconvenience, he is offered a lower premium. which type of Medicare policy does he own ?

answer

select

question

what does "level" refers to in "level term insurance "

answer

Face amount

question

which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of loss ?

answer

notice of claims

question

the policyowner of an adjustable life policy can increase premium payments and....

answer

have a limited pay policy

question

carol is insured under her employer's group life insurance plan at her place of employment, what is "not" true about her coverage ?

answer

that Carol could choose what type of insurance her conversion policy provided. (term or permanent) when you go from group to individual, the insurer will determine the type of coverage, which is usually permanent insurance

question

the sole beneficiary of a life insurance policy dies before the insured, if the policyowner fails to change the beneficiary before the insured's dead, the proceeds of the policy will go to...

answer

the insured's estate

question

what statement about H.R.A.'s is true ?

answer

the account allows roll-overs of unused balances at the end of the year at the employer's discretion

question

within how many days of requesting an "investigative consumer report" must an insurer notify the consumer in writting that the report will take place..

answer

3 days

question

in order to qualify for conversion from a group life policy to an individual policy of the same coverage , a person must have been insured under the group plan for how many years...

answer

5 years

question

what is "not" the purpose of H.I.P.A.A. ?

answer

to provide immediate coverage to new employees who had been previously covered for 18 months

question

a life insurance policyowner has the flexibility to increase the amount of premium and then decrease it at a later date . the person is also allowed to skip premiums payments, provided that there's enough cash value in the policy to cover the premium amount. this is....

answer

universal life

question

the following would not qualified as a dependent under a "dependent care flexible spending account...

answer

jeremy had to have both legs amputated, but has learned how to take care of himself and get around in a wheelchair

question

under the extended term insurance policy, the policy cash value is converted to

answer

the same face amount as in the whole life policy

question

a deductible is

answer

a specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits

question

an insurer is helping a married couple determine their children needs, assets and liabilities, in the even both spouses should die, what is the term most closely associated with this ?

answer

survivor protection

question

a waiver of premium provision may be included with which kind of health insurance policy?

answer

disability income

question

all others factors been equal, the least expensive firs-year premium payment is found in......

answer

annually renewable term

question

what option for Universal Life allows the beneficiary to collect the death benefit and cash value upon the death of the insured ?

answer

option B

question

in what instance would the premium be tax-deductible...

answer

premiums paid by the employer on a $30,000 group term life insurance plan for employee's

question

ray has an individual major medical policy that requires a co-insurance payment. Ray very rarely visits the physician and would prefer to pay the lowest premium possible. Which co-insurance arrangement would be best for Ray ?

answer

50-50

question

all others factors been equal, what would the premium be like in a "survivorship life" policy as compared to the premium in a "joint life"

answer

lower

question

what is "not" true regarding a decreasing term policy ?

answer

that the payable premium amount steadily declines throughout the duration of the contract

question

jim is covered by a high deductible plan. he makes regular contibutions to his HSA. how are those contributions treated in regards to taxation ?

answer

the contributions are Tax-Deductible

question

if toms's policy allows him to make periodic additions to the face amount at standard rates, without proving insurability, his policy includes a.....

answer

guaranteed insurability option

question

what is "not" true regarding the guaranteed insurability rider is....

answer

that the rider is available to all insured

question

what is not a dividends option ?

answer

a fixed period installment

question

which Universal Life option has a gradually increasing cash value and a level death benefit ?

answer

option A

question

which non-forfeiture option provides coverage for the longest period of time ?

answer

reduced paid-up option

question

who must notify the replacement company of a policy that is been replaced ?

answer

agent

question

what would make it easier to qualify for total disability benefits

answer

the more liberal - own occupation

question

what is true regarding a term health policy

answer

it is nonrenewable

question

the purpose of a managed care health insurance plan is to

answer

control health insurance claims expenses

question

what are the two components of a universal policy

answer

insurance and cash account

question

under an individual disability policy, the minimum schedule of time in which claim payments must be made to an insured is

answer

monthly

question

disability income coverages specifies that the policy covers the insured if he is unable to perform any jobwhich he is qualified. in this case, total disability is defined as

answer

any ocupations - more restrictive than other definitions

question

what is guaranteed to the policyowner through nonforfeiture values ?

answer

the cash value in a policy belongs to the insured even if the policy lapses or is surrender

question

life insurance benefits for minors must be places in the hands of either a guardian or a trustee. alhought the guardian may or may not be accountable for

answer

the assets

question

what is correct concerning the taxation of a Key Person life insurance policy premiums and death benefits ?

answer

permiums are not deductible as a business expense and the death benefit is not taxable to the company

question

Which clause is said to be the "heart of the policy", containing the company's promise to pay?

answer

Insuring Clause

question

Sara has battled a chronic orthopedic condition for most of her life. The only way that she can obtain individual health insurance at a reasonable cost is by allowing the insurer to exclude her condition from coverage. What is the name of this rider?

answer

Impairment Rider

question

Which of the following is the term for the specific dollar amount that must be paid by an HMO member for a service?

answer

Copayment

question

How can a new physician be added to the PPO's approved list?

answer

Agree to follow the PPO standards and charge the appropriate fees.

question

Which of the following provisions is mandatory for health insurance policies?

answer

Physical examination and autopsy

question

The Probationary Period is

answer

A specified period of time that a person joining a group has to wait before becoming eligible for coverage.

question

Jim is covered by a high deductible health plan. He makes regular contributions to this H.S.A. How are those contributions treated in regards to taxation?

answer

The contributions are tax-deductible

question

Regarding Medicare "select" policies, what are restricted network provisions?

answer

They condition the payment of benefits.

question

What is FALSE, regarding the process of completing and signing an application?

answer

Only the insured is required to sign the application.

question

What is available to employers of all sizes?

