How can an AD&D (Accidental Death & Dismemberment) policy be written?
As a rider to a health insurance policy, or as a separate policy.
What is the time requirement for terminated employees to convert the group health coverage to an individual plan?
31 days after termination of the employment.
If a group health policy covers individuals that reside in more than one state, which state has jurisdiction over the group policy?
The state in which the policy was delivered.
When are newborns covered in individual health insurance policies?
From the moment of birth.
With key person disability insurance, who pays the policy premiums?
The Business/Employer
What is the "own occupation" disability?
Insured's inability to perform duties of his or her current job or an occupation for which the insured is educated and trained.
After the elimination period, a totally disabled insured qualified for benefits from a disability income policy that has a waiver of premium rider. What will happen to the premium that was paid into the policy during the elimination period?
Premium will be refunded.
Who determines the eligibility and contribution limits of an HRA?
The Employer
What do individual insureds receive as proof of their group health coverage?
Certificate of Insurance
What term is used to describe a situation when a medical caregiver contracts with a health organization to provide services to its members but retains the right to treat patients who are not members?
Open Panel
What is the purpose of a buy-sell agreement for health insurance policies?
To specify how the business will pass between owners when one of them dies or becomes disabled.
How are HMO territories typically divided?
Geographic Areas
Who are the parties in a group health contract?
The Employer and the Insurer
If an employee covered under a health reimbursement account changes employers, what happens to the HRA?
It remains with the originating employer.
What is the purpose of respite care in long-term care insurance?
To provide relief for a major caregiver, usually a family member.
What is the main principle of an HMO plan?
Preventive Care
What types of injuries and services will be excluded from major medical coverage?
Injuries caused by War, Intentionally Self Inflicted injuries, injuries covered by Workers Compensation, Regular Dental/Vision/Hearing Care, Custodial Care, and Elective Cosmetic Surgery
If the insureds share in the cost of health insurance premium with the employer, this would be known as what type of group plan?
Contributory
What is the purpose of COBRA?
To allow continuation of health insurance coverage for terminated employees (and ex-spouses).
In group insurance, what is the name of the policy?
Master Policy
What are the tax implications for employer contributions to Health Reimbursement Accounts?
Employer contributions are tax deductible as business expenses.
When a business receives benefits from its key person disability insurance, how are those benefits taxed?
The key person disability insurance benefits are received tax free.
What is the main purpose of HIPPA regulations in group health plans?
To limit exclusions for pre-existing conditions.
What is the role of the gatekeeper in an HMO plan?
To control costs for the services of specialists.
What are the three types of basic medical expense insurance?
Hospital, Surgical, and Medical
In order to be eligible for coverage by an HSA, an individual must also be covered by what type of health plan?
High Deductible Health Plan (HDHP)
Can an insured who belongs to a POS plan use an out-of-network physician?
Yes, but the copays and deductibles may be higher.
In what type of health plans are providers paid for services in advance, regardless of the services provided?
Prepaid Plans
What is the term for a period of time immediately following a disability during which benefits are not payable?
Elimination Period
What is a Fee-For-Service health plan?
Under a Fee-For-Service plan, providers receive payments for each service provided.
How do insurers determine the cost for a group policy?
Ratio of Men & Women
Average Age
What are the two types of Flexible Spending Accounts?
Health Care Accounts and Dependent Care Accounts
A waiver of premium provision may be included with what type of health insurance policies?
Disability Income
To be eligible under HIPAA to convert group health coverage to an individual policy, the insured must apply for the individual plan within how many day of losing the group coverage?
63 Days
How can an HMO member see a specialist?
Referral by the primary care physician.
What types of groups are eligible for group health insurance?
Employer-Sponsored and Association-Sponsored Groups
What does the amount of disability benefit that an insured can receive depend on?
The insured's income at the time of policy application.
What type of health insurance would pay for hiring a replacement for an important employee who becomes disabled?
Key-Person Disability Insurance
What are the tax implications for contributions to a Health Savings Accounts by the individual insured?
Contributions are tax deductible.
How many members must an association have to qualify for group insurance?
100 Members
Does group health insurance require medical examinations?
No, the underwriter evaluates the group as a whole, rather than each individual member.
What is the purpose of managed care health insurance plans?
To control health insurance claims expenses.
What is the primary purpose of disability income insurance?
To replace income lost due to a disability.
If medical caregivers are contractually obligated to provide services only to members or subscribers of a specific health organization, what is the name for this type of arrangement?
Closed Panel
What percentage, if any, of the individual disability income policy benefits are taxed to the insured?
Benefits are not income taxable.
Under what type of care do insurers negotiate contracts with health care providers to allow subscribers to have access to health care services at a favorable cost?
Preferred Provider Organization (PPO)
What is a presumptive disability provision?
A provision found in most disability income policies that specifies the conditions that will automatically qualify for full disability benefits.
Who chooses a primary care physician in an HMO plan?
The Individual Member
In group insurance, who is issued a certificate of insurance?
Individual Insured
Why do HMOs encourage members to get regular checkups?
To help catch health problems early when treatment has the greatest chance for success. (Preventive Care)