KY Health

Question Answer
To apply for hearing after aggrieving act 60 days
An arrangement that allows group policy holders to postpone premium payments for a period of time beyond the grace period Premium delay arrangement
Room and board, lab and x-ray charges, medicines, use of operating room and supplies while the insured is confined in a hospital is covered by Basic Hospital Expense
What do you pay for Outpatient Hospital Treatment under Medicare Part B? 20% of billed amount after deductible
What does Medicare Part A pay after day 90 of a hospitalization? All but the daily deductible
Flexible Spending Account (FSA) premiums Not deductible
Health Reimbursement Account (HRA) premiums Deductible
Medicare Part B is funded by Monthly premiums and from general revenues of the government
The concept in which the insured and the insurer share the cost of medical expenses, with the insurer bearing the greater share? Coinsurance
An insurance company that is incorporated in another state (operating outside of the state in which its home office is located) Foreign insurer/ company
Key Person Disability Benefits Not taxable
What do you pay after day 100 in Skilled Nursing Facility Care under Medicare part A? All cost
What do you pay for Home Health Care under Medicare part A? Nothing for services, 20% of approved amount for medical equipment
Continuing Education required every 2 years 24 hours
A termination of a policy by an insurer on the anniversary or renewal date Nonrenewal
Health Reimbursement Account (HRA) benefits Not taxable
What does Medicare Part A pay for Home Health Care? 100% of approved amount for services, 80% for medical equipment
Insurers location of incorporation and the legal ability to write business in a state Domicile of Insurer
Group Disability Income Premiums Deductible for the employer
The portion of the premium for which policy protection has not yet been given Unearned Premium
What do you pay for if you need blood under Medicare part A? First 3 pints
Commissioners term in office 4 years
An insurance company that is incorporated outside the United States Alien Insurer
What does Medicare Part A pay for the first 60 days of a hospitalization? All but the deductible
A percentage of the principal amount of a policy paid to the insured if he/she suffered the loss of an appendage capital sum
The office of Insurance will keep complaints on file 5 years
Examine domestic insurers 5 years
What does Medicare Part A pay for days 61-90 of a hospitalization? All but the daily deductible
What metric will be used to classify the risk when an insured holds more than one occupation? Most hazardous
Notice of hearing 20 days
Age to apply for license 18
A policy, endorsements, and any attached papers constitute the ____________. Entire Policy
What is included in the insuring clause of a health insurance policy? The insured, the insurance company, and what kind of loss is covered
What do you pay for day 21-100 in Skilled Nursing Facility Care under Medicare part A? Daily Deductible
License renewal period 2 years
Prior group coverage can reduce a pre-existing exclusion period if there has not been an intervening break in coverage of how many days? 63
Maximum term of temporary licenses 180 days
Policies offering benefits restricted to certain contingencies, such as travel, accident, or death by specified cause are broadly classified as ______________. Limited Policies
__________ provides that in the event of a permanent and total disability, premiums will be waived for the duration of the disability. Waiver of premiums provision
Agent may represent an insurer without an appointment 15 days
Requires the insured to pay a certain percentage of the insured medical expenses, usually above a deductible Coinsurance Clause
An insurance company that is incorporated in the state Domestic insurer
What does Medicare part A pay for Hospice Care? All but limited costs for outpatient drugs and inpatient respite care
Business Overhead Expense Premiums Deductible for employer
Group Long-Term Care benefits Not taxable
What does Medicare Part A pay for days 21-100 in Skilled Nursing Facility Care? All but daily deductible
What does Medicare Part B pay for Medical Expenses? 80% of the approved amount after the deductible
Group Disability Income Benefits Taxable
What do you pay for medical expenses under Medicare Part B? Deductible, 20% of the approved amount, and limited charges above approved amount
Insurer must notify the Commissioner of termination of agent's appointment 30 days
What do you pay for Hospice Care under Medicare Part A? Limited cost sharing for outpatient drugs and inpatient respite care
Disability Buy-Sell premiums Not deductible
Business Overhead Expense Benefits Taxable
A policy that does not provide for the insured to share any surplus declared by the company Nonparticipating
An insured has a policy which the insurance company declines to renew at the policy anniversary date. The policy is ________________. Optionally Renewable
What do you pay for the first 20 days in Skilled Nursing Facility Care under Medicare Part A? Nothing
Flexible Spending Account (FSA) Benefits Not taxable
An insurance company authorized and licensed to transact insurance in a particular state Authorized (Admitted) Insurer
Key Person Disability Premiums Not deductible
A group insurance plan that requires the employees to pay part of the premium Contributory
Group Medical Benefits Not taxable
A provision that specifies to whom payments are to be made Payment of claims
Within an HMO, use of a Primary Care Provider is common as part of ________________. The gatekeeper system
What does Medicare Part A pay for the first 20 days in Skilled Nursing Facility Care? (After you have been in the hospital at least 3 days) 100% of Approved Amount
Group Medicare Supplement Premiums Deductible for employer
What do you pay for days 61-90 of a hospitalization under Medicare Part A? Daily deductible
Susan's company pays the entire premium for her group disability coverage. If Susan becomes disabled, what percentage of the benefits are taxable? 100
To qualify for the Accidental Death rider, death must occur within how many days of the accident? 90
To report change of address 30 days
Brenda names her husband, Trent, as the beneficiary of Accidental Death Benefits in her health insurance policy. She relinquished her right to change her beneficiary. According to Required Provision 12: Change of Beneficiary, Trent is ______________. Irrevocable
An insurance company that has not applied for, or has applied and been denied a Certificate of Authority and may not transact insurance in a particular state. Nonauthorized/ nonadmitted
Federal law that was enacted to ensure that employees receive the pension and other benefits promised by their employers Employee Retirement Income Security Act of 1974 (ERISA)
Individual medical premiums Not deductible
Some major medical policies begin with first dollar coverage that pays up to the limits then the insured pays a certain dollar amount of excess before major medical school portion begins again. What term applies to the dollar amount the insured must pay? Corridor Deductible