answer

H.R.A.'s or Health Reimbursement Accounts

question

Regarding the free-look provision, the insurance company

answer

Must notify the insured of their rights.

question

An insured committed suicide 6 months after his life insurance policy was issued. The insurer will

answer

Refund the premiums paid. If the insured commits suicide within a certain period of time following the policy effective date, the insurer's liability is limited to a refund of premium.

question

What is the name of a clause that is included in a policy that limits or eliminates the death benefit if the insured dies as a result of war or while serving in the military?

answer

Military service or war. There are two different types of exclusions that may be used by life insurers that limit the death benefit if the insured dies as a result of war or while serving in the military. The status clause excludes all causes of death while the insured is on active duty in the military. The results clause only excludes the death benefit if the insured is killed as a result of an act of war.

question

Which provision of a life insurance policy states the insurer's duty to pay benefits upon the death of the insured, and to whom the benefits will be paid?

answer

Insuring clause. The insuring clause states that the insurer agrees to provide life insurance for the named insured which will be paid to a designated beneficiary when proof of loss is received by the insurer.

question

The minimum number of credits required for partially insured status is

answer

6 . To be considered partially insured, an individual must have earned 6 credits during the last 13-quarter period.

question

An insured owns a $50,000 whole life policy. At age 47, the insured decides to cancel his policy and exercise the extended term option for the policy's cash value. What would be the face value of the new term policy?

answer

$50,000 . The face of the term policy would be the same as the face amount provided under the whole life policy

question

Which of the following is NOT true regarding the death benefit in a variable whole life policy?

answer

The death benefit does not change. Under a variable life policy, the death benefit may increase or decrease over the life of the policy depending on the investment performance of the separate account. However, the death benefit cannot decrease below the initial face amount of the policy, and in that sense it is guaranteed.

question

A primary beneficiary discovers upon the death of her uncle that he chose the interest only option. What does this mean?

answer

The beneficiary will only receive payments of the interest earned on the death benefit. With the Interest Only Option, the insurance company retains the policy proceeds and pays interest on the proceeds to the recipient (beneficiary) at regular intervals (monthly, quarterly, semiannually, or annually).

question

Withdrawals from an IRA taken before the participant reaches age 59 1/2 are subject to

answer

Income taxation and a penalty. If funds are withdrawn from an IRA before the participant reaches age 59 1/2, the funds are subject to both income taxation and a penalty.

question

Which of the following statements concerning Medicare Part B is correct?

answer

It pays for physician services, diagnostic tests, and physical therapy.

question

A Universal Life Insurance policy is best described as

answer

An Annually Renewable Term policy with a cash value account. A universal policy has two components: an insurance component and a cash account. The insurance component (or the death protection) of a universal life policy is always annual renewable term insurance

question

An insured owns a 20-year Return of Premium term life policy. If the insured is still alive after 20 years, the premiums will be refunded

answer

In full as non-taxable income. Since the amount returned equals the amount paid in, the returned premiums are not taxable.

question

Under an extended term insurance policy, the policy cash value is converted to

answer

The same face amount as in the whole life policy. Under this option the insurer uses the policy cash value to convert to term insurance for the same face amount as the former permanent policy.

question

Which of the following is considered a qualifying event under COBRA?

answer

Divorce. Other qualifying events include the voluntary termination of employment; an employee's change from full time to part time; or the death of the employee.

question

All of the following are dividend options EXCEPT

answer

Fixed period installments. Fixed period installments option is not one of the dividend options.

question

An insured purchases a policy in 2000 and dies in 2005. The insurance company discovers at that time that the insured concealed information during the application process. What can they do?

answer

Pay the death benefit. The incontestability clause prevents an insurer from denying a claim due to statements in an application after the policy has been in force for 2 years, even on the basis of a material misstatement of facts or concealment of a material fact.

question

What required provision protects against unintentional lapse of the policy?

answer

Grace period. The grace period is the period of time after the premium due date that the policyowner has to pay the premium before the policy lapses (usually 30 or 31 days). The purpose of the grace period provision is to protect the policyholder against an unintentional lapse of the

question

Contracts that are prepared by one party and submitted to the other party on a "take it or leave it" basis are classified as

answer

Contracts of adhesion. Insurance policies are written by the insurer and submitted to the insured on a "take it or leave it" basis. The insured does not have any input into the contract, but simply adheres to the contract.

question

Which nonforfeiture option provides coverage for the longest period of time?

answer

Reduced paid-up. The reduced paid-up nonforfeiture option would provide protection until the insured reaches 100, but the face amount is reduced to what the cash would buy.

question

What amount of care is provided in LTC's intermediate care?

answer

Daily care by medical personnel

question

Employees actively at work on the date coverage is transferred to another insurance carrier are

answer

Automatically covered and exempt from any probationary period.

question

A producer who omits a statement which may mislead or deceive the persons addressed has committed

answer

Misrepresentation. Making false or misleading statements with the intent to defraud another is misrepresentation.

question

what contitutes the entire contract ?

answer

the policy, copy of application, along with any riders and amendments

question

what is the insuring clause ?

answer

is the basic agreement between the insurer and the insured. it states the insurer's promise to pay the death benefit upon the insured's death.

question

what is in the first page of the policy ?

answer

unsuring clause, who the parties to the contract are, the premium to be paid, for how long the coverage is in force and the death benefit.

question

what is free look ?

answer

is a specified number of days from receipt to look over the policy and if dessatisfied, return it for a full refund

question

what is consideration ?

answer

both parties to a contract must provide consideration in order to be valid. the consideration given by the insured is the premiums and the statements made in the application. by the insurer is promise to pay in accordance with the terms of the contract.

question

what is owners rights ?

answer

naming and changing the beneficiary, receiving the policy living benefits, selecting benefits payment options and assigning the policy.

question

what are the policyowner responsabilities?

