Life Policy Provisions and Options Pt. 2
The _________ _________ in life insurance is typically 31 days and provides for the Payment of the premium to be received after its due date without a penalty or lapse in coverage
Grace Period
In regards to the Fair Reporting Credit Act, what must the applicant provide?
Written consent
_____ usually require patients to select a Primary Care Physician (PCP) as the person who will oversee and direct their basic health care in most cases.
HMO
An initial amount the insured must meet per year before benefits are paid. This applies as per person or family.
Deductible
____ ____ _______ policies are traditional plans that provide various coverages for hospital, surgical, and miscellaneous medical expenses
Basic Health Insurance
**Triple Jeopardy**
_______ ______ ____ provide for an early payment of a portion of the face amount prior to death. This provides tax free access to policy benefits based on an insured qualifying as terminally ill or chronically ill. A person is considered terminally ill when a physician has certified that person has a condition which is expected to result in death within ____ months
What Act was passed to help detect and prevent this illegal activity including but not limited to drug trafficking and acts of terrorism?
The Patriot Act
**Double Jeopardy**
True or False: Providers charge a discounted fee negotiated in advance is a specific to PPO
True: Unlike an HMO prepaid plan, the providers perform services to subscribers and charge a discounted fee negotiated in advance.
Expenses that did not satisfy the previous year’s deductible and were incurred in the last 3 months of that year are used towards satisfying the current year’s deductible
The Carry-Over Provision
The ________ _______ ______ plan provides benefits for miscellaneous medical expense charges including office visits, diagnostic x-rays, laboratory charges, ambulance charges, and nursing expenses when not hospitalized and not related to surgery. Some plans may include coverage for prescription drugs. Coverage is limited and subject to a waiting period for maternity, mental illness, substance abuse, and pre-existing conditions.
Basic Medical Expense
What provision: Party who has all rights to cash, loan values, dividends and other benefits
Ownership Provision
Financial institutions are required to report any activity they believe or even have reason to suspect is an effort to launder money. A Currency Transaction Report (CTR) must be filed with FINCEN (Financial Crimes Enforcement Network) through the Department of Treasury for every cash transaction that exceeds _______ and wire transfers in excess of ______.
$10,000, $3,00
True or False: PPOs are deemed to be both a health care financing and servicing mechanism.
False:
HMOs are deemed to be both a health care financing and servicing mechanism. The principal objectives are to reduce medical expenses by:
Define Co-Insurance
After the annual deductible has been met, the coinsurance feature applies. Coinsurance is a cost sharing feature and is stated as a percentage, such as 80/20, of sharing between the insurer and the insured; the insurer pays the larger percentage
_____ ______ ____ insurance coverage combines the features of the Basic and Major Medical policy into a single policy.
Comprehensive Major Medical
**Double Jeopardy**
True or False: Policy Loan Provisions include the death benefit of a policy is automatically reduced when a loan is requested
False: Policy loans do not automatically reduce the death benefit in a policy. If an outstanding loan exists at the time of death, the amount of the loan will then reduce the benefit paid to the beneficiary.
Based on the Principle of Indemnity, insurance is designed to restore an insured to the same physical or financial condition which existed prior to the loss, without a ___ _____ ____
profit or gain.
Which one is managed care plans arranged through a network of healthcare providers, independent hospitals and medical practitioners, which become preferred providers in a specific geographic area.
PPOs
**Triple Jeopardy**
If several family members are injured in the same accident, only one deductible is applied
Common Accident Deductible
Basic health plans provide “first dollar” coverage, which means
Benefits are payable starting with the first dollar of expenses incurred up to a stated maximum benefit and without a deductible
Policy loans with fixed rates can have a maximum fixed interest rate of _% or less, as stated in the policy. For policy loans with an adjustable (variable) interest rate, the maximum rate is based upon ______ _____ bond yield average and is stated in the policy. The policy loan amount cannot exceed the available cash surrender value.
8, Moody's Corporate
What are the 4 elements of a Legal contract?
Competent Parties, Legal Purpose, Agreement (Offer and Acceptance), and Consideration.
Define POS
Point of Service Plans combine PPO and HMO benefits. Members can choose (at the point of service) which part of the plan to use. If the subscriber stays in network, benefits are paid as an HMO. A Primary Care Physician, or gatekeeper, will apply and referrals will be necessary if the plan is being utilized as an HMO.
This plan provides for Major Medical coverage designed to supplement a Basic Plan. It is written to pay benefits once the Basic Plan benefits are exhausted. The Basic Plan provides first dollar coverage. Once the Basic Plan benefits are exhausted, an additional deductible called a corridor deductible is required to be paid before benefits are payable under the _________ _______ ________ plan.
Supplemental Major Medical
An insured is covered under a major medical plan with a $500 deductible that has not been paid and 80/20 coinsurance requirement. A minor injury is suffered and the total covered cost for treatment is $1,500. How much will the insurance company cover?
The insurance company will pay $800 of the $1,500 loss. The insured is responsible for the initial deductible of $500. Of the remaining $1,000, the insurer is responsible for 80%, or $800.