AD Banker

Question 1

Commissioner

Answer 1

• Issue, Refuse, Revoke or suspend license or cert of authority.
• Aid in interpretation of any state law.
  *Inquire into all violations
  DOES NOT
  * Have auth to revise or create rules and regulations
  * Set the rates fro workers compensation

Question 2

Prospective Review

Answer 2

• Conducted prior to the requested medical service.

* Med records may be required

Question 3

Concurrent Review

Answer 3

*Conducted while the care is being provided. Monitors treatment and care.

Question 4

Retrospective

Answer 4

• Review after the fact to confirm necessity of service, identify coordination of benefits and determine non - pre- certification penalty apply.

Question 5

pre- certification

Answer 5

*Requires prior notification prior to non- emergency care

Question 6

PPACA

Answer 6

• Minimum health standards (Essential Health Benefits
• Anyone without will be assess a Shared Responsibility Payment if over 50 employees.
• Eliminated co-pay, coinsurance and deductible for preventative care.

Question 7

Medi- CAl

Answer 7

Cover under 65 with income up to 138% of FPL. Free to those who qualify.

Question 8

Advanced Premium Tax. Credits

Answer 8

Available from federal gov to health lower costs

Question 9

Cost - Sharing reduction

Answer 9

Out of pcocket reductions for expenses (Deductible and copay)

Question 10

Certified Insurance Agent (SHOP) Qualifications

Answer 10

• Created agent account coveredCA.com
• Select payment method
• Submit Application
• Complete Exchange Training
• Pass Exchange Exam
• Recertification every 5 years

Question 11

Medical Expense

Answer 11

Must cover:

  * Dependents 26 under
  * Newborn infant covered birth to 31 days 
  * Mental Health and Substance Abuse

Question 12

Long Term Care LTC

Answer 12

May not have following provisions:

     * Cancel, terminate or refuse renewal based on age, deterioration of mental or physical health.  (Only cancel for nonpayment) 
     * New waiting with conversion or replacement. 
     * Must pay actual expenses not Reasonable and customary

Question 13

Qualified Long- Term Care

Answer 13

• Only protection in the contract is LTC
• Contract does not pay any medicare reimbursement expenses.
• Policy must be guaranteed and renewable
• No cash value or accumulation
• All refunds or dividends must apply to Lowe premium or increase benefits
• unable to care for self for at least 90 day due to loss of at least 2 of the 6 ADLs

Question 14

Medicare Summary Notice (MSN)

Answer 14

Lists the details of the services and supplies that were billed to Medicare in the last 90days.

Question 15

Medicare part B Exclusions

Answer 15

• Routine Dental care
• Prescription drugs unless given in med facility
• Routine foot care
• LTC
• Routine Hearing, eye
• Acupuncture
• Cosmetic surgery unless medically necessary

Question 16

Medicare Part B Benefits

Answer 16

• Physician and surgeon services
• physical, occupational and speech therapy
• Certain DME
• Dialysis
• preventive Care
• Lab services
• Home Health Care
• Mental Health Care
• outpatient hospital (ER and Urgent Care)

Question 17

Relationship to earnings

Answer 17

• Disability income can not be greater Thant the insureds monthly earnings at the time of disability.
• Can’t be reduced to under $200