answer

pay the policy premium and must have an insurable interest in the insured at the time of application of the insurance

question

what is third party ownership ?

answer

when the policyowner and the insured are not the same person

question

the policyowner may change the complete or partial ownership of the policy without changing the

answer

insured or amount of coverage

question

what are the two types of policy assignments ?

answer

absolute, when permanent and total transfer of ownership and collateral when only partial rights are involved

question

what is beneficiary desigantions ?

answer

is a person or interest to which the policy proceeds will be paid upon the death of the insured. this person does not have to have an insurable interest in the insured

question

what are the two types of beneficiary's ?

answer

primary, which has first claim to the proceeds and contingent which has second claim in the event that the primary beneficiary dies before the insured.

question

what is the different types of beneficiary designations ?

answer

revocable, in which the policyowner may do any changes to the policy and irrevocable where in order to do certain changes, the policyowner needs written consent from the beneficiary

question

what is common disaster clause ?

answer

which is provided under the uniform simultaneous death law, will asume that the primary beneficiary died first in a common disaster where the insurer and primary beneficiary where involved. an specific time period of 30, 60 or 90 days must occur in order to follow this provision

question

what is minor beneficiarys ?

answer

this proceeds will be paid to the minor's guardian, trustee or as directed by a court.

question

what is the premium mode ?

answer

is the manner or frequency that the policyowner pays for the premium, could be annual, semmi-annual, quarterly or monthly, been the last one the most expensive.

question

what is the grace period ?

answer

period of time after the premium due date , that the policyowner has to pay the premium before the policy lapses.

question

what are the two types of premium ?

answer

level, where the premium remains the same for the duration of the contract and flexible where the policyowner pay more or less than the planned premium. for example the universal life

question

what is reinstatement ?

answer

allows the lapsed policy to be back in force, ussualy the limit is 3 years after it lapsed. policyowner may be required to pay back owned premiums, interest and any outstanding loans and interest. the benefit is that it willbe restored at the insured's issue age

question

what is incontestability ?

answer

prevents the insurer from denying a claim due to statements in the application after the policy has been in force for two years. does not apply in nonpayment of premiums, age, sex and identity.

question

what is misstatement of age and gender ?

answer

is a provision that allows the insurer to adjust the policy at any time due the misstatement of age and gender.

question

what is policy loan ?

answer

option is only found in policies that contain cash value. policy will not lapsewith outstanding loans unless the amount and accrued interest exceeds the cash value. also the insurer must give a 30 day written notice to policyowner before policy laspes. this loans can take up to six months to be approved unless is to pay policy premiums

question

what is automatic premium loan ?

answer

this type of loan prevents from the unintentional lapse of a policy due to non payment.

question

what are exclusions ?

answer

type of risk the policy will not cover. aviation, hazardous occupation and hobbies and war or military service. this last one could be a status clause which excludes of types of death where active in the military or results clause which only excludes if killed in war.

question

what is the suicide clause ?

answer

usually stipulates a period of time during which the death benefit will not be paid if insured commits suicide

question

what is policy riders ?

answer

are added to the basic life insurance in order to add, modify or delete policy provision. must be attached to a policy and generally require payment of additional premium

question

what is a policy rider that delete coverage ?

answer

exclusions

question

what is waiver of premium ?

answer

waive the premium of the policy if the insured becomes totally disable. has a 6 months waiting period and expires at 65

question

what is totally disability ?

answer

is the insured's inability to perform the duties of his own occupation for the first two years

question

what is waiver of premiums with disability income ?

answer

in the event of disability the insurer will waive the policy premiums and pay a monthly income to the insured. is normally a percentage of the policy face amount.

question

what is guaranteed insurability ?

answer

allows the insured to purchase additonal coverage at specific future dates, usually every 3 years or events without proof of insurability. expires at 40

question

what is payor benefit ?

answer

use with juvenile policies. if the payor become disable for 6 months or dies, the insurer will waive the premiums until the minor reaches a certain age , such as 21. also used when the owner and the insured are two different people

question

what is accidental death and accidental death and dismemberment ?

answer

accidental death pays multiple of face amount if death is result of and specified accident, double or triple indemnity. death must occur between 90 days of accident. and A.D.D. pays the principal for death and a capital, which is half , for dismemberment

question

what is term riders ?

answer

allows for an additional amount of temporary insurance

question

what is L.T.C. coverage ?

answer

is a rider that provide payment of part of the death benefit in order to take care of the insured's health care expenses. this reduce the face value of the policy

question

what is spouse term rider ?

answer

is coverage for a limited time and specific amount. expires at 65

question

what is children term rider ?

answer

allows children of insured to be added to the coverage for a limited period and amount. usually expires when reach 18 or 21. is also an option to convert to a permanent policy without insurability

question

whats is nonfamily insureds ?

answer

it's not permited to additional insured, but instead allows for the change of insureds, subject to insurability

question

what is accelerated benefit ?

answer

provides for an early payment of part of the policy death benefit if insured is diagnosed with a terminal illness that will result in death within 2 years or has other qualifying conditions

question

what is return of premium ?

answer

implemented by using increasing term insurance. when added to a whole life, provides that a death prior to a certain age, will not only pay the original face amount but also will pay an amount equal to all premiums paid. expires at 60

question

what is nonforfeiture options ?

answer

because permanent life insurance have cash value, certain guarantees are a must and cannot be forfeited by policyowner. cash surrender value, reduced paid-up insurance and extended term

question

what is cash surrender ?

answer

policyowner surrendersthe policy for a current cash value. if cash value exceeds premiums paid, the excess is taxable as ordinary income. a surrender charge may be charged by insurer.

question

whats is reduce paid-up insurance ?

answer

the cash value is used by the insurer as a single premium to purchase a comlpletely paid-up permanent policy that has a reduced face amount

question

what is extended term ?

