-no deductibles -first-dollar coverage -low dollar limits -coverage for catastrophic medical expenses, coverage for catastrophic medical expenses U5, What is NOT a benefit of a POS plan? -partial benefits -full benefits until the blindness lifts -no benefits -full benefits, Which of the following types of agent authority is also called "perceived authority"? -Disability Buy-Sell -Business Overhead -Key Person Disability -Group Disability, Which of the following is INCORRECT concerning taxation of disability income benefits? What type of agent authority does this describe, For an individual who is eligible for Medicare at age 65, and who is still employed and covered under employers plan which of the following is true, The employer plan is primary coverage and Medicare is secondary coverage, A waiver of premium provisions may be included with which kind of health insurance policy, Which is the contact provision that allows the insured to nonrenew health coverage if certain events occur, Which is not true regarding an insured who is considered to be a standard rest, The insured may have to pay slightly higher premiums, Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policy owner, And insured has mistakenly failed to enroll in her husbands health plan what would happen following a major health expense, If the insured under disability income insurance policy changes to a more hazard occupation after the policy has been issued and a claim is filed the insurance company should do which of the following, I just the benefit in accordance with the increased risk. Under the Fair Credit Reporting Act, the producer or company is obligated to inform the client of the name and address of the reporting agency that furnished the report. -0% -50% -100% -amount paid by insured, 0% (premiums are paid with after tax dollars. For how many years can the insured expect to receive payment for the ensure before Social Security benefits begin, Which of the following are the main factors taken into account when calculating residual disability benefits, Present earnings in earnings prior to disability, When benefits are paid directly to the insured under a health insurance policy the policy provides benefit on what type of basis, Prior to Insurance of a long-term care policy to the applicant age 80 or older the insurer must obtain all the following except, Which of the following types of agent authority is also called perceived authority, Concerning group medical and dental insurance which of the following statements is incorrect, Employee benefits are Tax deductible the year in which they were received, Because an agent is using stationary with the logo of an insurance company applicants for insurance assume that the agent is Author rise to transact on behalf of that insure. Life and Health producers may issue conditional receipts, but not binders of coverage. -loss of hearing in one ear -loss of one hand or one foot -loss of two limbs -loss of one eye, loss of two limbs (presumptive disability is a provision that is found in most disability income policies that specifies conditions that will automatically qualify the insured for full disability benefits, such as the loss of two limbs) U4, Which statement accurately describes group disability income insurance? What type of license should the producer obtain? -application -policy request -insurance request form -request for insurance, In which of the following situations is it illegal for an insurer to disclose privileged information about an insured? Clause defines type of coverage, as well as identifies the rights and duties of each party of the contract, identities of both the insured and insurer? The producer is sometimes referred to as a "front-line" underwriter, since they generally have personal contact with the applicant. B) the identities of the insurance company and the insured. . Following a disability she begins receiving benefit payments from the insured. -an insurer with a home office in another country -an insurer with licensed agents doing business in other countries -an insurer with licensed agents who are citizens in more than one country -an insurer with a home office in another state, an insurer with a home office in another state U1, The authority granted to an agent through the agent's contract is referred to as: -apparent authority -implied authority -absolute authority -express authority, On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are: -not taxable since the IRS treats them as a return of a portion of the premium paid -paid at a fixed rate every year -taxable as ordinary income -guaranteed, not taxable since the IRS treats them as a return of a portion of the premium paid U1, An applicant knowingly fails to communicate information that would help an underwriter make a sound decision regarding coverage. After he becomes disabled he receive payments from the company. The Pre-existing Condition Exclusion and the Probationary Period are the same thing. The National Association of Health Underwriters is a trade organization, not a source of underwriting information. For the insurer most likely do, When in employee is done. -they allow several small employers purchase less expensive insurance together -they make deals with local hospital to provide low cost coverage to the needy -they provide insurance for larger corporations -they provide insurance companies with medical information on applicants, they allow several small employers purchase less expensive insurance together U6, In a noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective? How soon after health insurance Reinstatement will accident and health claims be available? 