-decrease -increase -remain the same -either increase or decrease, Which of the following is NOT a cost-saving service in a medical plan? To what extent will he receive Presumptive Disability benefits? Individual Health Insurance Policy General Provisions Flashcards Which of the following options best depicts how the eligibility of members for group health insurance is determined? Insuring Clause Of A Disability Policy - quranatcal.com However, injuries due to an accident, such as medical bills due to a broken leg, are covered. -30 days -7 days -10 days -15 days, What statement best describes the free look provision? This explanation explains the meanings starting Insuring Clause and why it matters. They benefit both the policyholder and the insurer because the policyholder does not want to lose coverage, and the insurer does not want to lose a client. Weekly: 7 Days Monthly: 10 Days All Other: 31 Days How soon after health insurance Reinstatement will accident and health claims be available? $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 The insuring clause is the section of an insurance policy that outlines the risks assumed by the insurer. Chapter 7 Health Insurance Policy Provisions, Clauses, and Riders Created by: Hayley92 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. -no benefits -full benefits -partial benefits -full benefits for 2 years, full benefits (Presumptive Disability plans offer full benefits for specified conditions. This is considered to be a very important provision required by HIPAA, the federal Health Insurance Portability and Accountability Act of 1996) U3, When a group disability insurance policy is paid entirely by the employer, benefits paid to disabled employees are: -deductible income to the employee -deductible business expense to the employer -taxable income to the employer -taxable income to the employee, A small business owner is the insured under a disability policy that funds a buy-sell agreement. However, the social history of persons with disabilities in . What term best describes this act, In insureds disability income policy includes an additional monthly benefit rider. However, it is unlawful to discriminate based upon religion, race, national origin, etc. How do employer contributions to health savings act affect the insureds taxes, Employer contributions are not included in individual insured taxable income, Which of the following is the most common way to transfer risk, Which of the following statements is correct concerning taxation of long-term care insurance, Which of the following statements is the most correct concerning the changing of irrevocable beneficiary, They may be changed only with the written consent of that beneficiary, If your health care plan has characteristics of an HMO and PPO what type of plan do you have, Minimum fine for violating insurance code is, Health insurance policy May cover all of the following risks except, If a business wants to buy a disability income policy on a key employee which of the following is considered the applicant, Which of the following is an eligibility requirement for all Social Security disability income benefits, Long-term care insurance policies must cover which of the following, A license life producer has committed 12 of his continuing education hours for this. 900 SW Fifth Avenue Portland, Oregon 97204-1282 (503) 321-7000. Accident: immediately Sickness: 10 days A _______ of claim and Proof of loss are the insureds duties. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. Disability Insurance Sample Clauses: 3k Samples | Law Insider The insuring clause of a disability policy usually states all of the following EXCEPT A That insurance against loss is provided. What income taxation will be imposed on the benefits received? -5 days -7 days -10 days -3 days, If an insurer wants to raise its premium rates, the new rates must be submitted to the Commissioner for the review and will take how many days to go into effect? Other Insurance in this Insurer provision provides a ____ _____ benefit?? Disability Insurance. PDF Long Term Disability Plan - University of Washington Human Resources Otherwise, being approved for individual health insurance would be difficult) U6, When employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles? What type of policy is this? If they are covered on an expense incurred basis and neither company was notified in advanced that the insurer has other coverage. 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? Kevin and Nancy decide to legally separate, which means that Nancy will no longer be eligible for health insurance coverage under Kevin. Existence Insurance Extractor B) Must be informed of the source of the report. In response to a Misstatement of Age or Gender, benefits are adjusted to the correct premium. Contributing to Social Security for 40 quarters (10 years) attains fully insured status) U4, All of the following are requirements of eligibility for Social Security disability income benefits EXCEPT: -fully insured status -waiting period of 5 months -being age 65 -inability to perform any gainful work, A man's physician submits claim information to his insurer before she actually performs a medical procedure on him. Upon reaching age 65 in eligible for Medicare which of the following is the employees option, Remain on the group health insurance plan and defer eligibility for Medicare until retirement, Which of the following options depicts How eligibility of members for group health insurance is determined, Which statement best defines a multiple employer welfare arrangement, A joining together by employers to provide health benefits for employees, Which writer when added to a disability income policy provides for changes in the benefits payable based on consumer price index, A long term care shoppers guide best be presented at which point, When an insurer offers services like Pred mission testing, second opinions regarding surgery, and preventative care which term best applies, Not all losses are insurable and there are certain requirements that must be met before a risk is a proper Subject for insurance. Health Policy Provisions, Clauses, and Riders - Brainscape B) It is an unlawful practice known as "replacement". (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 . An insuring clause in a health or disability policy specifies exactly what the insurance company is liable for (or the risk that it assumes) and how much it will pay in benefits. -prospective review -concurrent review -anticipatory treatment -suspended treatment, An insured is admitted to the hospital for surgery on a herniated disk. It also. The insured must notify the insurer of a change of occupation, or the policy will be cancelled If the insured changes to a less hazardous occupation, he/she may apply for a rate reduction The insuring clause of a disability policy usually states all of the following, EXCEPT? The producers birthday is on October 17 the producer last renewed her license in 2012 by what date was the producer renew her license again, Insurance policy specifies that it will be $600 for the Specific loss. -only post-hospitalization benefits -full benefits -partial benefits -no benefits, Under the Physical Exam & Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending? 