answer

the insurer uses the policy cash value to convert to term insurance for the same face amount as the former permanent policy. if nonforfeiture option has been choosen, the insurer implement this one

question

what are dividens and dividens options ?

answer

paid only in participating policies. dividens are a return in excess premiums and for that reason they are not taxable to the policyowner. they can not be guaranteed.

question

what are the options policyowners have for taking their dividens ?

answer

cash, usually annually. application to reduce premiums, where the insurer uses the dividens to reduce the next year's premium and accumulation at interest wherethe insurer keeps the dividensi in an account where accumulates interest. can take the dividends at any time. although the dividends are not taxable, the interest are

question

what is paid-up additions ?

answer

dividends are used to purchase a single premium premium policy in addition to the face amount of the permanent policy. each additional premium will increase the death benefit of the original policy

question

what is paid-up ooption ?

answer

if the insured has a continuous premium whole life policy, where premiums are paid to 100, with this option will pay up the policy early

question

what is one year term option ?

answer

insurer uses dividends to purchase additional insurance in the form of one year term insurance, that increases the overall policy death benefit.

question

what is acceleration of endowment ?

answer

requires the insurer to first accumulate the dividends at interest and then the accumulated amount is used to either shorten the endowment period or convert the whole life policy intoan endowment

question

what is settlement options ?

answer

are the methods used to pay the death benefit to a beneficiary upon the insured's death or to pay the endowment benefit if the insured lives to endwoment date. beneficiary can only change the settlement option if the policyowner did not choose one at the time insured's death

question

what is fixed period ?

answer

a specific period of years is selected and equal installments are paid to the recipient. not guarantee payment for life, but entire principal will be distributed

question

what is fixed amount ?

answer

pays a fixed, specified amount in installments unitl the proceeds are exhausted

question

what is life income ?

answer

provides the recipient with an income that connot outlive. installment are guaranteed for as long as the recipient lives

question

what is life income with period certain options ?

answer

the recipient is provided with a combo of lifetime income and guaranteed installment period. if recipient dies, the beneficiary fro the reminder of the guarantee period.

question

what is life income joint and survivor /

answer

this option guarantees an income for two or more recipientsfor as long as they live. could be joint and 1/2 survivor or joint and 2/3 survivor in which the survivor recipient receives 1/2 or 2/3 of the income when both where alive

question

what is interest only ?

answer

the insurance company retains the policy proceeds and pays interest on the proceeds to the recipient at regular intervals. this is considered a temporary option since the proceed are retain until are paid in a lump sum.

question

what is medical expense insurance ?

answer

3 basic coverages, hospital, medical and surgical. they are first -dollar coverages. unlike mejor medicel policies they do not require a deductible

question

what is basic hospital expense coverage ?

answer

cover hospital room and board and miscellaneous expenses, such as x rays, medicines, etc when insured is in the hospital and specified a dollar amount per day and a maximum number of days

question

what is miscellaneous hospital expenses ?

answer

can be expressed as a multiple of the room and board charge or a flat amount

question

what is a basic medical expense coverage

answer

provides coverage for nonsurgical services a physician provides. limites to patients confined in a hospital. could also cover emergency, maternity, mental disorders, hospice care, outpatient care and nurse's expenses

question

what is basic surgical expense coverage ?

answer

pay for the cost of surgeon's services in or out of the hospital.

question

whats is relative value ?

answer

each surgical procedure will be assigned a number of pointst that are relative to the number of points assigned to the maximum benefit. the conevrsion factor represents the total amount payable per point

question

what is mejor medial policies ?

answer

this policies offer a broad range of coverage. this policies usually carry deductibles, coinsurance requirements and large benefits maximums/

question

what is supplemental mejor medical policies ?

answer

afetr basic policy pays, the supplemental will provide coverage, the insured must pay a corridor decuctible.

question

what is H.M.O. ?

answer

provide benefits in the form of services rather than reimbursement. also provides both the financing and patient care for its members.

question

what is H.M.O. limited service area ?

answer

offer services to those in a specific geographic areas.

question

what is H.M.O. limited choice of providers ?

answer

it limit the cost by only providing care from physicians that meet their standards at a prenegotiated price

question

what is H.M.O. copayment ?

answer

is an specific part of the cost to be paid by the member

question

what is H.M.O. prepaid basis ?

answer

is a prepaid medical plan

question

what is H.M.O. preventive care ?

answer

they reduce the cost by utilizing preventive care, free annual check ups and free immunization to members

question

whats is primary care physician ?

answer

a limited number the physician that are approved also call gatekeeper

question

what is referral physician ?

answer

in order to see an specialist must be refer first by the gatekeeper

question

what is emergency care and hospital services in H.M.O. ?

answer

can be provided in or out of service are as long is an emergency or for treatment of mental disorders, alcohol abuse, drug abuse.

question

what is a P.P.O. ?

answer

physician are paid a fee for service. members can use any physician or facility.

question

what is open panel ?

answer

when a phisician retain the right to also treat patients who are not members. they are not considered P.P.O. employee's

question

what is closed panel ?

answer

doctors are considered amployee's and can only treat members.

question

what is P.O.S. or point of service ?

answer

a combination of h.m.o. and p.p.o. a different choice can made every time. however, a member copay, coinsurance and deductibles may be much higher, just like the p.p.o.

question

what is a gatekeeper P.P.O. ?

answer

can be choose be member to lower out of pocket cost

question

what is flexible spending account ?

answer

employee is allow to deposit certain amount from paycheck before paying income taxes.they are subject to maximum amounts and use or loose rule. it could be health care account or dependent care account. this accounts are exempt of all taxes forms

question

flexible spending account qualifying for dependants ?