20 10 15 Which statement is inaccurate regarding the Change of Occupation Provision? Their answer is considered to be a: Accident and Health Insurance Basics DISABILITY PORTION, B) Making sure all material facts are included in the application. What provision states that claim must be paid immediately upon written proof of loss, A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as, Which of the following is a statement that is guaranteed to be true and if untrue Maybridge an insurance contract, Events in which a person has both the chance of winning or losing are classified as, Pertaining to insurance what is the definition of fiduciary responsibility, Probably forwarding premiums to the insurance company, Medicare supplement renewal commission paid in the third year must be as high as the commission of what year, The authority granted to an agent through the agent contract is referred to as, Who must pay for the cost of a medical examination required in the process of underwriting, In long-term care insurance what type of care is provided with intermediate care, Which of the following is not required to be stated in the outline of coverage provided with the long-term care policy, Basic information about the supplementary policies, Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. a man is injured while robbing a convenience store. She is doing this to see if the procedure is covered under the patient's insurance plan and for how much. To what extent will he receive Presumptive Disability benefits? (a) The Company shall procure for Employee as soon as practical after the date hereof and shall maintain in full force and effect during the Term a Supplemental Disability Policy which will supplement the benefits payable under any disability benefit provided to Employee by the Company under its basic employee health care benefit program, so that, subject to Section 6.07 . -until the insurer cancels the policy -until age 65 -until the disability ends or the debt is satisfied, whichever is sooner -only for 6 months after the onset of a disability, until the disability ends or the debt is satisfied, whichever is sooner U2, In a group prescription drug plan, the insured typically pays what amount of the drug cost? Basics of an Insuring Clause Insurers take on a certain amount of risk when providing an insurance policy, and the risk the company assumes is stipulated in an insuring clause. allows the insured a period to look over the policy, and if dissatisfied for any reason, return it for a full refund. There is never any coverage unless the premium has been paid. There is no such thing as a pre-existing accident. The insurance company monitors the treatment and progress in order to make sure that everything proceeds according to the insurer's schedule. These requirements include all of the following except, Mike Armstrong is a producer and wants to operate under the name of the insurance palace. India enacts 'the Rights of Persons with Disabilities Act, 2016' to secure the rights of persons with disabilities. She also wishes to retain all of the rights of ownership. The consideration on an insurance policy is the premium paid by the insured and the statements they make on their application. Disability clauses are necessary in life insurance policies because policyholders sometimes become disabled. The insured may cancel an insurance policy at any time! The free look period is the required time period in which a new life insurance policy owner can terminate the policy without any penalties,. Which of the source releases coded information to ensures regarding information including on previous insurance applications, Which of the following responsible for making premium payments in an HMO plan, And insured wants to name her husband as the beneficiary of her health policy. B The types of losses covered. Her only options are to reject the policy or excepted as it is what contract feature does this describe, What an insured makes truthful statements on an application for insurance and pays the required premium it is known as which of the following, Which of the following information regarding an insured is not included in the investigative consumer report, And insured has a social Supplement rider in her disability income plan. An incontestability clause is a provision in a life or disability insurance policy that prevents the insurance company from canceling the policy based on misstatements in the policy application after the insurance has been in effect for a certain period of time, usually two years. Two years ago he suffered from a head injury from an accident, so he cannot remember parts of his past, but is otherwise competent. -marriage -relocation -promotion -divorce, 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) U6, Which of the following factors would be an underwriting consideration for a small employer carrier? What type of health benefits will her health insurance policy pay for her injuries if the policy includes the narcotics & intoxicants provision? -prospective review -concurrent review -anticipatory treatment -suspended treatment, An insured is admitted to the hospital for surgery on a herniated disk. Ch. Nevertheless, until the adoption of the UN Convention on the Rights of Persons with Disabilities (CRPD), the world's largest minority group was largely excluded from global human rights protection (e.g., UN human rights treaty work), global initiatives (notably the Millennium Development Goals), and national level law and policy programming . If the owner dies or becomes disabled, the policy would provide which of the following? -a person's total loss of income -a person's inability to qualify for insurance coverage -a person't ability to work is significantly reduced or eliminated for the rest of his/her life -a person's inability to perform one of the regular duties of his/her occupation, a person't ability to work is significantly reduced or eliminated for the rest of his/her life U4, The relation of earnings to insurance provision allows the insurance company to limit the insured's benefits to his/her average income over what period of time? Her blood alcohol level is over the legal limit. These policies typically require the loss of at least two limbs (loss of use does not qualify in some policies. -waiver of monthly premium -pro rata provision -rehabilitation benefit -relation of earnings to insurance, relation of earnings to insurance (the relation of earnings to insurance provision allows the insurance company to limit the insured's benefits to his/her average income over the last 24 months) U4, An insured has been injured in an accident. -when the employee is 59 -when the amount of the benefit is equal or less than the amount of contributed by the employer -when the benefits received are equal or less than the employee's percentage of the contribution -when the employer makes all the premium payments, when the benefits received are equal or less than the employee's percentage of the contribution U8, All of the following are true regarding Key Employee Disability Income insurance EXCEPT: -benefits are taxable to the employer -the employer owns the policy -benefits are paid to the employer to retrain a new person -premiums are not tax deductible for the employer, Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer? In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. Contents of Inspection Reports may be disclosed to applicants, but the producer or company is under no obligation to give a copy of the report to the client. Chapter 7 Health Insurance Policy Provisions, Clauses, and Riders Created by: Hayley92 For Social Security disability benefits, According to the rights of renewability rider for cancelable policies all of the following are correct about the cancellation of an individual insurance policy except, Unearned premiums are retained by insurance company, Canyon sure wishes to compare the information given in an insurance application with previous insurance applications by the same applicant but for different companies. What income taxation will be imposed on the benefits received? Coverage is statutory, meaning that coverage would be the same no matter where it is purchased. If the owner dies or becomes disabled the policy would provide which of the following, Cash to owners business partner to accomplish buyout, Which renewal option does not guarantee renewal and allows the insurance company to refuse renewal of policy at any premium due date, Under the fair credit reporting act individuals rejected for insurance due to information contained in a consumer report, Must be informed of the source of the report, Hey small hardware store owner is involved in a car accident that renders him totally disabled for half a year. How soon after this surrender can her license be reinstated? -insuring clause -cancellation provision -renewal provision -policy duration provision, renewal provision (renewability provisions are included in each health insurance contract and outlines both the insurers and insureds right to cancel or renew coverage. Cancellable Policy Which type of insurance would help him pay for expenses of company during his time disabled, Which of the following cases would constitute a violation of Louisianas control business statute, Producer B writes group policy covering large hospital where his wife is the comptroller. when a claim is pending, the insurance company may require, an independent examination as often as reasonably required. -certificate of insurance -master policy -entire contract -certificate of authority, The Coordination of Benefits provision in Utah requires that both primary and secondary plans pay the benefit in equal shares if the plans cannot agree on the order of payment within how many days after receiving the claim information? -the insurable risk needs to be statistically predictable -an insurable risk must involve a loss that is definite as to cause, time, place & amount -insureds cannot be randomly selected -insurance cannot be mandatory, In forming an insurance contract, when does acceptance usually occur? 2003-2023 Chegg Inc. All rights reserved. The insuring clause of a disability policy usually states all of the following EXCEPT A That insurance against loss is provided. The amount of benefits that an insured receives is determined by the insured's earned income & is usually limited to a certain percentage of that amount) U2, What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided? -20 -50 -100 -15, In long-term care (LTC) policies, as the benefit period lengthens, the premium -LTC premiums are not based on benefit periods -decreases -increases -remains unchanged, What type of health insurance policy provides an employer with funds to train a replacement if a valued employee becomes disabled? The Federal Fair Credit Reporting Act protects applicants when a consumer (credit) report is ordered in connection with insurance, employment or banking. $1000 Health insurance policy May cover all of the following risks except War related injuries If a business wants to buy a disability income policy on a key employee which of the following is considered the applicant Employer Which of the following is an eligibility requirement for all Social Security disability income benefits To help the insurance company to prevent over-utilization of the policy. -termination of employment due to downsizing -termination of employment for stealing -eligibility for coverage under another group plan -eligibility for Medicare, termination of employment due to downsizing U6, Which of the following is true regarding MET's? If the employee and the dependent become legally separated or divorced, or if the employee dies, the dependent will be eligible for COBRA benefits for up to 36 months. However due to increasing financial strain they plan to raise premium cost for all insureds by 10% over the next two years. Assuming the premium has been paid (it was), coverage starts when the company underwriter approves the application. Which kind of insurance will protect the business? a. which of the following entities has the authority to make changes to an insurance policy? Claim is denied if the policy contains the Illegal Occupation provision. Usually the addition of a rider is reflected in an additional charge by the company and may require that the insured provide evidence of insurability. Pick the best answer. -apparent -express -implied -fiduciary, apparent (the appearance or the assumption of authority based on the actions, words or deeds of the principal or because of circumstances the principal created). 