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. Although they are similar, Critical Illness coverage will pay the insured a lump-sum upon the diagnosis of a critical illness, while Dread Disease coverage will pay only a specified amount per day if the insured is hospitalized due to a so-called "dread disease", such as cancer. AD&D is similar to life insurance in that the client may name both a primary and contingent beneficiary, which can be changed at any time unless the designations are "irrevocable.". they are temporary insuring agreements (with a conditional receipt, insurance coverage is effective as of the date of the receipt, so long as the application is approved) U2 A typical Accidental Death & Dismemberment policy covers all of the following losses EXCEPT: -limb -life -income -eyesight income U2 What Ryder does the policy most likely have that would cause this, In insurance company ensures its new policy holders that their premium cost will not increase for a period of at least five years. After the accident is determined to be her fault, the police give her a breathalyzer test to determine whether or not she had been drinking alcohol before the accident. -as soon as possible -within 20 days -within 60 days -within 90 days or as soon as reasonably possible, but not to exceed 1 year, within 90 days or as soon as reasonably possible, but not to exceed 1 year, The insuring clause of a disability policy usually states all of the following EXCEPT -that insurance against loss is provided -the types of losses covered -the method of premium payment -the identities of the insurance company and the insured, the method of premium payment (the insuring clause, usually on the first page of the policy, is the general statement that defines the insurance agreement and identifies the insured and the insurance company and states what kind of loss (peril) is covered), An insured is involved in a car accident. C) Policies usually define accidents that occur within 15 days after the effective date as pre-existing conditions. -full amount until a deductible is met, then a small copay -copayment -none -full amount until a deductible is met, then nothing for the rest of the year, Because of the history of cancer in her family, Julie purchased a policy that specifically covers the expense of treating cancer. allows the insured a period to look over the policy, and if dissatisfied for any reason, return it for a full refund. -everything after first 3 -1 pint -first 3 -none; Medicare pays for it all, Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations? 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 . -end-stage renal failure -black lung -leukemia -end-stage heart failure, end-stage renal failure (OBRA requires end-stage kidney (renal) failure to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage) U7, Which of the following statements is INCORRECT concerning Medicare Part B coverage? What Is a Free Look Period and How Does It Work? - Investopedia when the insured initiates the cancellation of a policy, the unearned premium will be refunded on a ______ _____ basis? Benefits are not income taxable) U8, In an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. -nonresident -temporary -broker -limited lines, Existing and replacing life insurers are required to keep copies of all summaries, notices, and statements used in sale transactions until the conclusion of their next examination by the Insurance Department, or for the current calendar year plus: -three years -five years -one year -two years, What is the maximum penalty for habitual willful noncompliance with the Fair Credit Reporting Act? Although the Commissioner or Director of Insurance may have to approve the rates, eligibility for coverage is determined by another state agency, which is known as the State Industrial Commission in most states. How soon after health insurance Reinstatement will accident and health claims be available? D) The insurance company accepts the risk. -possible modifications to include expanded coverage -permanent coverage -premiums are not elevated -more medical evaluations are required, Hospital indemnity/hospital confinement indemnity policy will provide payment based on? All About The Incontestability Clause In Life Insurance Which of the following options would be best for Nancy at this point? Disability, Social Policy and Inclusiveness: The Missing Links -if the total of benefits paid meets the minimum state taxation standard -whether the premiums were tax deductible -state statutes -contract provisions, whether the premiums were tax deductible (the taxation status of benefits is often determined by whether the premium has been tax deducted) U8, If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply? -residential care -assisted living -home health care -adult day care, What is necessary in order to be eligible to receive benefits from a long-term care policy? Accidental dismemberment, This statement about a provisory receipt is true?a. -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. 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. Disability clauses are necessary in life insurance policies because policyholders sometimes become disabled. -AD&D -Disability Buy Out -Medical Expense -Group Disability Income, group disability income (disability benefit payments that are attributed to employee contributions are not taxable, but benefits payments that are attributed to employer contributions are taxable to the employee) U4, Which of the following would best describe total disability? Coverage is mandatory if an employer has one or more employees. However due to increasing financial strain they plan to raise premium cost for all insureds by 10% over the next two years. -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? -implied -assumed -apparent -express, apparent authority (the appearance or the assumption of authority based on the actions, words or deeds of the principal or because of circumstances the principal created) U1, Which of the following factors is NOT considered by an underwriter when determining the premium rates for an individual seeking insurance? Drawing on a critical disability framework of policy sociology, the paper considers the policy problem of access to education for people with disabilities under recent reform by means of the National Disability Insurance Scheme (NDIS), which commenced full roll-out across the country from July 2016. 