answer

dependant under 13, spouse that physically or mentally can't care of herself and a dependant that is mentally challange

question

limited contribution to F.S.A. is

answer

$5,000 and is a family limit....

question

what is health reimbursement account H.R.A. ?

answer

funds set aside by employers to reimburse employee's for quelified medical expenses. not a taxable employee benefit, employer contribution are tax deductible, balances can be roll-over, allows employer to reduce health plan costs by coupling the h.r.a. with high deductibles. no statutory limits, they are all set by employer

question

high deductible health plans h.d.h.p. and related savings accounts h.s.a.

answer

this plan have high deductible and out of pocket limits but with reduce premiums

question

H.S.A. accounts

answer

contributions are tax deductible and designed to help save for qualified health expenses that spouses and dependents may incur. to qualify, the individual must be covered by a high deductible health plan, no covered by other helth insurance, not elegible for medicare and not be calimed as a dependent. h.s.a. money can be used for other expenses but must pay taxes plus a 10% penalty if before 65. after 65 only taxes

question

stop and loss insurance

answer

provide coverage for employer who self fund or self insure their employee's health insurance. here, the employer is the one insured. the pre-establish limit at which the stop and loss goes in effect is the deductible

question

individual disability income insurance

answer

designed to replace lost income. could be individual or through an employer

question

presumptive disability

answer

specifies the conditions that will automatically qualify for full desability benefits, provides a benefit for dismemberment

question

recurrent disability

answer

is a period of time, usually 3 to 6 monthsduring which a recurrence of an injury will be considered a continuation of a prior disability

question

elimination period

answer

waiting period to the insured from onset of the disability until the benefit payment commence. is a deductible in days instead of dollars. range from 30 to a 180 days, longer elimination translates in lower premium

question

benefit period

answer

lenght of time over which the monthly disability benefit payment will last

question

injury

answer

the damage to the body that is unexpected or unintended

question

sickness

answer

a disease contracted after the policy has been in force for 30 days

question

benefit limitations in disability income policies

answer

is based in the percentage of the insured past earnings, it's about 66% of average earning for 2 years preceding the disability

question

social security rider or social insurance supplement is

answer

used to supplement or replace benefits that might be payable under social security disability. could be to cover the benefits before the 5 months waiting period, or insured has been denied coverage or when the amount is less than the aount payable under the rider, only the difference will be paid.

question

business overhead expense

answer

sold to small business who must pay overhead expenses following the desability of the owner. has an elimination period of 15 to 30 days and payments limited to a max of two years. premiums are tax deductible but benefits taxable

question

business disability buy out policy

answer

this agreement will specify who will purchase a disable partner's interest and legally obligates that person to purchase such interest upon disability. elimination period could be 1 or 2 years. premiums are not tax deductible but the benefits are tax free. usually in a lump sum.

question

group disability income policy

answer

benefits based on percentage of worker's income, max benfit period of 26 weeks, benefit 50% to a 100% of incomeemployee must have worked 30 to 90 days before elegible, are supplemetal to workers compensation and limited coverage to nonocupational disabilities

question

key employee

answer

contract owned by the business, premium is paid by the business and is also the beneficiary. benefit is collected tax-free

question

A.D.D. accidental death and dismemberment

answer

can be a rider or separate policy. it could be principal sum for accidental death or capital sum for dismemberment. could be limited risk, which defines specific risk or special risk which cover unusual type of risk.

question

L.T.C. definition

answer

provide coverage for individuals who are no longer able to live and independant lifestyle. elimination period is 30 days. benefit period is up to 5 years. payment is specific dollar amount per day. most are guaranteed renewable but premiums may increase. could be an individual or group contract

question

L.T.C. exclusions

answer

pre-existing conditions, mentl and nervous disorders, alcoholism and drugs, illness caused by war, criminal activities, attempted siucide and treatment paid by goverment such a medicare, workers comp, etc

question

L.T.C. level of cares

answer

skilled cared that can only be provided by medical personnel, intermediate care is nursing and rehabilitation services in a 24 hours bases, custodial care is assisting in eating , dressing, etcby nonmedical personnel, home health care is provided by skilled nursing in one's home, home convalescent care provided by attending physician in one's home, residential care is provided in a retirement community, adult day care is provided for functionally impaired adults in less than a 24 hours bases and respite care which is designed to provide relief to the family caregiver

question

group insurance definition

answer

coverage must be incidental to the group. it could be employer-sponsored or association-sponsored. insurability not required.

question

association group

answer

at least 100 members, active for 2 years, have a constitution , by laws and hold a yearly meeting. may be contributory or non. has a master contract and issues certificates of insurance to his members

question

group conversions

answer

individual can convert group to individual insurance without proof of insurability if is between 31 days of termination, it may have limitation in pre-existing conditions but will expire in two years

question

cobra

answer

for 20 or more employee's. qualifying events are, voluntary termination, termination of emplyment other than missconduct, emplyment status change, from full to part time. coverage extended up to 18 months. must excercise extension within 60 days of separation. for employee's death, divorce or legal separation is 36 months for the dependants

question

H.I.P.A.A. definition

answer

health insurance portability and accountability act, ensures portability of group insurance coverage. also regulates protection for group by limiting pre-existing exclusions, discrimination and opportunities in a new plan. and for individuals guaranteeing acces to individual policies and renewability.

question

H.I.P.A.A. elegibility

answer

employers can not discriminate based in health factors like, health status, medical conditions, claim experience, medical history, etc. to convert from group plan to an individual plan must be 18, been covered by a group plan, have use any cobra, not elegible for medicare or medicaid, not have other health insurance and apply within 63 days of loosing coverage. pre-existing condition for 6 months won't be covered and can impose a 12 waiting period on pre-existing conditions or 18 months if late enrollee. is also guranteed renewability

question

dread disease or limited risk

answer

are benefits for an specific desease, such as cancer, etc. benefits are paid in a fixed dollar mount

question

critical illness

answer

pays a lump sum to the insured upon diagnose of critical illness

question

dental expense

answer

an important feature is the inclusion of diagnostic and preventive care

question

vision & hearing plans

answer

some employers offer eye examinations, eyeglasses or hearing aids on a limited basis.