Individual disability income premiums Not deductible
Activities individuals must do every day such as bathing, toile ting, mobility, continence and eating Activities of Daily Living
Individual Medical Benefits Not taxable
Premium payment mode that will result in the highest total premium Monthly
Group medical premiums Deductible for employer
When the insurer overestimates the cost of a policy Surplus
HMO model that contracts with a combination of independent physicians, medical groups, and associations Individual Practice Association (IPA)
The insured is totally disabled by an accident and then totally disabled by an illness at the same time, what happens? insured can collect total disability since there has only been one loss of income
Individual long-term care premiums Not deductible
What does Medicare Part B pay for Outpatient Hospital Treatment? Medicare payment to hospital based on hospital cost
Producer must maintain records of all insurance transactions 5 years
After a legal name change, how many days do you have to inform the commissioner? 30
CE credit hours can be carried over to the subsequent biennium 12 hours
Students at a major university who wish to purchase health insurance could ____________________. Obtain group health insurance via a blanket insurance policy
What does Medicare Part A pay after day 100 in Skilled Nursing Facility Care? Nothing
Group Long-Term Care Premiums Deductible for employer
What does Medicare Part A pay for if you need blood? All but the first 3 pints each calendar year
Continuing Education credits in Ethics 3 hours
Business overhead expense policies are a specialized form of ________________. Disability
Disability buy-sell benefits Not taxable
A policy that contains the wording "accidental means" is ___________________________. More favorable than one that includes accidental bodily injury.
In order to obtain group health insurance without providing proof of insurability, what do individuals generally have to do? Submit enrollment form within a specified eligibility period
An insured may, by written request, have benefits under the policy paid to __________________. A A hospital, physician or surgeon
What do you pay for if you need blood under Medicare Part B? First 3 pints plus 20% of approved amount for additional pints after the deductible
The amount a health insurance policy pays for accidental death is technically called the ___________. Principal sum
A periodic payment to the insurance company to keep the policy in force Premium
HMO model that contracts with 2 or more medical groups, and can contract with independent physicians in order to enhance the selection and accessibility of providers for the HMO members Network
When will a newly insured persons health insurance policy take effect? On the date specified by the policy
Individual Medicare Supplement Premiums Not deductible
An HMO in a certain city contracts with an independent medical group to provide services to HMO subscribers, the HMO pays the group organization rather than paying the individual medics, providers. What type of model is represented? Group
Which type of renewability provision can be included in individual long term care policies? Guaranteed and noncancellable
Major medical policies that include a type of deductible wherein the insured must pay a new deductible amount for each different event are known as __________. Per-cause
Health insurance replacement notices are not required in the replacement of which type of health insurance product? Conversion from group coverage
Care required in the agents line of authority 6 hours
Individual Disability Income Benefits Not taxable
What do you pay for the first 60 days of a hospitalization under Medicare Part A? Deductible
To pass a licensing examination after filing an application with the Commissioner 120 days
Who pays the taxes that finance Social Security Disability Benefits? The employee and the employer with each paying a like contribution
The amount of a disability benefit is generally designed to replace ______________. A percentage of after-tax income
Group Medicare Supplement Benefits Not taxable
An insurance contract that the insured has a right to continue in force by payment of premiums that remain the same for a substantial period of time Noncancellable
Social Security taxes are paid by employers with ________________. Tax deductible dollars
What does Medicare Part B pay for Clinical Laboratory Services? Generally 100% of approved amount
What does Medicare Part B pay for if you need blood? 80% of approved amount after deductible, and starting with the 4th pint
Commissioner may suspend a license for misrepresentation or fraud 24 months
An agent licensed in a state in which he or she is not a resident Nonresident agent
Primary support for Medicare Part A comes from ____________________. Social Security Payroll Taxes
Individual Medicare Supplement Benefits Not taxable
What do you pay for after day 90 of a hospitalization under Medicare Part A? Daily deductible
What do you pay for Clinical Laboratory Services under Medicare Part B? Nothing for services
Individual Long-Term Care benefits Not taxable
Second surgical opinions, pre-certification, retrospective reviews are examples of _______________. Case management
Period of time after the premium due date in which premiums may still be paid, and the policy and its riders remain in force Grace period
A provision that allows an insurer, at its own expense, to have an insured physically examined when a claim is pending or to have an autopsy performed where not prohibited by law. Physical examination and autopsy
The intentional misrepresentation or deceit with the intent to induce a person to part with something of value Fraud
A false statement or lie that can render the contract void Misrepresentation
A demand of a person to stop committing an action that is a violation of a provision Cease and desist order
An unfair trade practice in which one agent or insurer makes an injurious statement about another with the intent of harming the persons or company's reputation Defamation
The chief executive officer and administrator of the insurance department Commissioner/Director/ Superintendent
The withholding of known facts which, if material, can void a contract Concealment
Any inducement offered in the sale of insurance products that is not specified in the policy Rebating
A form of misrepresentation in which an agent persuades an insured/owner to cancel, lapse, or switch policies, even when it's to the insured's disadvantage Twisting
An unfair trade practice in which an insurer uses physical or mental force to persuade an applicant to buy insurance Coercion
A part of the insurance contract that states that both parties must give something of value for the transfer of risk, and specifies the conditions of the exchange Consideration clause
A general statement that identifies the basic agreement between the insurance company and the insured, usually located on the first page of the policy Insuring clause