2. Notice of Claim and Proof of Lossa What are the insurer's duties during the claim? Although he is still receiving benefits from his disability income policy, he does not have to pay premiums. A Stock Life Insurance Company. Disability Insurance Definitions and Terms | Guardian - Ch. 8 Death due to sicknessc. PDF The Disability Insurance Policy - JSTOR There is never any coverage unless the premium has been paid. The insured may cancel an insurance policy at any time! After he becomes disabled he receive payments from the company. -coverage is not renewable beyond the insured's age 65 -the insured's benefits cannot be reduced -the insurer can increase the policy premium on an individual basis -the insured has a unilateral right to renew the policy for the life of the contract, the insurer can increase the policy premium on an individual basis (guaranteed renewable provision has all the same features that the noncancellable provision does, with the exception that the insurer can increase the policy premium on the policy anniversary date. The Federal Fair Credit Reporting Act requires both pre-notification and post-notification regarding consumer reports. An applicant for health insurance has not had a medical claim in 5 years. when a claim is pending, the insurance company may require, an independent examination as often as reasonably required. Key terms and phrases you should know when shopping for and selected an disability insurance policy, either as an individual or through an employer. D) The contents of an inspection report cannot be disclosed to the applicant. This definition explains the meaning by Insuring Clause and why it thing. What type of health benefits will her health insurance policy pay for her injuries if the policy includes the narcotics & intoxicants provision? -pap smear -annual physical exam -mammogram -chemotherapy, On a major medical insurance policy, the amount that an insured must pay on a claim before the insurer will pay is known as: -deductible -copayment -inside limit -coinsurance, In order to be eligible for group health insurance, all of these are conditions an employee must meet EXCEPT: -must have dependents -must be working in a covered classification -must be actively at work -must be a full-time employee, Which of the following is considered a qualifying event under COBRA? Which of the following is NOT true? Assuming the premium has been paid (it was), coverage starts when the company underwriter approves the application. Although replacement is not unlawful, it can lead to errors and omissions if the producer fails to explain that a new probationary period may apply and that the incontestability clause starts over. A) Completed insurance policy to the applicant. Ch. 8 Individual Health Insurance Provisions - Chegg India enacts 'the Rights of Persons with Disabilities Act, 2016' to secure the rights of persons with disabilities. -marital status -age -income -gender, income (disability benefits are paid to those who are unable to work as they normally would, due to an accident or illness. GROUP LONG TERM DISABILITY INSURANCE Policyholder: Washington State Health Care Authority Policy Number: 377661 -B Effective Date: July 1, 1992 and as amended 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. 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. Which type of Medicare policy does the insured own? Which of the following best describes the situation, The insured should contact the insured to confirm her actual Social Security benefit amount. The underwriter orders the MIB report, not the producer. -closed panel -corridor -probationary -open panel, Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage? How long is accident and health insurance grace period. -notice of policy cancellation -payment of premium -promise to renew the policy at the end of the policy period -providing warranties on the application, Which of the following entities has the authority to make changes to an insurance policy? Its used to purchasing transition insurance that terminates in 6 montsh and . Life and Health producers may issue conditional receipts, but not binders of coverage. 4. She is doing this to see if the procedure is covered under the patient's insurance plan and for how much. D) National Association of Health Underwriters (NAHU). Health insurance ExamFX Flashcards | Quizlet Two years ago he suffered from a head injury from an accident, so he cannot remember parts of his past, but is otherwise competent. Claim is denied if the policy contains the Illegal Occupation provision. 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. 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. Health & Disability Insurance Clauses & Provisions | Study.com -cost reduction -claims reduction -claims discrimination -case management provision, case management provision (cost-saving services, also known as case management provisions, include the following: controlled access of providers, large claim management, preventive care, hospitalization alternatives, second surgical opinions, preadmission testing, catastrophic case management, risk sharing, and providing high quality of care) U5, Which of the following is true regarding inpatient hospital care for HMO members? The ensure issues the policy and learns of this history when youre later what will probably happen, In insurance transactions fiduciary responsibility means, Handling insurer funds in a Trust capacity, A producer has been notified by the commissioner to stop using and approve trade name how many days is a producer have to change the name before being fined, Any licensed person Whos activities affect interstate commerce and who knowingly makes false material statements related to the business of insurance may be imprisoned for up to, Two individuals are in the same risk and age class yet they are charge different rates for their insurance policies do to in significant factor what is this called, Which of the following is not a goal of risk retention, To minimize insureds lever of liability in event of loss, Within how many days of requesting an investigation consumer report mess and ensure notified the customer in writing that the report will be obtained, What is a penalty tax for nonqualified distributions From a health savings account, And insurance company ensures its new policy holders that their premium cost will not increase for a period of at least five years. -5% -7% -10% -15%, 10% (most people who itemize their deductions can claim deductions for unreimbursed medical expenses, those that are not covered by health insurance, that exceed 10% of their adjusted gross income) U8, Premium payments for personally-owned disability income policies are: -not tax deductible -eligible for tax credits -tax deductible -tax deductible to the extent that they exceed 10% of the adjusted gross income of those itemizing deductions, Which of the following determines whether disability insurance benefits are taxed?