question

term life definition

answer

is a temporary protection for a specific time period. if insured die during the term, the policy pays the death benefit to the beneficiary, if policy expires or is canceled prior indured's death, nothing is to be paid and there is no cash value or living benefits. is renewable, convertible or both

question

term renewable insurance

answer

allows the policycowner the renew at expiration day without insurability proof. premium will be based in current age

question

term convertible insurance

answer

policyowner can convert to a permanent policy without insurability proof. premium will be based in current age

question

level insurance types

answer

is base in how the face amount changes during the policy. level, decreasing and increasing

question

level term insurance

answer

the most common, death benefit stays level throughout the policy life

question

annually renewable term

answer

is level but the premium increases annually according to the attained age.

question

decreasing term insurance

answer

it has level premium and death benefit that decreases each year over policy duration. use for mortgages or other debts. can be conertible but not renewable since the death benefit is $0 at the end of the policy term.

question

increasing term insurance

answer

it has level premiums and death benefits that increases every year over duration of the policy term. used by insurance companies to fund certain riders, like refund on premiums

question

return of premiums

answer

is an inceasing term insurance that pays an additional death benefit to the beneficiary equal to the amount of premiums paid

question

permanent life insurance

answer

is various forms of life insurance that build cash value and remain in effect the entire life of the insured or unitl 100

question

whole life insurance

answer

provides lifetime protection and includes a savings element or cash value. this policies endow at the insured 100 birthday, which means the cash value is equal to the face amount of the policy at age 100. 3 types of whole life, straight life, limited -pay life and single premium life.

question

straigth life

answer

is the basic whole life policy where policyowner pays the premiums from the policy issue till death or 100

question

limited-paid whole life

answer

is designed so that the premiums for coverage will be completely paid up well before 100. premiums are much higher here.

question

single premium whole life

answer

it has level death benefits to age 100 and a one time time lump sum payment. it generates immediate cash and most companies will require a minimum premium for policy maintance.

question

ajustable life

answer

it offers the best of both words, term and permanent coverage. premium and coverage is determine by the insured and can be change at any time for, period of protection and increase or decrease permium, paying period and face amount. also can be converted from term to whole life and viceversa, however may required proof of insurability. cash value develops when premium amount are more than the policy cost

question

universal life

answer

or flexible premium universal life where policyowner has the lfexibility to increase or decrease the premium, may even skeep a premium if they have sufficient cash valueat the time.

question

universal life premium can be

answer

minimum just to keep the policy in force or target where a recommended amount must be paid to keep the policy in force thruoghout its lifetime

question

universal life components are

answer

an insurance component which is always an annually renewable term and a cash account

question

unversal life has two death benefits options

answer

a, which is a level death benefits and b, which is an increasing death benefit

question

option a

answer

death benefits remains level, while the sach value increases. the death benefit increases at a later point is to comply with the I.R.S. corridor or gap

question

option b

answer

death benefits includes the annual increase in cash value so the death benefit increases each year by the amount that cash value increases

question

variable whole life

answer

it does not have the same guarantees of pricipal and interes that are found in whole life policies. the main difference is that the policyowner may alocate the premiums into a sub-account that is held by the insurance company, called, separate account . here death benefit and cash value is not guaranteed, however the death benefit cannot decrease below the initial face amount. premium is fixed and will not change for the policy life. because it involves investments accounts, security license and life insurance license is required

question

variable universal life

answer

combo of universal and variable life. i tprovides policyowners with flexible premiums. adjustable death benefits and the policyowner decides where the net premiums will be invested. cash value is not guaranteed and the death benefit is not fixed

question

interest-sensitive whole life

answer

is a fixed premium whole life that provides guaranteed death benefitas to age 100. it credits the cash value with the current interest rate comparable to money markets. also a minimum rate of interest.

question

equity indexed whole life

answer

is that the cash value is dependent upon the performance of the equity index although minimum cash value is guaranteed. premiums are fixed and death benefits are guaranteed

question

joint life

answer

is a single policy to insure two or more lifes. could be term or permanent insurance. most common form is joint group life where the premiums is based on an average age between the insured's and that the death benefit is paid upon the first death only.

question

survivorship life

answer

is much the same as joint life with the difference that the death benefits are paid on the last death, resulting in much lower premiums

question

annuities

answer

is a contract that provides income for an specific period of years or life. may protect a person from outliving his own money. they are not life insurance but rather a way of accumulating money. annuities don't pay any death benefits and probably payment stop with the death of the annuitant

question

annuitant

answer

is the person who receives benefits or payments from the annuity, who's life expectancy is taken in consideration. although annuities can by own by a trustee or corporation, the annuitant must be a natural person. they have nonforfeiture values which may be witdrawn prior annuitization date. annuities can be used for any purpose that requires a steady stream of income at some future point.

question

annuities periods

answer

accumulation period, is where the annuitant makes payments and the pay-out period is where the accumulated sum is converted into an stream of income payments to the annuitant

question

annuities are classified by

answer

method used of funding, annuity payment, date of annuity payment begin and underlying investment configuration of the annuity

question

method of funding annuities

answer

single payment, periodic payment and flexible premium

question

annuity method of payment

answer

immediate, the one purchased with a single payment and payments start within one year and deffered. where payments begin sometime after one year. this annuity could be funded by one lump sum or through periodic payments

question

annuity method of grow

answer

fixed, where the annuitant knows exactly the amount of each payment will receive, may be eroded by inflation or variable, where the value of the investment account may be subjet to variation. premium are deposited in a separate account. then converted to annuity units, the income is then paid to the annuitant based in the value of the annuity units. this type serves as an hedge against inflation. variable annuity require security and life insurance and to be registered with the F.I.N.R.A.