900 SW Fifth Avenue Portland, Oregon 97204-1282 (503) 321-7000. Before being able to complete the responses and pay the initial premium, they were confined to a hospital for a condition that would ordinarily be covered by the policy. The agent is required to do all the following except, Warn applicant about 10 day look free period, Under a key person disability income policy premium payments, Are made by business and are not tax deductible, Which of the following is not covered under plan A in Medigap insurance, Your client has a social Insurance supplement rider on his disability policy. -if paid by the individual, the premiums are tax deductible -if the employer paid the premiums, income benefits are taxable to the insured as ordinary income -if the insured paid the premiums, any disability income benefits are tax-free -if the benefits are for a permanent loss, the benefits paid to the employee are not taxable, if the employer paid the premiums, income benefits are taxable to the insured as ordinary income (if an individual purchases his or her own disability insurance with before-tax dollars, any benefits paid are tax free, but the premium is not tax deductible. -the insured is in an accident & incurs a large claim -the insured does not pay the premium -the insured reaches the maximum age limit specified in the policy -within 2 years of the application, the insurer discovers a misrepresentation, the insured is in an accident & incurs a large claim U3, Items stipulated in the contract that the insurer will not provide coverage for are found in the: -exclusions -insuring clause -benefit payment clause -consideration clause, Which renewability provision allows an insurer to terminate a policy for any reason, & to increase the premiums for any class of insureds? This means that the policy includes, If authorized to write life and property and casualty insurance how many hours of continuing education are producers required to complete every two years, An individual pies for life policy. A) Completed insurance policy to the applicant. What is the benefit is based on the insurance loss of earnings after recovery from disability, All of the following long term coverages would allow an insured to receive care at home except, The rider that may be added to disability income policy that allows for an increase in the benefit amount under certain conditions is called, An insured has Been injured in an accident. Globally, there has been a major shift in the understanding of disability and recognition of rights of persons with disabilities within human diversity. Her coverage will become effective when: Health insurance rates may be based upon all of the following, EXCEPT: An applicant for an individual health policy failed to complete the responses to the medical history questions because they had forgotten some important past treatment dates. A) Payments of Claims B) Reinstatement -24-hour care -relief for a major care giver -daily medical care, given by medical personnel -institutional care, Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis? 3. Its a interim insuring agreementb. -type of illness -premiums paid into the policy -medical expense incurred -number of days confined in a hospital, Which of the following factors about the insured determines the amount of disability benefit that the insured will receive? Benefits are paid, even if the insured is able to work) U4, All of the following are true regarding key person disability income insurance EXCEPT: -the employee is the insured -premiums are tax deductible as a business expense -the employer receives the benefits if the key person is disabled -the employer pays the premiums, premiums are tax deductible as a business expense U4, What provision can reduce the disability benefit based upon the insured's current income? -the insurer can rate-up the policy -the insurer will issue a conditional coverage -the insurer can increase the premium -the insurer can add exclusions to the policy, the insurer will issue a conditional coverage U4, In which of the following health plans are benefit payments attributed to employer contributions taxable to the employee? This is an example of: -claims-delayed treatment -suspended treatment -prospective review -concurrent review, Which of the following are responsible for making premium payments in an HMO plan? Abstract. -4 years -2 years -1 year -3 years, A resident agent licensed in another state may obtain a nonresident license in Utah without taking the examination provided that: -the agent is currently licensed in the state of domicile -the agent has obtained that license by passing a test suitable to the Utah Department -the state where the agent lives affords the same privilege to residents of Utah -all of these requirements are met, An agent voluntarily surrendered her license. Warranties are sworn statements of truth, but are not required on insurance applications. It guarantees that the applicant is allowable to the insurance companyc. -if a person receives disability benefits, he or she is eligible for credits on their group policies for future disabilities -a person receiving disability benefits cannot receive a credit disability policy -if an insured has filed bankruptcy & his premiums are waived, he can be issued a credit disability policy -if an individual is in debt to a specific creditor, payments will be made for him/her until the return to work, if an individual is in debt to a specific creditor, payments will be made for him/her until the return to work U2, Which of the following groups would most likely be covered under a blanket accident policy? However, the premiums can only be increased on a class basis, not on an individual policy), How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company? Pete Rathburn What Is the Free Look Period? A _______ of claim and Proof of loss are the insureds duties. Coverage for death due to sickness is provided by Life insurance. If an employer pays the premium, the employer may deduct the premium as a business expense. when insurer may increase the policy premium (on class basis only) on the policy anniversary date; insured has the uni-lateral right to renew the policy for the life of the contract? Optional provision thats lets the insurer adjust benefits if the insured changes occupations? However, the social history of persons with disabilities in . If the insured could reasonably Perform another job utilizing similar skills after one month how long would she receive benefits under an own occupation disability plan, Which of the following cases would in any occupation disability income policy pay the benefits, The insured is unable to perform any jobs in the field related to the insureds education and experience, Which of the following hospice expenses would not be covered in a cost containing setting, Which of the following statements regarding conditional receipts is true, When in employee is still employed upon reaching age 65 in eligible for Medicare which of the following is the employees options, Remain on the group health insurance plan in different eligibility for medicare until retirement, What is the amount each position or supplier bills for a particular service or supply, A producer was originally license in April 1 of 2001.

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