Basics of Health Insurance

Question 1

What are the two types of insurance providers through “Private insurance”?

Answer 1

Commercial
Health and managed care

Question 2

list two insured perils

Answer 2

accidental injury
illness

Question 3

BOTH commercial and managed care providers offer coverage to ___?

Answer 3

Individuals and Groups

Question 4

Name of government insurance provider on the state level?

Answer 4

Medicaid

Question 5

Name of the government level insurance provider?

Answer 5

Medicare

Question 6

Income replacement when disability prevents insured from working?

Answer 6

Disability income

Question 7

Type of health insurance that covers the cost of medical care and medical services ?

Answer 7

Medical expense - commercial or managed care company

Question 8

Pays lump sum benefits in event of accidental death or dismembering injury

Answer 8

Accidental death and dismemberment (AD&D)

Question 9

Private insurance that supplements Medicare

Answer 9

Medicare supplement

Question 10

Covers the cost of long-term care (nursing home, home health care)

Answer 10

Long-term care

Question 11

type of health insurance for: dental, vision, prescription drug, specified ‘dread’ disease.

Answer 11

Limited benefits

Question 12

How many types of health insurance?

Answer 12

6

Question 13

Covers the cost of medical care and medical services on an indemnity (reimbursement) basis.

Answer 13

commercial insurer-medical expense

Question 14

Insurance like coverage through the “provider” that combines medical care and insurance services.

Answer 14

Managed care company -Medical expense-

Question 15

AD&D (accidental death&dismemberment) also covers what other condition?

Answer 15

blindness

Question 16

Provides care to people under 65 who become totally disabled.

Answer 16

Social security disability

Question 17

Medicare supplement is also referred to as what other name?

Answer 17

Medigap- “covers the gaps”

Question 18

Name of insurance plan that the employer holds the contract and each employee is issued a certificate of coverage.

Answer 18

Group insurance

Question 19

No single type of health insurance policy can cover every health risk. what is the option to do?

Answer 19

instead a variety of policies can address the different risks.

Question 20

Basic principle that the PPACA (affordable care act) requires 100% participation by americans not covered by employer health plans?

Answer 20

to lower the cost of health insurance by having a maximum # of healthy people in the “pool” and not just sick people.

Question 21

What are the essential differences between a bronze, silver, gold, and platinum plan of ACA?

Answer 21

the difference is the percentage of essential health benefits paid = to the percentage of copay.

Question 22

What contract has a set amount of money payable for a claim that is set in stone when the policy is issued?

Answer 22

Valued contract

Question 23

Whats the name of the contract that pays the amount of actual loss suffered?

Answer 23

Indemnity aka reimbursement

Question 24

List two examples of a type of valued contract

Answer 24

Life
AD&D (accidental death & dismemberment)

Question 25

What is an example of a indemnity contract?

Answer 25

Medical expense plan

Question 26

For the ACA coverage must meet what kind of standards?

Answer 26

Minimum

Question 27

ACA does not apply to what two types of health insurance?

Answer 27

disability and long term care

Question 28

When is OEP (open enrollment period)?

Answer 28

Nov 1- Jan 15

Question 29

When can a person enroll for insurance after open enrollment window has ended?

Answer 29

if a life event qualifies them during a special enrollment period.

Question 30

What are 5 life events that qualify for the special enrollment period?

Answer 30

1. marriage 2. birth of a child 3. loss of other health insurance 4. becoming a US citizen 5. release from prison

Question 31

Name of plan that is for people younger than 30, cannot afford any other health insurance, or want minimal coverage w/ a high deductible and low premium?

Answer 31

catastrophic plan

Question 32

Under ACA insurance plans issued on or after Jan 1 2014 must cover what?

Answer 32

pre-existing conditions

Question 33

An insured's health policy pays a flat rate of 200$ a month if she becomes disabled, regardless of her actual income. What kind of policy does she have?

Answer 33

A valued policy.

Question 34

Under ACA dependent children are covered under their parents medical plan until the age of?

Answer 34

26

Question 35

Under ACA- what is the term for when insurers must spend a minimum % of premium money earned on providing health care coverage and improving the quality of health care?

Answer 35

Medical Loss ratio

Question 36

Medical loss ratio is a standard that insurer's must follow to ensure that they spend premiums primarily on health care coverage and NOT on ?

Answer 36

business expenses.

Question 37

What is the name of the contract used to make a clear plan on how to distribute the policy owners business interest/estate.

Answer 37

a buy-sell agreement

Question 38

When is a statement of good health typically required in the insurance process?

Answer 38

When there is a "reinstatement"

Question 39

When does coverage become effective if the first premium has not been paid and a conditional receipt has been issued?

Answer 39

At the time of delivery with the collection of premium

Question 40

What is the source of medical information provided for applicants seeking high coverage amounts?

Answer 40

The attending physician's statement

Question 41

How long is a temporary insurance license typically valid for?

Answer 41

90 days

Question 42

Under the fair credit reporting act, for what purpose can a consumer report NOT be used?

Answer 42

for preparation of a lawsuit

Question 43

Who is the Certificate of authority, issued by the insurance commissioner, intended for?

Answer 43

The insurance companies and agents

Question 44

If an agent provide's false statements about a policy's benefits to a proposed client during a sale, what offense is committed?

Answer 44

Twisting

Question 45

how often does an agent have to renew their license? How many hours total? What is the breakdown of the hours of CE required?

Answer 45

every two years 24 hours total 20 hours elective and 4 hours MUST be law and ethics in the license type held.

Question 46

Can a material misrepresentation made by an insurance agent result in license suspension, revocation, or denial?

Answer 46

yes.