question

index annuities

answer

are fixed annuities that invest on an aggresive basis for higher returns. has a guaranteed minimum interest rate and is tie to Santdard and Poor's 500. normally, insurance companies reserve the initial returns for themselves an pay the excess to the annuitant

question

The Probationary Period is

answer

A specified period of time that a person joining a group has to wait before becoming eligible for coverage.

question

The minimum number of credits required for partially insured status is

answer

6

question

All of the following are dividend options EXCEPT

answer

Fixed period installments.

question

What are the 2 types of Flexible Spending Accounts?

answer

Health care accounts and Dependent care accounts

question

Which of the following is INCORRECT regarding HIPAA's creditable coverage?

answer

The 12 months of creditable coverage must all come from the same employer.

question

Which of the following is NOT an exclusion in medical expense insurance policies?

answer

Chiropractic care

question

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within

answer

90 days of a loss.

question

In a basic expense policy, after the limits of the basic policy are exhausted, the insured must pay what kind of deductible?

answer

Corridor

question

Which health insurance provision describes the insured's right to cancel coverage?

answer

Renewal provision

question

Which of the following is NOT a feature of a noncancellable policy?

answer

The insurer may terminate the contract only at renewal for certain conditions.

question

All of the following are correct about the required provisions of a health insurance policy EXCEPT

answer

A reinstated policy provides immediate coverage for an illness.

question

If the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following?

answer

Adjust the benefit in accordance with the increased risk.

question

What is NOT a benefit of a POS plan?

answer

It allows guaranteed acceptance of all applicants.

question

Who can make a fully deductible contribution to a traditional IRA?

answer

An individual not covered by an employer-sponsored plan whose earned income is below a required limit

question

Which provision of a life insurance policy states the insurer's duty to pay benefits upon the death of the insured, and to whom the benefits will be paid?

answer

Insuring clause

question

A Universal Life Insurance policy is best described as

answer

An Annually Renewable Term policy with a cash value account.

question

Another name for a Keogh Plan is

answer

HR 10.

question

An insured owns a 20-year Return of Premium term life policy. If the insured is still alive after 20 years, the premiums will be refunded

answer

In full as non-taxable income.

question

Q was treated for hypertension prior to applying for a major medical policy. As the producer who is writing the replacing policy, what should you tell Q?

answer

His hypertension may be considered a pre-existing condition, and may not be covered under his new policy.

question

Which rider, available in disability income insurance, will provide benefits above the base policy amount?

answer

Multiple indemnity rider

question

Under an extended term insurance policy, the policy cash value is converted to

answer

The same face amount as in the whole life policy

question

Disability income coverage specifies that the policy covers the insured if he is unable to perform any job for which he is qualified. In this case, total disability is defined as

answer

Any occupation - more restrictive than other definitions.

question

A premature distribution from a Roth IRA made before the individual reaches age 59½ is subject to a 10% penalty tax unless the distribution was for

answer

A first-time home purchase.

question

All of the following are characteristics of a Universal Life policy EXCEPT

answer

The planned premium pays for mortality charges and expenses and any excess is returned to the policyowner.

question

An insured purchases a policy in 2000 and dies in 2005. The insurance company discovers at that time that the insured concealed information during the application process. What can they do?

answer

Pay the death benefit

question

An insured owns a $50,000 whole life policy. At age 47, the insured decides to cancel his policy and exercise the extended term option for the policy's cash value. What would be the face value of the new term policy?

answer

$50,000

question

When a disabled dependent child reaches the age limit for coverage, how long does the policyowner have to provide proof of dependency in order for the dependent to remain covered under the policy?

answer

31 days

question

Should an employee of an employer with fewer than 20 employees voluntarily terminate his/her employment, they would be eligible to continue their coverage under the group health policy for how many months?

answer

0 months. The Continuation of Coverage provision of group health insurance does not apply to those employees who voluntarily leave employment.

question

What is the maximum amount that the Nevada Life & Health Insurance Guaranty Association may be obligated to pay - with respect to disability insurance for 1 life?

answer

$300,000

question

How many days after the death of an insured does an insurer have to pay group life insurance policy benefits?

answer

30 days

question

What amount of care is provided in LTC's intermediate care?

answer

Daily care by medical personnel

question

The duties of a managing general agent may include all of the following EXCEPT

answer

Altering policies.

question

medicare has the following parts

answer

part a, hospital insurance. part b, medical insurance, part c, health care services and part d, prescription coverage

question

medicare part a

answer

pays for, inpatient hospital care, nursing facility, home healt care and hospice care. must be 65 or 65 with spouse benefits or lees than 65 but disable for 24 months or renal disease or has A.L.S. enrollment could be initial, general or special

question

inpatient nursing facility

answer

up to 90 days in hospital, first 60 no deductible.

question

home health care

answer

no limit in home visits, part time skilled nurse, physical and speech terapy

question

skilled nursing facility

answer

up to a 100 days, follow by 3 days inpatient hospitalfor related illness

question

hospice care

answer

covers docotrs, nurses, medical appliances and supplies

question

blood

answer

all but the first 3 pints per year

question

medicare part b

answer

medical and other supplies not covered by part a. is optional and must be declined for anyone who has part a. no maximum out of pocket limit on the 20% coinsurance

question

doctor services

answer

no matter where in the U.S.

