Term
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Definition
| TAKE IT OR LEAVE IT, NO NEGOTIATION ON THE INSUREDS PART |
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Term
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Definition
| ONLY ONE SIDE(INSURER) IS LEGALLY BOUNT TO A CONTRACT |
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Term
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Definition
| CONTRACT CONDITIONS MUST BE MET BEFORE THE ISNUR'S PROMISE IS MET. |
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Term
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Definition
| CONTRACT BEWTWEEN THE INSURED AND INSURER |
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Term
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Definition
| UNEQUAL EXVHANGE FOR MONEY |
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Term
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Definition
| A PRODUCER CONCEALS, MISREPRESENTS, OR MAKES MISLEADING COMPARISON TO MAKE THE INSURED GO TO YOUR COMPANY AND LEAVE THEIRS. |
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Term
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Definition
| PREVENTS REASERTING A RIGHT PREVIOUSLY WAIVED |
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Term
| PURE PROTECTION LIFE POLICY |
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Definition
| DEATH BENEFIT ONLY. TERM POLICY |
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Term
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Definition
| DEATH BENEFIT AND LIVING BENEFIT, CASH LOANS. WHOLE LIFE POLICY-ENDOWMENTS-FLEXIBLE |
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Term
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Definition
| LEVEL FACE AMOUNT-LEVEL PREMIUMS |
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Term
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Definition
| DECREASING FACE AMOUNT BUT LEVEL PREMIUM |
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Term
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Definition
| INCREASING FACE VALUE USUALLY LEVEL PREMIUM |
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Term
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Definition
| SINGLE POLICY WRITTEN ON TWO OR MORE LIVES |
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Term
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Definition
| TERM AND WHOLE LIFE COMBINED INTO ASINGLE POLICY |
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Term
| penalty be for a person who transacts insurance without a valid license |
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Definition
| A misdemeanor punishable by $30,000 and 2 months in a county jail |
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Term
| role of the Commissioner and the Department of Insurance |
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Definition
| Regulate the conduct of agents and insurers in California |
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Term
| An insurer who practices unfair discrimination found to be a general business practice is penalized by a fine of |
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Definition
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Term
| A Special Surplus Line broker may transact all of the following except: |
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Definition
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Term
| Any agent who violates the LTC insurance laws will be fined not less than |
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Definition
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Term
| When an insurance company pays claims after a self-insured specified limit has been reached this is known as: |
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Definition
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Term
| A long term care policy with the lowest premium would consist of: |
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Definition
| longest elimination period and longest benefit period. |
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Term
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Definition
| Is automatic unless declined |
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Term
| The COBRA act was changed and clarified by: |
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Definition
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Term
Timely entry under HIPAA is defined as which of the following?
36 DAYS OR LESS
63 DAYS OR LESS
93 DAYS OR LESS |
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Definition
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Term
| MEDICAID IS FUNDED BY WHO |
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Definition
| FEDERAL, STATE TAXES AND LOCAL TAXES |
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Term
| Benefits received under a group noncontributory disability income policy are considered: |
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Definition
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Term
| The insured is eligible for a waiver of premium benefit under a disability income policy: |
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Definition
| AFTER THE FIRST 6 MOTNHS OF DISABILITY |
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Term
| THE_________rider would not increase premium in a disability policy? |
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Definition
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Term
| DOES MEDICARE HAVE NURSING HOME BENEFITS? |
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Definition
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Term
| What is the purpose of the recurrent disability provision? |
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Definition
| To do away with the elimination period in case of a relapse |
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Term
| Insurable risks must involve: |
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Definition
| THE POSSIBILITY OF LOSS ONLY |
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Term
