Term
| What are the two major causes of loss under a health insurance policy? |
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Definition
| Accidental Bodily Injury and Sickness |
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Term
| What are the four types of losses and benefits? |
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Definition
Loss of Income From Disability
Medical Expense
Dental Expense
Long-Term Care Expense |
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Term
| There are two separate types of insurance included in the generic term "health insurance" What are they? |
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Definition
| loss of income and expenses related to health care. |
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Term
| What are the three most important underwriting factors considered in in accepting or classifying health insurance applicants? |
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Definition
Occupation
Moral or Morale Hazards
Physical Condition of the Applicant |
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Term
| Why man an underwriter's attitude toward group risks be less restrictive than with individual policies? |
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Definition
| Group policies are subject to annual reevaluation on the anniversary date. |
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Term
| Private insurance companies provide much of our individual and group health insurance. The Federal Government, however, provides coverage for... |
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Definition
| some disabled individuals and those over age 65 in the form of Medicare. |
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Term
| Medicaid offers assistance as both a ____ and _____ sponsored program. |
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Definition
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Term
| What's the difference between limited and comprehensive insurance? |
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Definition
| Limited health insurance policies only cover specific accidents and diseases. A comprehensive plan would cover all sickness or accidents that are not specifically excluded. |
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Term
| The limited policy notice must be what? |
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Definition
| plainly state on the first page of the policy "THIS IS A LIMITED POLICY" |
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Term
| What are the 7 types of Limited Policies? |
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Definition
Accident-Only
Specified (Dread) Disease
Hospital Indemnity (Income)
Credit Disability
Blanket Insurance
Prescription Drugs
Vision Care |
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Term
| What's a Hospital Indemnity policy provide? |
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Definition
| Set amount of money on a daily, weekly, or monthly basis. Based upon the number of days confined in a hospital, irrespective of medical expenses incurred. |
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Term
| What's a credit disability policy? |
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Definition
| In case of disability, payments to the creditor will be made for them until able to return to work by the definition of the policy. |
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Term
| What is blanket insurance? |
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Definition
| Insurance for a particular group when participating in a particular activity. Often the individual's name is not known. |
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Term
| What is a Prescription Drug policy? |
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Definition
| An optional benefit under a group policy in which the insured pays a co-payment, insurer pays balance. There are limits on the amount of drugs purchased. |
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Term
| Name the 7 common exclusions from coverage? |
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Definition
Pre-existing conditions
Intentionally self-inflicted injuries
War or an act of war
Elective cosmetic surgery
Conditions covered by workers compensation
Government plans
Participation in criminal activity |
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Term
| When may the Elective Cosmetic Surgery exclusion non apply? |
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Definition
| When due to correct a condition due to an accident or due to birth defect. |
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Term
| Pre-existing conditions are conditions for which in the insured has received diagnosis, advice, care, or treament during the last ___ months prior to the application. |
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Definition
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Term
| Under the Pre-existing Conditions Exclusion, group health may be put on probation for ___ months unless there is creditable coverage within the last ___ days. |
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Definition
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Term
| It is an unfair trade practice to make any statement that an insurer's policies are guaranteed by the existence of the... |
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Definition
| Life and Health Guaranty Association |
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Term
| What does malingering mean? |
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Definition
| To feign an illness or other incapacity to avoid duty or work. |
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Term
| A "notice to the applicant" must be issued to all applicants for health insurance to inform them of what? |
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Definition
| The insurer will obtain credit history and past history/applications with other health insurers. |
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Term
| Any change in an insurance application must be made in two ways: |
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Definition
| cross out the incorrect answer and write the correct answer in, or start with a fresh application. |
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