DE Accident & Health Insurance
Major medical policies may include which types of deductibles? - ANS-Flat, corridor, per
cause
Most long term care policies provide coverage for ____________ care - ANS-Home
health care
The commissioner is elected by - ANS-The citizens
Guaranteed renewable health insurance policies ensure renewability up to - ANS-A
specific age of the insured
What is the maximum amount in life insurance benefits covered by the Delaware Life
and Health Insurance Guaranty Association? - ANS-$300,000
Medicare—Part D Prescription Drug Coverage is available to - ANS-Anyone enrolled in
Medicare Part A
Suppose an insurer has knowingly accepted insurance business from an individual who
is not licensed. He can be fined up to: - ANS-$20,000.00
Commissioner charges how much for nonwillful violations and how much for willful
violations? - ANS-$1000 per violation up to $10,000 for nonwillful violations
$5000 fine for willful violations, up to a total of $50,000 in any 6-month period.
Is illegal occupation a mandatory provision? - ANS-No , it is optional, because in some
cases it is not needed
Loss-of-time benefit adjustment - optional or required? - ANS-Optional , because in
some cases it is not needed.
Change of beneficiary - optional or required? - ANS-Required!
Dentists that are on a specified list, and whom are paid on a flat per capita basis,
characterizes an - ANS-HMO
Group plans are not tailored to - ANS-the individual
What is the maximum number of days of skilled nursing facility care for which Medicare
will pay benefits? - ANS-100 days
According to the disability insurance time limit on certain defenses provision, how long
after the date of a policy's issue can innocent misstatements on an application be used
to void a claim?
For the life of the policy
5 years
2 years
1 year - ANS-2 years
Disability benefit payments with employee contributions are - ANS-Not taxable
Disability benefit payments funded fully by employer - ANS-Are taxable
How long must replaxing and existing insurers maintain a replacement register and
copies of all written communications regarding replacement? - ANS-Three years
A nonresident agent would not apply for a temporary license in Delaware, but for a -
ANS-nonresident agent's license
Identify the number of days the insured or insurer must do the following in this order:
Notice of Claim, Claims Forms, Proof of Loss, Waiting Period for Sickness Claims upon
Reinstatement - ANS-20, 15, 90, 10
Which of the following statements regarding persons participating in an HMO is correct?
They negotiate health care service fees with contracted HMO providers
They pay for health care services are they incurred
They pay a fixed periodic fee whether or not health care services are used
They pay for health care services as they are incurred, at a rate discounted for the HMO
- ANS-They pay a fixed periodic fee whether or not health care services are used
What is the definition of pre-existing condition in a long-term care policy? - ANS-A
condition for which advice or treatment was received within 6 months before the
effective date of coverage
Under many dental expense plans, diagnostic care is - ANS-Covered
Injuries covered by workers compensation are technically _______ under health
insurance - ANS-Excluded. Workers comp is a separate thing.
A managed health care system that finances and delivers health care services through
contract providers is called - ANS-a Health Maintenance Organization (HMO)
Benefit periods for short-term disability income policies typically range from: - ANS-6
months to 2 years
Benefit periods for long-term disability income policies typically range from: - ANS-2
years or longer
To be considered currently insured, and therefore eligible for disability benefits under
Social Security, a worker must have earned a minimum of - ANS-6 credits in the last 13
quarters
Who sets the requirements that must be met for LTC policies to be considered qualified
- ANS-HIPAA 1996
A group of employers from a similar industry assembled to qualify for group health
insurance is - ANS-A multiple employer trust
Benefits received from a tax-qualified, long-term care insurance plan for employees are
- ANS-NOT subject to income tax
Three distinct categories of basic health coverage exist: - ANS-Medical expense,
disability income, and accident-only
Because of Pearson's financial situation, he must rely on Medicaid to pay the cost of
long-term care. Pearson is not a good candidate for - ANS-LTC
Utilization review is a set of techniques to evaluate - ANS-The clinical necessity of
health care services `
METs can provide benefits on a self-funded basis, or they can - ANS-Add benefits
through a contract issued by an insurance company.
The free look provision in a long term care policy allows for how many days for a full
refund? - ANS-30 days
ERISA requires certain information concerning group insurance plans be made
available to - ANS-Plan participants and their beneficiaries
The IRS
The Department of Labor
Qualifying events under COBRA include - ANS-Medicare eligibility, reduction in work
hours, termination of a child's dependent status and divorce
Union workers as a class may be excluded since - ANS-Their compensation and
benefits are covered by a collective bargaining agreement
How many continuing education credits must Delaware resident producer licensees
earn every two years? - ANS-24 credits (12 per year)
Bob is severely injured after falling off of his roof while cleaning the gutters. If he is
unable to provide proof of loss within 90 days, it may - ANS-Be filed up to one year after
the date of loss
What type of plan integrates its coverage with basic medical expense coverage,
providing benefits in excess of those specified in the basic plan - ANS-Supplementary
Major Medical
After an individual has received the eligibility notice for COBRA continuation from the
employer, the option to elect coverage expires - ANS-60 days from the date of receipt
Medicare supplement policies (Medigap) pay for medical costs arising from extended
___________ - ANS-Custodial (nursing home) care
Petra is self-employed and pays $5000 a year in premiums for health insurance
covering her family. If her spouse also works and is covered by an employer-sponsored
health plan, what is the maximum income tax deduction Petra can take for her health
insurance coverage? - ANS-$0 . THE DEDUCTION IS NOT AVAILABLE TO THOSE
WHO COULD BE COVERED BY THEIR SPOUSES GROUP POLICY.
Major medical policies may include any of the following types of deductibles -
ANS-Integrated/per-cause, corridor, or flat
A license is being used for controlled business if more than - ANS-25% of the agent's
total commission is earned from controlled business
To be eligible for disability benefits under Social Security, a worker must have earned a
minimum of - ANS-6 credits in the last 13 quarters
A POS plan allows a subscriber to access care - ANS-Both in-network and
out-of-network
Medicare Part A covers 80% of the cost of - ANS-Durable medical equipment
Medicare Part A specifically excludes - ANS-Private duty nursing, non-medical services,
intermediate care, custodial care, and the first three pints of blood
The Medical Reimbursement benefit available in some individual disability income
policies is a percentage of - ANS-The monthly income benefit
A nonforfeiture benefit is an ____________ benefit to a long-term care insurance
policy? - ANS-Optional
Presumptive Disability provision will provide benefits - ANS-For very severe conditions
that raise the presumption of total disablement
Coverage for the reasonable cost of the first 3 pints of blood must be included in all
_______________ - ANS-Medicare Supplement Policies. All CORE benefits must be
included
To be eligible for Social Security disability benefits, one of the requirements is that the
person - ANS-Be totally and permanently disabled for at least 5 months
Change of occupation provision states that a change in occupation from a more
dangerous to less dangerous occupation specifies that - ANS-Premiums will be reduced
and the insurer will return the excess pro-rata unearned premium to her
Changes made to a health policy in Delaware must be approved ...... - ANS-In writing by
an executive officer of the insurance company
An employer funded account that pays employees for qualified medical expenses they
incur - ANS-Health Reimbursement Account
