3495321
| Question | Answer |
| The waiting period for Temporary Disability insurance benefits is | 7 consecutive days |
| To be eligible for Temporary Disability insurance, an individual must have been in employment for at least ___ weeks, during which they worked _____ hours and earned wages of at least ___ during the 52 weeks immediately preceding their first day of disability. | 14 weeks 20 or more hours $400 in wages |
| A person is eligible for Pre-Paid Health Care if they have been employed at least _____ weeks and work at least ____ per week. | 4 consecutive weeks at least 20 hours |
| for Pre-Paid Health Care and the Employers must pay what amount and employees must pay the balance. | at least one-half of the premiums |
| An “insured” may cancel their health insurance policy at anytime by | giving written notice to the insurer |
| Handicapped children may continue to be covered on their parent’s health insurance as long as the parents notify the insurer within | 31 days of the child’s attainment of the limiting age. |
| Persons covered by a group health policy may assign their benefits to a hospital or doctor, which is known as an | “assignment of benefits” |
| what clause states that "This policy, including the endorsements and attached papers, if any, constitutes the entire contract of insurance. No producer has authority to change this policy or waive any of its provisions. No change in the policy shall be valid until approved by a company officer”. | Entire Contract |
| A health policy shall be incontestable after 3 years, except for fraud. The name of this provision is the | "Time Limit on Certain Defenses Clause" |
| The maximum probationary period on an individual health policy is usually | 1 year |
| the insurer shall not define a preexisting condition as one that occurred more than ____ prior to the effective date of the policy. | 12 months |
| The maximum probationary period on Medicare Supplements, group health and long term care policies is | 6 months |
| The insured shall send Notice of Claim to the insurer within | 20 days |
| The policy provision that states to whom a claim is payable is called | "Payment of Claims" |
| The policy provision that says claims should be paid immediately is called | "Time Payment of Claims" |
| The policy provision that allows the insurer to ask a disability income claimant to see the insurer's doctor is called "Physical Exam and Autopsy". | "Physical Exam and Autopsy" |
| The "Legal Actions" provision allows the insured to sue the insurer in the event of nonpayment of a valid claim after ___ days | 60 days up to 3 years. |
| Newborns must be covered from | the moment of birth |
| Complications from pregnancy are covered the same as | any other illness |
| Medicare supplements and LTC policies are required to have a___________, starting from policy delivery (there is no coverage if you return the policy). | 30 day free look |
| All insurers selling Medicare Supplements (Medigap policies) must offer at least known as the "core" or "basic" benefits | Plan ‘A’ coverage |
| Under COBRA (a federal regulation), a terminated employee may stay in the group for up to _______ months but has to pay their own premium including any portion formerly paid by their employer. | 18 months |
| Insurers must _________ for treatment of alcoholism and substance abuse. | provide coverage |
| Underwriters utilize the Medical Information Bureau (MIB) to prevent | Adverse Selection |
| Upon termination of employment, employees must be given the option of conversion to an individual policy without evidence of insurability within ______ | 31 days |
| Medicare Supplements and Long Term Care (LTC) policies where the insurer must offer renewal to a certain age or date, BUT rates may be changed by "class" are | guaranteed renewable |
| Medicaid is for low income people regardless of age (medical welfare) funded by | state and federal monies |
| A retired person age 65 or older who has Medicare Parts A & B should also consider buying this to fill in Medicare's "gaps" in coverage. | Medicare Supplement (Medigap) policy |
| A Medicare Supplement is required to have a ______ starting after a retired person enrolls in Medicare Part B, during which time the applicant may not be rejected or up-rated by an insurer. | 6 month open enrollment period |
| All social security benefits are based upon the participant’s. | Primary Insurance Amount (PIA) |
| Anyone on kidney dialysis or who qualifies for disability benefits under social security for 2 years, regardless of their age, is eligible for | Medicare |
| Only persons eligible for social security disability are ages | 65 and under |
| You must have "fully insured" status under social security in order to get disability benefits, meaning contributed at least ____ quarters | 40 quarters (10 years) |
| Social Security benefits are "indexed" for ______ tied to the ______ | Inflation Consumer Price Index |
| There are how many Medicare Supplement Plans available | 12 Medicare Plans (Plans A through L) |
| All insurers selling Medicare Supplements must offer at least | Plan A (the basic core benefits) |
| 2 health policies that both cover nursing homes. | Long Term Care (LTC) policies and Medicaid |
| Grace periods on health insurance are 7 days, 10 days or 31 days, depending upon the | "mode" of payment |
| Complications from pregnancy must be covered on what policies. | ALL Medical expense policies |
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