| Part A of Medicare not provide coverage for? |
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Definition
| OUTPATIENT HOSPITAL SERVICES |
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Term
| In an HMO the fixed monthly fee paid to the service provider is known as: |
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Definition
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Term
| MENTAL ILLNESS MAYNOT BE EXCLUDED IN A LONG TERM POLICY |
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Definition
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Term
| The type of disability where the insurance company pays disability benefits, and not requires the insured to submit to periodic examinations, to prove continuing disability would be: |
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Definition
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Term
| Long-term care policies can be sold in all the various ways except:` |
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Definition
| AS A SUPPLEMENT TO THE SOCIAL HEALTH INSURANCE PROGRAM |
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Term
| Employer group plan is primary to Medicare |
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Definition
| Employer group plan is primary to Medicare |
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Term
| COBRA allows terminated employees to continue their coverage |
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Definition
| COBRA allows terminated employees to continue their coverage |
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Term
| the probationary period in a health insurance contract BEGINS WHEN |
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Definition
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Term
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Definition
| IS AUTOMATIC UNLESS DECLINED. |
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Term
| Which component of Medicare would pay for a hospital stay? |
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Definition
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Term
| FMLA allows eligible employees to take off up to how many weeks for a birth of a child? |
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Definition
| 12 weeks in a 12 month time frame. |
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Term
| is in patient hospital care provided by a ltc policy |
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Definition
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Term
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Definition
Medicare is the federal health insurance program for:
Most people age 65 and over
Certain people younger than 65 with disabilities |
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Term
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Definition
| covers inpatient hospital stays, inpatient skilled nursing facility stays, home health care and hospice care. |
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Term
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Definition
| covers outpatient medical services such as doctor visits, diagnostic lab tests and preventive care. |
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Term
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Definition
| covers most prescription drugs |
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Term
| PPO-PREFFERED PROVIDER ORGANIZATION |
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Definition
ARRANGEMENT GROUP HOSPITALS & MEDICAL PROVIDERS WHO AGREE TO PROVIDE SERVICE AT A PRE ARRANGED COS.
ORGANIZER CAN BE INSURER, THE BLUES, HMOS, AND GROUP EXCEPT SCHOOLS!! |
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Term
| EPO-EXCLUSIVE PROVIDER ORGANIZATION |
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Definition
| THESE PLANS HAVE LIMITS ON PROVIDERS AND DO NOT PAY FOR SERVICES OUT OF NETWORK |
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Term
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Definition
| OUT OF NETWORK SERVICE OK BUT U HAVE TO PAY HIGHER FEE FOR THE SERVICE. COMBINES MEDICAL EXPENSE AND HMO BENEFITS |
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Term
| HMO- HEALTH MAINTENANCE ORGANIZATION |
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Definition
GATEKEEPER- PRIMARY CARE PHYSICIAN
MONITORS HEALTH CARE CONTROLS COST
APPROVE/DISAPPROVE REFERRALS TO SPECIALISTS
0B-GYN CAN BE GATEKEEPERS |
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Term
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Definition
| PROVIDES BENEFITS FOR THE COST OF MEDICAL CARE DUE TO ILLNESS OR INJURY |
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Term
| BASIC PLANS/FIRST DOLLAR PLANS |
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Definition
THESE PLANS PLACE LIMITS ON THE TYPE OR DURATION OF SERVICES AS WELL AS DOLLAR LIMITS THAT WILL BE PAID
PROVIDE BENEFITS UP FRONT WITHOUT REQUIRING THE INSURED TO SATISFY HIS DEDUCTIBLE |
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Term
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Definition
PROVIDE BROADER RANGE OF COVERAGE
DESIGNED TO PROTECT AGAINST PROLONGED ILLNESS OR INJURY . CAN BE INDIVIDUAL OR GROUP |
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Term
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Definition
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Term
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Definition
ARE WRITTEN ON EITHER AN OCCUPATIONAL OR NONOCCUPATIONAL BASIS
OCCUPATIONAL- COVERS ILLNESS AND INJURY ON OR OFF THE JOB
NONOCCUPATIONAL- COVERS ILLNESS N IN JURY ONLY OFF THE JOB.
MOST GROUP PLANS ARE WRITTEN NON OCCUPATIONAL CUZ EMPLOYEES ARE COVERED BY WORKERS COMP |
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Term
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Definition
| LOSS OF SIGHT, HEARING, SPEACH OR ANY TWO LIMBS |
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Term
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Definition
| WITHIN 80 DAYS IF SAME CAUSE |
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