question

outpatient hospital services

answer

for diagnosis and treatment, emergency room, etc

question

home health visits

answer

as long is recommended by the insured's doctor and the insured is elegible

question

other medical and health serices

answer

ambulance transport, home dialysis, supplies, support services, oral surgery, lab tests and x rays

question

prescriptions drugs

answer

only medicines that are administered in a hospital outpatient department

question

outpatient treatement of mental illness

answer

but 45% coinsurance

question

medicare part c

answer

or medicare advantage must be in part a and b. medical services except emergencies. also provides special health care for specific groups of people. a medicare private fee for services plan is part of advantage

question

medicare part d

answer

is optional, provides 75 % of prescription cost until a benefit cost is reached, then a donut hole occurs. catastrophic coverage is up to 95 %

question

medicare supplement policies

answer

or medigap are issued by private insurance , designed to fill the gaps in medicare. under obra, may not discriminate. open enrollment is up to 6 months where first sign up for part b

question

medigap plan

answer

guaranteed renewable, insurer must use same format, definitions, etc in all plans and 30 days free look. can not restrict coverage on pre-existing for more than 6 months

question

medicare select

answer

is a supplemental policy that contains restricted netowrk provisions, that conditions the payment of benefits in part or as a whole on the use of network providers

question

medicaid

answer

federal and state program for low income people. to qualify one's must be poor

question

social security benefits

answer

provides disability income for proper insured people and meet the definition of disability and waiting period.

question

definition of disability

answer

inability to work as a result of a medical or mental impairment that is expected to result in death or last for at least 12 months

question

qualifications for disability

answer

before 24, 6 credits and 3 years prior. 24 to 31 years and 12 credits and after 31years from 20 to 40 depending on age. 5 months waiting period. payment will be based in on person P.I.A. or personal insurance amount

question

uniform individual accident and sickness policy provisions law

answer

this law establish the provisionsto be included in all individual health insurance. it defines the rights and duties of policyolders and insurers

question

entire contract

answer

the policy, copy of signed application and any attached riders or amendments constitutes the entire contract. only the executive officer of a company can make changes

question

grace period

answer

period of time after the payment due date that the policy still be in force. 7 days for weekly, 10 days for monthly and 31 days for yearly

question

reinstatement

answer

is automatic if insurer accepts the policy premium. accident are cover right away but sickness after 10 days

question

change of beneficiary

answer

irrevocable or revocable

question

notice of claim

answer

unsured's duty to provide notice between 20 days of loss

question

claim forms

answer

must be suplied by insurer within 15 days

question

proof of loss

answer

the claimant must submit proof of loss whitin 90 days but not exceed 1 year

question

time of payment claims

answer

could be 60, 45 or 30 days. however disability income must be paid not less than monthly

question

payment of claims

answer

specified to whom the proceeds are to be paid to

question

physical examination and autopsy

answer

at insurer's expense as much as neccessary

question

time limit on certain defenses

answer

no statement or misstatement, except fraud, can be denied if policy has in force for 2 years. also applies for pre-existing conditions

question

legal actions

answer

limits of time where the insured , may seek recovery from insurer. must wait 60 days but no more than 3 years after proof of loss

question

misstatement of age

answer

benefits would be adjusted to correct age

question

optional provisions

answer

change of accupation, where the insurer is allow to adjust benefits if insured changes jobs. more hazardous benefits may reduce the benefits or less hazardous may reduce the premium. also illegal ocupations, where benefits may be denied if insured is injured during illegal acts

question

insuring clause

answer

identifies the insured, insurance company, kind of loss that is covered

question

free look

answer

period to look over the policy and return it if not satisfied. applies from delivery date

question

probationary period

answer

is period of time that must lapse before coverage goes in effect

question

waiver of premium

answer

in the event of permanent or total disability, permiums will be waived for disability duration. to qualify, must be totally disable for 3 to 6 months and waiting period is also 3 to 6 months . expires at 65

question

pre-existing conditions

answer

coverage will not apply within a certain amount of time before application

question

recurrent disability

answer

specified period of time that must lapse between 2 illnesses

question

coinsurance

answer

sharing expenses between insured and insurance company. could be 80-20. 50-50. etc. to limit out of pocket amount is the stop and loss limit where after certain amount, insurance company covers 100%

question

deductible

answer

specific dollar amount that the insured must pay before the insurance pay policy benefits. could be annual, individual, family, flat, integrated, etc. time deductible is elimination period.

question

carry over provision

answer

allows the insured to carry over the last 3 months expenses to next year's policy

question

exclusions

answer

spicify what the insurer will not pay. maternity, mental disorders, substance abuse

question

redcutions

answer

are decrease of benefits for a time period, like, sering military, resides in foreing country, etc

question

copayment

answer

set dollar amount that the insured will pay each time certain medical services are used

question

pre-authorization

answer

some health policies require prior approval before some medical procedures, etc

question

usual, reasonable and customary charges

answer

means the insurer will pay an amount for a given procedure based in the average of that procedure in that geographic area

question

impairment rider

answer

eliminates coverage for an specific pre-existing condition

question

guaranty insurability rider

answer

allows the insurer to purchase additional amounts of disability income coverage without insurability, expires at 50

question

multiple indemnity

answer

certain benefits are double or tripled when death of insured was due to specific circunstances. death must occur in 90 to 100 days from time of accident

question

right of renewability

answer

insured rigths to cancel or renew coverage

question

non-cancelable

answer

insurer can not cancel nor the premium can be increased beyond what is stated in the policy

question

cancelable

answer

allows the insurer to cancel the policy at any time ar at end of policy period. proper notice the cancellation must by issued and refund any unearned premiums

question

guaranteed renewable

answer

similar to noncancellable but here the insurer can increase the premiums. expires at 65

question

conditionally renewable

answer

the insurer may terminate the contract only at renewal for certain conditions

question

optionally renewable

answer

the insurer may cancel for any reason. renewablity is an insurer option. if renew the policy may also increse the premium.. may not renewal due to claims experience

question

period of time

answer

coverage is a term health policy which is not renewable

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