Define It
This is the time after a premium due date before the policy lapses for nonpayment.
Grace Period
This increased the quality and affordability of health insurance. Lowing the uninsured rate by expanding public and private insurance coverage and reducing the cost of health care for individuals.
Patient Protection and Affordable Care Act ( PPACA)
An indemnity contract is an agreement to pay on behalf of another party under specified circumstances, such as when a loss occurs. Under the principle of indemnity, insurance will only restore the insured to the ___financial condition that existed before the loss. The insured cannot profit from the loss.
Same
All of these are classes of Insurance Except: Life, Fire, Marine, Title, Parental or Liability
Parental
True or false: A claimant can be a person who is conducting an investigation of a claim on behalf of an insurer.
False
This provision in the Affordable Care Act is designed to eliminate discrimination based on health status by insurers. Insurers must provide health insurance to any person, regardless of medical history or current state of health. Insurers may no longer rate and charge higher premiums for substandard risks. Rates are strictly based on regional costs and the age of the insured.
Guaranteed Issue
This Act states employers with 20 or more employees must provide a health coverage continuation option to all covered employees and dependents up to 18 months in the event of:
Termination of employee (unless it is for cause as defined by federal law)
Reduction of hours for employee, so they no longer qualify as a full-time employee
Coverage may continue up to 29 months if an employee or dependent is totally disabled at the time of a qualifying event
COBRA
The _____of a health plan equals the % of the total Average costs that a plan pays for Essential Health Benefits. If a health plan had an average ____of 60%, insured individuals would be responsible for paying 40% of the costs covered benefits. A plan meets the min value req if it is designed to pay at least 60% of the total costs for covered benefits.
Actuarial Value
Group Coverage Provisions Include all of the following except: Misstatement of
Age, Dependent Eligibility and Continuation, Incontestability, Domestic Partners or Guarantee Issue
Guarantee Issue
True or False: An Express Warranty is made in the policy itself.
True
When a mutual Insurance company decides to convert to stock company it is referred to as?
De-mutualization
Under this an employer always must maintain the employee's existing level of health coverage (including family or dependent coverage) under a group health plan during the period of this leave, provided the employee pays his or her share of the premiums.
FMLA
The insurer may rescind the contract on basis of misrepresentation,____, or fraud by the insured.
concealment
Which of these is not an Underwriting Factor: Age, other insurance, health history, number of dependents, or other insurance
Number of Dependents
True or False: An insurance agent transacts life insurance.
Flase
An initial amount the insured must meet per year before benefits are paid. This applies as per person or family. Can vary in cost and are designed to allow the insured to assume a portion of the risk. Changing this amount will affect the premium cost. The higher this amount results in a lower premium.
Deductible
This was designed to provide protections for persons with preexisting conditions who left one employer and might not be covered by a new group health plan. In addition, this created a number of regulations concerning privacy protections for personal health information, including safeguards for recordkeeping and sharing of medical records.
HIPAA
Physical, Moral, and Morale are all types of ___
Hazards
Which of these is not a type of insurance license: Producer, Life licensee and Life Agent, Life- Only Agent, Accident and Health Agent, Insurance Broker, Surplus line Broker, or Indemnity agent.
Indemnity Agent
True or False: The Privacy Protection Act enables applicants and policyholders to obtain reasons for adverse underwriting decisions.
True
A possibility of loss, no loss, or gain.
Speculative Risk
Consists of all state and territorial insurance commissioners or regulators. It provides resources, research, legislative and regulatory recommendations and interpretations for state insurance regulators. It also promotes uniformity among states. Members may accept or reject recommendations. It has no legal authority to enact or enforce insurance laws.
NAIC
The Medicare Initial Enrollment Period lasts _ months and begins _ months before the moth of an individual’s 65th birthday and ends _ months after the month following when the individual turned age 65. The actual month of eligibility is the month of the individual’s birthday.
7,3,3
Medicare Part A covers which of the following: Mental healthcare, Primary Care visits, Eye Exams, inpatient hospitalization or acupuncture.
Inpatient Hospitalization
True or False: According to CIC Section 1711, an organization ceases to exist as an entity eligible to hold a license upon dissolution of copartnership.
False- upon termination of all contracts